Retinoic Acid for Acne: Understanding Its Types, Uses & Side Effects

What are retinoic acid and the possible side effects? Have you ever considered employing oral or topical retinoic acid after failing to treat acne with different diet therapies and skincare products? Cigna Smart Health understands the agony brought by acne, so that we will share the principles, uses and side effects of retinoic acid to help you reclaim your acne-free skin!

Principles and Uses of Retinoic Acid

Retinoic acid is a metabolite of vitamin A, also called vitamin A acid or retinoids, with topical and oral medication. Your doctor would prescribe either one of these medications based on your conditions.

Before understanding the principles of retinoic acid, let’s revisit the four major causes of acne.

1. Excessive oil secretion: Form acne due to hormone changes, temperature, diet and other external stimuli.
2. Hair follicles clogged by oil and dead skin cells: Abnormal keratin metabolism occurs, so dead skin cannot fall off.
3. Inflammation of follicles: Cause acne due to skin irritation.
4. Bacterial Infection: Propionibacterium acnes is one of the common bacterias that causes pimples.

Retinoic acid can improve the conditions with the following functions.

1. Control sebaceous glands to reduce the exudation of sebum
2. Remove dead skin to keep pores clear and open
3. Curb any skin inflammation
4. Lower the oil secretion to stop bacteria from growing

Simply speaking, retinoic acid treats acne by coping with all the causes above effectively.

Topical Or Oral Retinoic Acids?

In general, your doctor would prescribe topical retinoids for mild cases. If the conditions worsen and are out of control, your doctors may suggest taking oral vitamin A acid. Retinoic acid is a prescription-only drug that you should not purchase without any medical advice.

Generations of Retinoic Acids

Based on the chemical formula and concentration of retinoic acid, the medication can be divided into three generations, as shown below.

	1st Generation TRETINOIN	2nd Generation ISOTRETINOIN / ACCUTANE	3rd Generation ADAPALENE
Effects	Adjust cornified cells to control pimples and inflammation	In oral form mainly; reduce the exudation of sebum	Control inflammation, more stable and effective
Concentration of Retinoids	Highest	Lower	Lowest
Side effects	Higher stimulation and photosensitivity	Fewer side effects than the previous generation with a decreased rate of teratogenicity	Mild side effects compared with the previous generations

Side effects of Oral Retinoids (Isotretinoin / Accutane)

Although oral retinoids treat acne effectively, the treatment comes with numerous side effects. According to Dr Lisa Chan, Bachelor of Medicine and Bachelor of Surgery from CUHK, the side effects include:

• A worsening of acne at the beginning of use that usually resolves after use
• An allergic reaction causing symptoms such as stinging, burning (cheilitis), extreme dryness (dry eye syndrome (DES), swelling, itching, peeling, blistering, or difficulty breathing
• Hindered liver function in relation to blood lipids that usually resolves after use
• Teratism for the pregnant
• Hair loss
• Possible muscle and joint pain may occur for some patients

Precautions On the Use of Topical Retinoic Acid

• Apply only a thin layer on the skin once a day
• Cleanse your skin before use
• Moisturise your skin
• Avoid contacting sensitive skin areas like eyes or lips.
• Wear non-comedogenic sunscreen to avoid direct exposure to sunlight
• Improvement may be observed after continuously applying the cream or gel for weeks to months
• Please visit your doctor if severe or continuous inflammation, retinoic acid inflammation, occurs, such as peeling, itching, blister, cornified cells or swelling.

Precautions On the Use of Oral Retinoic Acid (Isotretinoin / Accutane)

• Regular blood test and liver function tests are required
• Contraception is needed one month before and after the treatment and during the treatment.
• Do not drive at night
• Avoid breastfeeding during the treatment
• Wear sunscreen when going out
• Do not donate your blood
• Do not take isotretinoin on an empty stomach or with alcohol

Where Can You Purchase Retinoic Acid?

Retinoids are prescription-only medicines. Please consult your doctors for more details and costs of treatments.

How Can Acne Be Prevented?

Only individuals suffering from severe acne are prescribed retinoic acid. For mild cases, you could prevent acne and reduce its damage to your skin by following the simple skincare tips below.

• Keep your face clean: Clean your face gently twice a day but not over-cleansing it, as it will make your skin dry and lead to more sebum secretion.
• Moisturise your skin: Use light and non-comedogenic moisturiser to keep your skin hydrated without clogging the follicles.
• Do not squeeze youracne: Do not use hands or blackhead remover to squeeze acne as it may cause a bacterial infection, which leaves acne scars.

You could also prevent and reduce pimples through your diet. Here are some dietary tips for being acne-free.

• Stop consuming sugar and milk: Research shows that sugar-sweetened and dairy products affect your skin conditions and causes acne.
• Consume more Omega-3 enriched foods: Omega-3 has a significant anti-inflammatory effect. Food examples include chia seed, salmond, deep-sea fishes, cauliflower and walnuts.
• Take in more probiotics： Digestive health contributes to healthy skin. Probiotics can help restore the balance when the gut is hit with an unhealthy level of harmful bacteria. It could also reduce inflammation and acne formation.
• Apply natural aloe vera gel: Aloe vera has anti-inflammatory, anti-acne and antibacterial effects.