Retinoids: Fascinating Up‐and‐Coming Scenario

Abstract

Retinoids have been in sharp focus ever since their introduction 30 years ago. They include any drug (s) that bind to retinoid receptors and elicit a biological response. Enormous information on the subject seems to embroil the recent literature. Practically it is impossible to clearly comprehend the undercurrents. The meticulously dispensing text envisages surmounting the perspective reader's predicaments. Accordingly, retinoids and their related facets namely retinoid receptors, classification, mode of action, and the pharmacological diversity have been precisely defined. Commonly used systemic retinoids too have been given a substantial fresh look along with their monitoring. Overall, adverse effects and relative and absolute contraindications have been scrupulously incorporated. Human immuno deficiency virus (HIV) and isoretinoid for acne, in particular, have been highlighted. Micronized isotretinoin formulations have also been taken care so also commonly used topical retinoids. Tretinoin and their newer formulation have also been accounted for along with tretinoin polymer cream. Adapalene, a new chemical entity possessing a unique physico-chemical activity similar to that of tretinoin has also been dealt with. Newer retinoids are likely to be a subject of intrigue. A focus on future potentials of retinoids is its special ingredient. The inclusion of details of rexinoid the most recent introduction in their purview is likely to invoke interest to further consolidate its reckoning in future. All in all the text of the paper should provide an insight into the current rumbling around retinoids.

Efficacy of low-dose isotretinoin in acne vulgaris

“…Another study where a combination with topical tretinion 0.025% was given also found an improvement with a remarkably low dose of isotretinoin (25-53 mg). [14] These differences between studies can be explained by the type of dosage (alternate day) and the proven anti-inflammatory and anti-bacterial property [10,11,14,19] of concomitant topical agents. Other factors explaining the variable cumulative dosages include sites (facial and/or truncal [4,11] ) and grade of acne studied (mild, moderate, severe).…”

“…[4][5][6][7][8][9][18][19] Selection criterion The selection criteria in studies varied but generally included cases of predominantly facial acne of a mild to moderate grade. [4,[7][8][9][11][12][13][14][18][19] In one study, [4] a stringent criterion of a total acne grade Ͻ1, inflamed lesion count Ͻ20 and sebum excretion rate Ͻ1.25 g/ cm 2 / min was used.…”

“…In an endeavour to surmount this limitation and to make the regimen cost-effective, low-dose regimens for mild/moderate grades of acne have been advocated. [4][5][6][7][8][9] Interestingly, low-dose isotretinoin was attempted initially for severe acne also, [10,11] with or without combination with other agents. In severe acne, lower doses of 0.3 or 0.5 mg/kg/day proved to be equally effective as the standard 1 mg/kg/day dose, [10,11] but the high relapse rates were instrumental in discarding its use in severe acne.…”

“…[4][5][6][7][8][9] Interestingly, low-dose isotretinoin was attempted initially for severe acne also, [10,11] with or without combination with other agents. In severe acne, lower doses of 0.3 or 0.5 mg/kg/day proved to be equally effective as the standard 1 mg/kg/day dose, [10,11] but the high relapse rates were instrumental in discarding its use in severe acne. Recent studies have reinforced the view that low-dose isotretinoin is useful for mild to moderate acne [4][5][6][7][8][9]12] with less side-effects (cutaneous, systemic and laboratory based) as compared with the standard regimen.…”

“…Recent studies have reinforced the view that low-dose isotretinoin is useful for mild to moderate acne [4][5][6][7][8][9]12] with less side-effects (cutaneous, systemic and laboratory based) as compared with the standard regimen. [11,[13][14][15][16][17][18][19] To compare the efficacy and relapse rate of standard versus the low-dose therapy, we analysed all the studies of low-dose isotretinoin in acne vulgaris with the studies of standard dosage leading up to the US FDA approval in 1982 and the international consensus guidelines of 1997. [1] The statistical analysis was performed using Graph Pad Analysis and the comparison of efficacy and relapse rate between standard therapy (1 mg/kg/day) and low-dose therapy was performed using the Mann-Whitney test (Unpaired t-test, non-parametric).…”