Vitamin a Derivatives Use in the Treatment of Skin Conditions

Abstract

Retinoids are used to treat various skin diseases. They add valuable impact of when used early in the treatment of dermatological conditions. Overall vitamin A derivatives are underused, with isotretinoin is the most used. This paper aims to develop prescribers’ knowledge about their benefits, to improve their usability and aids in alleviating patient concerns to improve therapeutic outcomes in dermatological conditions. In acne vulgaris, adapalene gel and tretinoin cream showed equal efficacy. In psoriasis the combination of acitretin and PUVA was superior to PUVA alone. Acitretin showed a reduction of 41% in the Nail Psoriasis Severity Index and similar efficacy to potent steroids and calcipotriol. In chronic hand eczema, alitretinoin showed 50% improvement in patient’s refractory to steroid treatment. In photoaging and aging, retinoids were shown to increase the synthesis and decrease the degradation rate of collagen and hyaluronate, reducing the impact of aging. In rosacea, topical and systemic isotretinoin showed complete remission in 24% of the patients compared to only 14 % with antibiotics (metronidazole and doxycycline). In lichen planus, isotretinoin demonstrated clinical and histopathological efficacy. In cutaneous T-cell lymphoma, bexarotene used alone or with PUVA or narrow band UVB, showed a response between 80.0% to 84.0%. Lastly in Kaposi sarcoma alitretinoin gel showed superiority to all other agents and better tolerance. This review highlights the benefit of timely use of vitamin A derivatives to encourage wider use.

Oxidative Stress in Acne Vulgaris

“…A recent study shows that oxidative stress plays a major role in the pathophysiology of acne through several other pathways, such as PPARs, mTOR, and TLRs [23]. Another study states that it is due to the anti-oxidative property, vitamin A derivatives can be used for the treatment of acne vulgaris [24].…”

Isotretinoin for Treating Acne Vulgaris

“…Retinoid can induce or suppress the expression of various genes and play an essential role in the cellular process. The mechanism of action includes normalizing follicular hyperkeratinization, decreasing the production of cytokeratin 1, 10, 14, filaggrin, matrix metallopeptidases (MMPs), and toll-like receptor 2 (TLR-2), and increasing the production of cytokeratin 7, 13, 19, laminina B1, and IL-1 [9,20].…”