First and second generation retinoids: mechanism of action and clinical efficacy of drugs

We continue the conversation about drugs, the use of which in practice has become a turning point in the treatment of some dermatoses.

Tretinoin

Mechanism of action. Tretinoin is a natural metabolite of retinol. When taken internally, it inhibits the differentiation and growth of a clone of altered blood cells, in particular human myeloid leukemia cells. A. Kligman reported in 1969 that tretinoin is effective in acne, and tried to explain its mechanism of action. When applied topically, 0.1% tretinoin enhances cell proliferation in the papillary layer of the skin, reduces the adhesion of cells involved in the formation of acne vulgaris, and promotes smoothing of the skin surface without signs of inflammation.

The antikeratotic effect of retinoids is due to a decrease in the adhesion of horny cells, which is explained by a change in the composition of the intercellular substance. Daily use of a 0.05% tretinoin cream for photodamage correction leads to a fairly rapid reduction in wrinkle depth, which correlates with the appearance of mucopolysaccharides in the epidermis, but the rapid initial improvement is temporary. The maximum possible improvement was achieved after 2 years of using the cream - in the dermal matrix, there is a partial replacement of damaged collagen with newly synthesized collagen, an increase in mucopolysaccharides in the skin, and a decrease in the number of melanocytes.

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