OBAGI - Tretinoin 0.1%

Obagi Tretinoin Cream 0.1% is a prescription topical retinoid containing 0.1% tretinoin in a hydrophilic cream formulation. Each gram contains 1 mg of tretinoin. It is supplied in a 20g tube and is indicated for the topical treatment of acne vulgaris.

Tretinoin is also known as all-trans retinoic acid. It belongs to the retinoid class of medicines and is distinct from cosmetic retinol skincare products.

Product information

• Product: Obagi Tretinoin Cream
• Active ingredient: Tretinoin
• Strength: 0.1% w/w, equivalent to 1 mg of tretinoin per gram
• Formulation: Hydrophilic topical cream
• Tube size: 20g
• Route of administration: Topical use
• Indication: Acne vulgaris
• Product code: NDC 62032-417-20

Indication

Obagi Tretinoin Cream 0.1% is indicated for the topical treatment of acne vulgaris. Acne vulgaris may include non-inflammatory lesions, such as open and closed comedones, and inflammatory lesions including papules and pustules.

The product’s prescribing information states that the safety and efficacy of its long-term use in the treatment of other disorders have not been established.

How tretinoin works

The exact mechanism responsible for every clinical effect of tretinoin has not been fully established. Current evidence indicates that topical tretinoin reduces the cohesion of follicular epithelial cells, helping to decrease the formation of microcomedones. It also increases the turnover of follicular epithelial cells and supports the extrusion of existing comedones.

Tretinoin is a pharmacologically active retinoid medicine. It should not be treated as equivalent to a cosmetic exfoliant or an over-the-counter retinol product.

Understanding the 0.1% concentration

A concentration of 0.1% means that each gram of cream contains 1 mg of tretinoin. It does not mean that the product contains 1% tretinoin.

• Tretinoin 0.025%: 0.25 mg per gram
• Tretinoin 0.05%: 0.5 mg per gram
• Tretinoin 0.1%: 1 mg per gram

Obagi Tretinoin Cream 0.1% contains twice the concentration of the 0.05% cream and four times the concentration of the 0.025% cream. It is the highest of the three Obagi tretinoin cream concentrations listed in the current manufacturer information.

These figures describe the amount of active ingredient in each gram. They do not establish that the highest concentration is universally the most effective or appropriate.

Cream formulation

Obagi Tretinoin Cream 0.1% uses a hydrophilic cream vehicle containing stearic acid, isopropyl myristate, polyoxyl 40 stearate, stearyl alcohol, xanthan gum, sorbic acid, butylated hydroxytoluene and purified water.

The concentration and formulation vehicle are separate product characteristics. A 0.1% cream cannot be directly equated with a gel, lotion or microsphere formulation containing tretinoin, even where the active ingredient is the same.

How to use Obagi Tretinoin Cream 0.1%

Use this medicine according to the directions provided with the prescription. The manufacturer’s product information describes application once daily before bedtime, using enough cream to cover the affected area lightly.

1. Gently cleanse the treatment area with a mild, non-medicated cleanser.
2. Pat the skin dry without rubbing or scrubbing.
3. Allow the skin to dry completely. The manufacturer’s instructions specify waiting approximately 20 to 30 minutes after cleansing.
4. Apply a thin layer over the affected area.
5. Avoid the eyes, mouth, corners of the nose, open wounds and mucous membranes.
6. Wash the hands after application unless the hands are being treated.

The manufacturer describes approximately half an inch or less of cream as normally sufficient to cover the whole face lightly. The cream should become effectively invisible after being spread over the skin.

Applying a larger quantity or using the cream more frequently does not produce faster or better results and may increase irritation.

Expected response during treatment

A temporary feeling of warmth or slight stinging can occur following application. Dryness, redness and peeling may also develop during the early part of treatment.

The manufacturer’s information describes a possible apparent increase in inflammatory lesions during the early weeks of treatment as previously unseen lesions develop. Its patient instructions place this most commonly around three to six weeks after treatment begins.

Initial changes may be noticed after two to three weeks, although more than six weeks may be required before definite effects are apparent. Continued improvement may occur over six to twelve weeks, and the manufacturer states that many users who respond notice improvement by approximately 12 weeks.

These timeframes describe the manufacturer’s clinical information and do not guarantee an individual result.

Skincare used with tretinoin cream

Cosmetics may be used, but they should be removed and the treatment area cleansed thoroughly before applying the cream. A suitable non-comedogenic moisturiser may help manage dryness.

Caution may be required with:

• Abrasive or medicated cleansers
• Products with a strong drying effect
• Astringents and products containing high concentrations of alcohol
• Products containing sulphur, resorcinol or salicylic acid
• Other topical acne medicines

These combinations may increase redness, dryness or peeling. Their use and application timing should follow the prescribed treatment plan.

Sun and environmental exposure

Unprotected exposure to sunlight, sunlamps and other artificial ultraviolet sources should be minimised during treatment. Sunscreen and protective clothing should be used when exposure cannot be avoided.

Do not apply tretinoin to sunburned skin until it has fully recovered. Wind, cold and other weather extremes may also increase dryness and irritation in treated skin.

Tolerability and adverse effects

Local skin reactions associated with topical tretinoin can include:

• Dryness
• Redness or erythema
• Peeling or flaking
• Warmth, burning or stinging
• Itching
• Skin discomfort

More pronounced reactions can include excessive redness, swelling, blistering or crusting. Severe or persistent irritation requires review, and the product should be discontinued if a reaction suggesting hypersensitivity occurs.

Tretinoin can cause marked irritation when applied to eczematous, damaged or sunburned skin. Temporary increases or decreases in pigmentation have also been reported in treated areas.

Topical retinoids, including tretinoin, are contraindicated during pregnancy in the UK as a precaution. Pregnancy, planned pregnancy and breastfeeding should be discussed before the medicine is used.

Clinical information

The current manufacturer information identifies acne vulgaris as the indication for Obagi Tretinoin Cream 0.1%. It describes initial changes after approximately two to three weeks, more than six weeks sometimes being required before definite effects appear, and continued improvement potentially occurring over six to twelve weeks.

The current label does not provide numerical head-to-head trial results comparing Obagi Tretinoin Cream 0.1% with the 0.025% or 0.05% concentrations. It therefore does not establish that the 0.1% concentration is universally more effective, produces faster results or is more appropriate than a lower concentration.

Ingredients

Active ingredient: Tretinoin 0.1% w/w, equivalent to 1 mg per gram.

Inactive ingredients: Stearic acid, isopropyl myristate, polyoxyl 40 stearate, stearyl alcohol, xanthan gum, sorbic acid, butylated hydroxytoluene and purified water.

Storage

The manufacturer’s information states that Obagi Tretinoin Cream should be stored below 27°C (80°F). Keep the tube securely closed and out of the reach of children.

Frequently asked questions

What is Obagi Tretinoin Cream 0.1%?

It is a prescription topical cream containing 0.1% tretinoin, equivalent to 1 mg per gram. It is supplied in a 20g tube and is indicated for acne vulgaris.

Is tretinoin 0.1% the same as 1%?

No. This product contains 0.1% tretinoin. A 1% formulation would contain ten times as much tretinoin.

Is tretinoin 0.1% stronger than 0.05%?

Yes in concentration: tretinoin 0.1% contains 1 mg per gram, while 0.05% contains 0.5 mg per gram. The 0.1% cream therefore contains twice as much tretinoin per gram.

Is tretinoin 0.1% four times stronger than 0.025%?

It contains four times the concentration of tretinoin: 1 mg per gram compared with 0.25 mg per gram. This concentration difference does not establish that it will produce four times the clinical effect.

Is tretinoin 0.1% too strong?

The 0.1% cream is the highest of the three concentrations in the current Obagi tretinoin cream range. Whether it is appropriate cannot be determined from the percentage alone and depends on the intended treatment, previous retinoid exposure and skin tolerance.

Is tretinoin the same as retinol?

No. Tretinoin is all-trans retinoic acid and is a prescription retinoid. Retinol is a cosmetic vitamin A derivative that requires conversion within the skin before becoming retinoic acid.

How long does tretinoin 0.1% take to work?

The manufacturer states that initial changes may be noticed after two to three weeks, but more than six weeks may be required before definite effects are apparent. Continued improvement may occur over six to twelve weeks.

Can tretinoin cause more blemishes at first?

The manufacturer describes a possible apparent increase in inflammatory lesions during the early weeks of treatment. This is sometimes informally called “purging”, although that is not the formal terminology used in the product label.

Can moisturiser be used with Obagi Tretinoin Cream?

Yes. The manufacturer recommends a suitable non-comedogenic moisturiser or moisturiser with sunscreen. Moisturiser may also help manage treatment-related dryness.

Can acids or other acne treatments be used with tretinoin?

Salicylic acid, sulphur, resorcinol, medicated cleansers and other drying topical products may increase irritation when used with tretinoin. Their use and application timing should follow the prescribed skincare plan.

Is this product indicated for fine lines or pigmentation?

The current product label identifies acne vulgaris as the indication for this particular tretinoin cream and states that the safety and efficacy of long-term use for other disorders have not been established. Any other intended use must be determined clinically.

Further ingredient information

Tretinoin: uses, strengths, formulations and UK status