Dermatological retinoids
Vitamin A derivatives that act on nuclear retinoid receptors to normalise skin cell growth. Used for acne and psoriasis; all are avoided in pregnancy.
What they are
Retinoids are natural and synthetic relatives of vitamin A. Topical ones (tretinoin, adapalene, tazarotene) are the backbone of acne treatment; oral ones (isotretinoin for severe nodular acne, acitretin for psoriasis) are powerful but highly teratogenic, so they are prescribed inside a pregnancy-prevention programme.
Mechanism of action
Inside the cell nucleus retinoids bind retinoic acid receptors (RAR) and, for some agents, retinoid X receptors (RXR). The receptor pairs switch genes that control how keratinocytes divide and mature. The result is less follicular plugging, less inflammation and, with oral isotretinoin, much smaller sebaceous glands that make far less sebum.
Target: Nuclear retinoic acid receptors (RAR-α, -β, -γ) and retinoid X receptors (RXR)
Drugs in this class
- IsotretinoinAn oral retinoid for severe nodular acne that shrinks the oil glands. It is highly teratogenic, so it is only given…Nuclear retinoic acid receptors (RAR), reached mainly through its active metabolites
- AcitretinAn oral retinoid for severe psoriasis. With alcohol it forms etretinate, which lingers for years, so pregnancy is…Retinoic acid receptors RAR-α, -β and -γ (exact mechanism in psoriasis not established)
- AdapaleneA topical retinoid-like gel for acne that stops new comedones forming. Stable in sunlight and with benzoyl peroxide…Retinoic acid receptors RAR-β and RAR-γ
- TazaroteneA topical third-generation retinoid for plaque psoriasis, acne and photoaging; it must not be used in pregnancy.Nuclear retinoic acid receptors (RARs)
Others in the class
- tretinoin
- tazarotene
- trifarotene
- alitretinoin
- bexarotene
Test yourself
Think of the answer, then tap the question to see it.
Why must isotretinoin and acitretin be given inside a pregnancy-prevention programme?
Both are highly teratogenic; even short exposure in pregnancy carries an extremely high risk of severe birth defects, so pregnancy is excluded and prevented before, during and after treatment.
Which antibiotic class is never combined with an oral retinoid, and why?
Tetracyclines: the combination has been linked to intracranial hypertension (pseudotumor cerebri).
Which topical retinoid stays stable in sunlight and next to benzoyl peroxide?
Adapalene (tretinoin is inactivated by light and by benzoyl peroxide).
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Retinoid-containing medicinal products - referral (European Medicines Agency (EMA), 2018); DailyMed - ISOTRETINOIN capsule (DailyMed (U.S. National Library of Medicine), 2026).
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Representative model, for educational purposes only.