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# 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.

Updated Nov 1, 2026

## 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)

## Key points

- Oral retinoids are highly teratogenic: there is no safe dose in pregnancy, and isotretinoin and acitretin need a pregnancy-prevention programme (pregnancy tests and contraception before, during and after).
- Acitretin turns into etretinate when combined with alcohol, which stays in the body for a very long time, so pregnancy is avoided for years after stopping.
- Never combined with tetracyclines: both can raise intracranial pressure (pseudotumor cerebri).
- Oral retinoids raise triglycerides and liver enzymes: fasting lipids and liver tests are checked before and during treatment.
- Topical tretinoin is broken down by sunlight and by benzoyl peroxide; adapalene is stable with both.

## Drugs in this class

- [**Isotretinoin** An 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](https://durgical.com/en/pharmacology/isotretinoin/)
- [**Acitretin** An 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)](https://durgical.com/en/pharmacology/acitretin/)
- [**Adapalene** A 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](https://durgical.com/en/pharmacology/adapalene/)
- [**Tazarotene** A topical third-generation retinoid for plaque psoriasis, acne and photoaging; it must not be used in pregnancy. Nuclear retinoic acid receptors (RARs)](https://durgical.com/en/pharmacology/tazarotene/)

## 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).

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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](https://www.ema.europa.eu/en/medicines/human/referrals/retinoid-containing-medicinal-products) (European Medicines Agency (EMA), 2018); [DailyMed - ISOTRETINOIN capsule](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4e8516dc-a3c6-4d8f-aa14-2c37c6c8f6e6) (DailyMed (U.S. National Library of Medicine), 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/classes/dermatological-retinoids/