Tretinoin (0.02%, 0.03%, 0.045%, 0.06%, 0.08%) | Hyaluronic Acid (0.1%, 1%)

Applied topically to the face (or affected area) once nightly, as directed by the prescriber. Apply a pea-sized amount to clean, dry skin after thorough washing and gentle drying. Avoid the eye area, nostrils, and lip margins. Apply at bedtime (tretinoin is photolabile and UV exposure increases retinoid irritation). Wear broad-spectrum SPF 30+ sunscreen every morning during treatment.

Apply a thin layer once nightly. Prescribers typically initiate at lower concentrations (e.g., 0.02–0.03%) and titrate upward based on skin response and tolerability:

• Initiation: 2–3 times per week for 2–4 weeks before advancing to nightly use, if tolerability is a concern
• Titration: increase concentration after 8–12 weeks if clinical response is inadequate and tolerability allows
• Hyaluronic acid concentration is selected for the patient's baseline skin dryness and tolerance

• Tretinoin: Binds and activates nuclear retinoic acid receptors (RAR-α, β, γ) and retinoid X receptors (RXR), which form heterodimers binding to retinoic acid response elements (RAREs) in DNA. This regulates transcription of genes involved in: keratinocyte differentiation (reducing hyperkeratosis), epidermal proliferation (accelerating cell turnover to expel comedone contents), procollagen type I and III synthesis (anti-photoaging), and MMP suppression (preventing collagen degradation by UV-induced matrix metalloproteinases). Tretinoin also reduces tyrosinase activity and dispersion of melanin granules, contributing to depigmentation.
• Hyaluronic Acid: A natural polysaccharide component of the extracellular matrix that retains up to 1000 times its weight in water. As a topical humectant, it draws moisture from the dermis and environment into the epidermis, maintains skin turgor, and forms a protective film on the stratum corneum. It does not penetrate intact skin but significantly improves hydration of the outermost layers, reducing retinoid-associated dryness and desquamation.

Used prescriber-directed for acne vulgaris (moderate to severe, comedonal and inflammatory), photoaging (fine lines, mottled pigmentation, rough texture), and hyperpigmentation syndromes including melasma. The variable concentration range allows individualized titration from initiation through maintenance. Hyaluronic acid inclusion reduces the retinoid dermatitis that often limits adherence, particularly at higher concentrations.

Monitoring considerations:

• Assess for retinoid dermatitis (erythema, peeling, dryness) at 4–6 weeks; adjust concentration or frequency
• Evaluate clinical response (acne, photoaging markers) at 8–12 weeks
• Educate on mandatory sun protection and avoidance of UV exposure during treatment
• Confirm negative pregnancy test in women of childbearing potential (Category C—avoid first trimester use)

Contraindications:

• Known hypersensitivity to tretinoin or retinoids
• Pregnancy, particularly first trimester (Category C—teratogenicity risk with significant systemic absorption)
• Sunburned or acutely eczematous skin at application site

Warnings & Precautions:

• Photosensitivity: tretinoin markedly increases UV sensitivity; strict daily sunscreen use is mandatory
• Retinoid dermatitis: erythema, peeling, and stinging are expected, especially at initiation; manage by adjusting concentration and frequency
• Avoid wax epilation, chemical peels, and laser procedures on tretinoin-treated skin without prescriber guidance
• Avoid concurrent use of other drying or irritating products (benzoyl peroxide—oxidizes tretinoin; alcohol-based toners)

Drug Interactions:

• Concomitant use with medicated or abrasive soaps, alcohol-containing products, or high-concentration AHAs increases irritation
• Benzoyl peroxide may oxidize tretinoin if applied simultaneously—use at different times of day

Common Side Effects: Erythema, dryness, peeling, stinging, and photosensitivity. These typically peak within the first 2–4 weeks and diminish with continued use.

Store at room temperature (15–25°C), protected from light and heat. Do not freeze. Tretinoin is photolabile; keep in original opaque packaging. Use within the beyond-use date assigned by Genesis Compounding.

Why is hyaluronic acid added to the tretinoin?

Tretinoin commonly causes dryness, flaking, and irritation—especially during the first few weeks of use. Hyaluronic acid is a powerful humectant that attracts and holds moisture in the skin, significantly reducing these side effects and improving patient adherence.

How do I know which tretinoin concentration is right for me?

Your prescriber selects the starting concentration based on your skin type, indication (acne, photoaging, pigmentation), and prior retinoid experience. Most start at 0.02% or 0.03% and titrate upward every 8–12 weeks based on tolerability and response.

Why do I have to wear sunscreen while using this?

Tretinoin thins the stratum corneum and dramatically increases UV sensitivity. Sun exposure while on tretinoin can cause severe sunburn and paradoxically worsen hyperpigmentation. Daily SPF 30+ is non-negotiable.

Is this FDA-approved?

Commercial tretinoin preparations are FDA-approved for acne and photoaging. This compounded combination with hyaluronic acid in multiple strengths is a 503A patient-specific preparation by Genesis Compounding and is not FDA-approved as a compounded product.

What should I do if I experience excessive peeling?

Reduce application frequency to every other night or use a lower concentration as directed by your prescriber. Apply a bland, fragrance-free moisturizer after the tretinoin has absorbed. Do not stop abruptly—contact your prescriber for guidance on adjusting the regimen.