Tretinoin / Azelaic Acid / Niacinamide Cream

Overview

Tretinoin / Azelaic Acid / Niacinamide Cream is a combination of prescription drug products that have been formulated into a hypoallergenic cream to address acne vulgaris as well as rosacea. While mild cases of acne may respond well to over-the-counter treatments, stubborn cases require stronger treatments. It is also difficult to find a single product that is effective in treating both acne vulgaris and rosacea. Combining tretinoin, azelaic acid, and niacinamide into one formulation may increase patient compliance with treatment and improve both conditions. The preparation is applied to the affected area once to twice daily and the ingredients work synergistically together to decrease redness and pimples. Other benefits of the compound may include the reduction of fine lines and wrinkles and the lessening of hyperpigmentation.

Tretinoin

Tretinoin, also called all-trans-retinoic acid (ATRA), is a naturally occurring derivative of vitamin A (or retinol) that increases cell turnover. Tretinoin when applied topically is used to treat mild to moderate acne (e.g., grades I-III), photodamaged skin, and keratinization disorders such as ichthyosis and keratosis follicularis. Topical tretinoin is effective in reducing fine lines, hyperpigmentation, roughness, and laxity associated with photodamaged skin. It clears the skin of blemishes and discolorations by speeding the process of cell renewal.^{1, 2, 3, 4}

Azelaic Acid

Azelaic acid is a naturally occurring substance found in wheat, rye, and barley. It is also produced naturally by a certain fungus found on human skin. Azelaic acid is used topically in the management of acne vulgaris, rosacea and other inflammatory skin conditions. It has been shown to be significantly better at reducing rosacea symptoms than metronidazole. Its mechanism of action is not entirely clear but it is believed to work by killing and stopping new growth of aerobic and anaerobic bacteria. It is generally well tolerated when applied topically, however, mild to moderate itching and dry skin are possible side effects of azelaic acid.^{5, 6, 7}

Niacinamide

Niacinamide is the physiologically active form of niacin (vitamin B3). Found naturally in food (e.g., meat, dairy products, legumes, nuts, seeds, green leafy vegetables, fortified grains, etc.), niacinamide is a precursor of the cofactors niacinamide adenine dinucleotide (NAD) and niacinamide adenine dinucleotide phosphate (NADP). NAD and NADP are key components of many essential metabolic pathways in the human body. Niacinamide holds anti-inflammatory properties and is used topically to manage a variety of skin conditions including bullous pemphigoid, IgA bullous dermatosis, acne vulgaris, and pruritus (itching). Studies have also shown niacinamide’s ability to reduce redness and hyperpigmentation when applied topically.^{8, 9}