Topical retinoids, including tretinoin and isotretinoin, act by decreasing epidermal proliferation and reducing the abnormal keratinization process in the hair follicle. This prevents new comedones forming and softens and removes existing comedones. There is also a reduction in the level of P. acnes within the hair follicle. Although topical retinoids are of particular value in severe acne, when there are numerous comedones present, they are also effective in other forms of mild to moderate acne. Initially, there may be some increased irritation and pain, but this usually settles with use. Tretinoin cream is preferable to tretinoin gel for those with dry or fair skin.
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