Retinoic acid, also called tretinoin or all-trans-retinoic acid , is a vitamin A derivative. It is mixed with Minoxidil and offered by some hair loss clinics to treat hair loss. Here we answer the top 10 questions you may have when considering using retinoic acid.
1. What is Retinoic acid?
Retinoic acid (see structure on the image above) has been used for decades as Retin-A® in the treatment of acne. More recently it is widely used as a treatment for fine wrinkles in the skin. It works essentially as a chemical peel by altering the follicular epithelium (the outer layer of skin) so that it doesn't keratinize (form a hard compact layer).
2. What are the other names for Retinoic acid.
Retinoic acid also called tretinoin, all-trans-retinoic acid, Vitamin A acid, Retin-A®, Atralin®, Avita®, Renova®, Tretin-X®. Do not confuse it with Isotretinoin (brand name Accutane). Isotretinoin to Tretinoin (retinoic acid) is like someone's left hand to right hand structurally. They look almost identical, but you can never overlap them. Isotretinoin is known to cause birth defect to baby when it is used during pregnancy. There are a few studies that showed tretinoin caused birth defect as well (https://mothertobaby.org/fact-sheets/tretinoin-retin-a-pregnancy/)
3. Why is Retinoic acid added to minoxidil?
A: Minoxidil has to be absorbed by scalp in order to be effective. Minoxidil itself cannot penetrate the scalp . That is why delivery vehicle such as propylene glycol or glycerin or dimethyl isosorbide (DMI) is used in all minoxidil products. The addition of retinoic acid can further help minoxidil penetrate the skin and reach hair follicles and thus enhance the effectiveness of minoxidil.
According Shin et al's study, when 5% minoxidil is mixed 0.01% retinoic acid (tretioin), it can be used once a day and achieve equivalent results as 5% minoxidil twice daily usage. (See the study at the end of this blog).
3. What are the common side effects of Retinoic Acid (tretioin)?
The most common side effects are scalp itchiness, skin peeling, redness, dry skin, flaking or dandruff of the scalp. Retinoic acid also makes the scalp sensitive to sun burn.
4. How can I reduce the side effects of Retinoic acid?
a). Use retinoic acid at night.
b). Avoid using the product after a hot shower.
c). Use the product progressively to let your scalp build tolerance. You can start with once every other night, then move to once every night, and finally increase to twice a day.
d). Add steroid such as 0.1% hydrocortisone to the retinoic acid minoxidil solution.
5. Why Minoxidilmax use Retinol instead of retinoic acid in the products?
Retinol nowadays is the most important ingredient in all anti-aging products. It is present in almost all skin repair solutions for its powerful stimulation of cell regeneration. Retinol can also help the penetration of minoxidil into scalp like retinoic acid. More importantly, retinol is converted into retinoic acid once it is absorbed by our cells. Retinol is not as harsh as retinoic acid and thus has much less side effects. In another words, retinol enhances the effectiveness of minoxidil like retinoic acid but with two major advantages: a). It stimulates follicle regeneration; b). it has less side effect than retinoic acid.
That is why retinol is included in almost all MinoxidilMax products.
6. Will I have shedding when starting Retinoic acid?
A small percentage of people may experience an initial increase of hair loss (shedding) at the onset of treatment similar to the use of minoxidil. However, the shedding resolves with time. (Read minoxidil shedding here)
7. Why is retinoic acid recommended to at night?
Retinoic acid is degraded by strong light, so there is no benefit to using it during the day, when the bright light will render the medication ineffective.
8. Can I still use minoxidil solutions with retinoic acid, if I like to be out in the sun or get a lot of sun exposure on my job?
The activity of Retinoic acid is be affected by direct sunlight as mentioned in the question 7. Therefore, if you are in the sun a lot, it is best to use Retinoic acid only at night and in the morning use solely the 5% Minoxidil. In addition, Retinoic acid also increases your sensitivity to the sun. Therefore if you apply any solution that contains Retinoic acid in the morning avoid direct sun exposure to the scalp or apply a sunscreen or wear a hat.
9. How to make 0.025% retinoic acid with 5% minoxidil?
A. You can add 15 mg retinoic acid powder (yellow color) to 60 ml of 5% minoxidil solution and mix the solution thoroughly; or you can add 1 ml of 1.5% of retinoic acid alcohol solution to 60 ml of 5% minoxidil and mix the solution thoroughly.
10. What else can be added to a retinoic acid minoxidil solution?
Finasteride 0.1% (DHT blocker), progesterone 0.25% (DHT blocker), Azelaic acid 5% (DHT blocker), caffeine 0.001% (hair growth enhancer), Vitamin E 0.1% (absorption enhancer), hydrocortisone 0.1% (help reduce scalp irritation), Biotin 3% (hair growth factor). Do all these ingredients have to be included in a solution? Absolutely not. You can compare the ingredients of different products here and choose the right one for you.
Article shows the addition of 0.01% retinoic acid to 5% minoxidil double the effetiveness of minoxidil.
5% topical minoxidil solution has been widely used to stimulate new hair growth and help stop hair loss in men with androgenetic alopecia (AGA). However, it is not convenient for patients to continue applying the solution twice daily on a regular basis. Tretinoin is known to increase the percutaneous absorption of minoxidil and, therefore, to enhance the response of AGA to minoxidil. For this reason, it was assumed that tretinoin would be helpful in alleviating the inconvenience associated with the recommended twice-daily application of minoxidil.
To compare the efficacy and safety of therapy using a combined solution of 5% minoxidil and 0.01% tretinoin once daily with those of the conventional 5% topical minoxidil therapy applied twice daily in the treatment of AGA.
A total of 31 male patients (aged 28-45 years, mean 39.7+/-4.5) with AGA (Hamilton-Norwood classification type III-V) were randomly assigned into two groups, one in which 5% minoxidil was applied to the scalp twice daily and the other in which the combined agent was applied once daily at night together with a vehicle placebo in the morning. The efficacy parameters were: (i) changes in total hair count, non-vellus hair count, anagen hair ratio, linear hair growth rate, and mean hair diameter assessed by macrophotographic image analysis; and (ii) the patient's and investigator's subjective assessments.
After therapy, increases in the macrophotographic variables of total hair count and non-vellus hair count were shown in both treatment groups. There were no statistically significant differences between the two treatment groups with respect to changes in macrophotographic variables or scores on subjective global assessments by patients and the investigator. The incidence of adverse effects such as pruritus or local irritation was similar in the 5% minoxidil group (4 of 14 subjects) and the combined agent group (5 of 15 subjects).
The efficacy and safety of combined 5% minoxidil and 0.01% tretinoin once-daily therapy appear to be equivalent to those of conventional 5% minoxidil twice-daily therapy for the treatment of AGA.
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