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Merge PDF files online - free and easy to use. Desktop application and API also available. selectively to the RAR receptor subtype However, with these improved molecules, the side effects from topically applied retinoids still persist, likely linked to intrinsic RAR activation The most common side effects of topical retinoids are skin irritation, desquamation, and redness (Fig 30-4) The increased desquamation and resultant flaking of the skin correspond with increased proliferation of keratinocytes, as indicated by a greater number of mitotic figures and enhanced expression of differentiation markers23 These findings seem to be related to the type and dose of the retinoid and usually occur within 2 to 4 days of beginning topical treatment24 New studies have suggested that patients may achieve maximum clinical improvement of photoaged skin without developing retinoid dermatitis In other words, the irritation produced by retinoids is separate from the photoaging benefits of retinoids This is demonstrated in the study that compared two different strengths of tretinoin (01% and 0025%) Although both strengths were equally efficacious in the treatment of photoaging, the degree of irritation differed markedly between the two treatment groups, with the 01% tretinoin-treated group exhibiting approximately a three-fold greater incidence of irritation than the 0025% tretinoin-treated group21 This irritation seems to be receptor mediated as implied by evidence that the topical application of tretinoin to the skin of transgenic mice deficient in RARs does not result in any apparent epidermal hyperplasia or desquamation25 This suggests that the development of newer retinoids with specific receptor and pharmacokinetic profiles and relevant dosing may lead to a lower incidence of irritation, flaking, and desquamation Erythema is another side effect of topical retinoids, one that elicits noncompliance from patients This symptom is caused by a different mechanism that appears not to be receptor mediated26 Patients with rosacea and naturally pink skin tend to be particularly disturbed by this side effect Using the techniques described in Table 30-1 may decrease the incidence of all types of skin irritation A study performed in the late 1990s suggested that after a 48-week regimen of once-daily 005% tretinoin emollient cream, the benefits of tretinoin could be sustained by using the treatment only 3 times weekly for an additional 24 weeks27 The tretinoin should be used at least 3 times a week, however, because the same study showed that once-. combine pdf files software free online: Download PDF Split and Merge Basic 3.3.7 for Windows - Filehippo ... pdf splitter and merger software free download full version PDF Combine - PDF Combiner Software Combines PDF Files ...
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