ABSTRACT
Vitamin A is a fat-soluble, unssturated, long-chain isoprenoid an4 classic active- form found in mammalian tissue is the all-trans alcohol vitamin A (vitamin A alcohol or retinol). Vitamin A acid (VAA) represents the terminal product of vitamin A oxidation. Harris et al in 1332, first proposed the term "antikeraStinizing effect" to expression of tne effect of vitamin A on various epithelia. In 1943, Straufjord,over-enth usiastically reported tbat oral use of vitamin A also had a beneficial effect on acn . Kligman, in 1969, reported that VAA produce peeling effect and fabourable results with topically applied UAA in acne vulgaris. Many investigators reported that VAA was effective in man hyperkeratotic disorders, including psoriasis, senile comedon, verruca plana, keratosis palmaris et plantaris, plantar wart etc. Mode of actio. of VAA is unclear as yet. But, it is obserbed that continued susceptibility of skin to VAA is related to labilize lysosomes, thereby releasing prot.olytic and hydrolytic enzyme capable of inciting inflammatory reaction; VAA accelerates tum over of homey cells and converted hard keratin into soft keratin, so lessening of the coheiveness of homey cells is implied. Thus the effect of VAA in acne treatment are that VAA inhibits the formation of comedon and existing comedones tend to be extruded by the increased production of noncoherent homey cells and acceleration of the flow of cells out of the sebaceous glands. For this study, 52 patients were treated with application of topical VAA alone and 9 patients concurrently with topical VAA anl comedon extraction. The results were as follows: 1. The 43 patients treated with topical VAA alone showed significant improvement up to 70% at the end of third week. In this group, closed comedon, papules, pustules are progressively reduced during the first week but the number of open comedon transiently increased (34%) during first week of treatment, decreased after that. 2. The 9 pa.tients treated with topical VAA and co nedon extraction showed similar effect(80%) at the third week of treatment. But no sign of increase of open comedon was not shown in first week of treatment. 3. Discomfortable clinical effects such as scaling, buming, tightness were seen up to 83%, occassionally pruritus, pain edema., contact dermatitis, lichenifcation were seen.