Future trends: a new generation of retinoids

The existence of several different types of retinoid receptors, response elements, and cofactors means that retinoid physiology is mediated by multiple discrete pathways and is highly complex. As a result, non-selective retinoids have a multitude of physiologic effects and are usually associated with toxicity problems that limit their therapeutic usefulness. In contrast, because receptor-selective retinoids have a more focused and targeted action, they are likely to have a better therapeutic index. Tazarotene is the first of a new generation of receptor-selective retinoids. Its actions are targeted on 2 retinoic acid receptors (RARs), RAR-beta and RAR-gamma. Current retinoid research is leading to the development not only of many more novel receptor-selective retinoids but also of novel types of function-selective retinoids such as RAR inverse agonists and RAR antagonists. These retinoids are expected to be of clinical benefit not only in dermatology but also in oncology, diabetes, and diseases associated with the human papilloma virus.