A nurse is reinforcing teaching with an adolescent who has a prescription for tretinoin topical for the treatment of acne.Which of the following instructions should the nurse include in the teaching?

Choice A rationaleSunscreen use with an SPF of 15 or higher is crucial during tretinoin treatment to prevent phototoxicity. Tretinoin increases the skin’s sensitivity to ultraviolet radiation by accelerating epidermal cell turnover, which can lead to redness or burning upon UV exposure. Sunscreen protects the skin from harmful UV effects and mitigates this side effect, ensuring safety during topical tretinoin therapy.Choice B rationaleApplying tretinoin 5 minutes after washing the face is incorrect because it is advised to wait at least 20–30 minutes for the skin to dry completely. Tretinoin penetrates better on dry skin, reducing irritation and ensuring optimal therapeutic action. Excess moisture may dilute the medication or exacerbate irritation, so timing is critical for effective treatment.Choice C rationaleMorning application of tretinoin is not recommended due to its photosensitivity. UV exposure after application can worsen skin irritation and reduce the drug's efficacy. It is best applied at night when UV exposure is minimized, allowing tretinoin to act on epidermal renewal without interference from sunlight.Choice D rationaleUsing a dime-sized amount of tretinoin is excessive and can cause significant irritation. Only a pea-sized amount is recommended to ensure targeted application to the affected areas. Overuse may lead to excessive erythema and peeling due to the drug's potent exfoliating effect. Proper dosing minimizes side effects while maintaining therapeutic efficacy.