Tretinoin 101: A Detailed Guide
Tretinoin is a type of retinoid, which is a class of vitamin A–based products that are used on the skin to treat acne, improve skin tone and texture, and reduce fine lines and wrinkles, according to the American Academy of Dermatology Association (AAD). In 1971, tretinoin became the first retinoid to be approved by the U.S. Food and Drug Administration (FDA) as a topical treatment for acne, according to the AAD.
“Tretinoin is one of the most well-known and studied prescription topicals in the class of medications known as retinoids,” says Julia Schwartz, MD, a dermatologist and the owner of Dorado Dermatology in Dorado, Puerto Rico. “There are a number of retinoids available over the counter, but these are significantly less potent than tretinoin.”
Retinol, for instance, is a much milder popular over-the-counter retinoid that’s available in a wide range of products, says Lisa Chipps, MD, a dermatologist in Beverly Hills. But because it’s much weaker than tretinoin — often as much as 10 times less potent — it can take longer to work on skin, and the effects may not be as noticeable.
What Is Tretinoin?
“Tretinoin has been a staple in dermatology treatments for decades, and is something we’ve been prescribing for many years,” says Dr. Chipps. “It works by increasing cell turnover, which helps to open up the pores and get rid of the blockage and debris on the surface, and it also helps to build up the collagen in the deeper layers.” In other words, says Chipps, tretinoin helps prevent breakouts by opening up the pores and unplugging them, and it helps treat acne scars and wrinkles by building up the collagen underneath.
This powerhouse of a prescription retinoid is sold under different brand names such as Retin-A, Renova, and Atralin, to name a few, and is available in gel, cream, and lotion form. Tretinoin comes in different strengths, ranging from 0.01 percent to 0.1 percent tretinoin, and can be combined with other ingredients including benzoyl peroxide, topical antibiotics, niacinamide, and hyaluronic acid, says Susan Massick, MD, a clinical associate professor of dermatology at the Ohio State University Wexner Medical Center in Columbus.
If you’re wondering if tretinoin is right for you, talk to your doctor. You can also read on to learn some key facts about tretinoin, including what it can do for your skin, side effects, and more.
Potential Benefits of Tretinoin
According to Dr. Massick, tretinoin is a highly effective prescription medicine that can be used to address a number of common skin concerns, including acne and sun damage, and is a product that many people seek out for its anti-aging properties.
“Tretinoin is a mainstay in the treatment of acne, but it also has a lot of anti-aging benefits,” says Chipps. “So it’s something that we use for patients from their early teen years, when they start to get acne, all the way through life, when their concerns become more about signs of aging on their skin.”
Here are some of the ways tretinoin may benefit your skin.
Less Acne
If you have acne, your dermatologist will likely recommend tretinoin. “Whether a patient has predominantly comedonal acne [characterized by lots of clogged pores] or more inflammatory forms of acne vulgaris [characterized by pimples that are deep in your skin and filled with pus], topical tretinoin is a first line treatment for acne,” says Kristina Collins, MD, a board-certified dermatologist and the founder and CEO of Austin Skin in Texas. “By increasing the rate of cell turnover [rate of new skin formation] and calming inflammation, tretinoin can help clear the debris from pores so they can shrink to normal size and reduce the redness and swelling from acne.”
Improved Hyperpigmentation and Photodamage
In addition to banishing acne, the vitamin A derivative can brighten and even out your skin tone. “Tretinoin has long been used to help with many forms of abnormal pigmentation, including lentigines [sun spots], melasma [patches of skin that are darker than your skin tone], and post-inflammatory hyperpigmentation from acne,” says Dr. Collins. “Increased cell turnover allows the damaged skin to exfoliate.”
A review of research on the effectiveness of tretinoin as a treatment for photoaging (premature aging of skin due to sun damage) found that people experienced dramatic improvement in their skin after using tretinoin.
Reduced Signs of Aging, Including Wrinkles
Not long after tretinoin was approved as an acne treatment, dermatologists started to notice that it also provided anti-aging benefits, according to the AAD. “As tretinoin speeds up the production of skin cells, it also stimulates the synthesis of collagen, the most important abundant protein in the body, and gives structure to our skin,” explains Collins. “This increase in collagen has major anti-aging effects, including a reduction in wrinkles. Just keep in mind: to gain the benefits of wrinkle reduction, it is necessary to continue use for the long term, at least three to 12 months,” she says.
Forms of Tretinoin
Tretinoin is available in three forms: cream, gel, and lotion. “A person may find their skin responds better to one form versus another,” says Collins. Here’s how each form of tretinoin is different, and how to tell which one is right for you.
Gel
“For people with oilier skin, the gel form may penetrate easier and more quickly into the skin, and therefore potentially pack a bigger acne-fighting punch,” explains Collins. “However, gel-based products typically contain alcohol and can be extremely drying.” One strategy to retain moisture is to apply tretinoin gel as directed and then put on a noncomedogenic moisturizer right afterward.
Cream and Lotion
A better option for those who need a bit more moisturizer in their product is a tretinoin cream or lotion. “For people with dry or [combination] skin, and especially those using the products for anti-aging, I recommend a cream base to reduce the potential for increasing skin dryness,” says Collins.
Those who prefer something between a light gel and a heavy cream may want to try a tretinoin lotion, such as Altreno, which contains skin-nourishing ingredients such as hyaluronic acid, glycerin, and natural collagen, says Whitney High, MD, the director of dermatopathology at the University of Colorado Anschutz Medical Campus in Aurora, Colorado.
A small study in which participants applied a 0.05 percent tretinoin lotion on one cheek and a 0.05 percent tretinoin cream on the other found that the lotion was associated with less skin irritation and a greater degree of improved appearance, with most people expressing preference for the lotion formulation.
Potential Side Effects of Tretinoin
Tretinoin is a prescription-grade retinoid, which means it’s one of the strongest, most-potent forms available. Unfortunately, that means there is a higher risk of side effects than with an over-the-counter formula.
“The most common side effects of tretinoin are dryness, redness, and skin irritation, particularly in the first weeks of treatment,” says Dr. Schwartz. “For many patients, there is an initial adjustment period where the skin gets used to the retinoid. During this time, they may experience a ‘purge,’ or slight worsening of acne while their skin adjusts.”
To minimize the side effects, Schwartz recommends starting out by using tretinoin every other night or even every two nights for the first two weeks (or whatever your doctor may recommend for you). “If and when [a patient’s] skin gets accustomed to the treatment, they can work up to it nightly,” she continues, adding that each person’s skin is different and their ability to tolerate tretinoin will vary.
Talk to your dermatologist about what might be right for your individual needs before, during, and after treatment. “I would really advise patients to use tretinoin under the guidance of a board-certified dermatologist to maximize their results and minimize any irritation,” says Chipps.
Skin irritation is a side effect that people with darker complexions may want to pay particular attention to, according to the AAD. That’s because in people with darker skin, irritation can trigger hyperpigmentation, in which patches of skin can become darker.
To avoid hyperpigmentation, start tretinoin treatment slowly, use it with moisturizer, and talk to your doctor about any skin irritation that doesn’t seem to be getting better.
Does Tretinoin React With Other Ingredients?
If you’ve been prescribed tretinoin, you should avoid using any products on your skin that contain a lot of alcohol, such as astringents or aftershave lotions, as these can cause irritation. You may also want to steer clear of exfoliating products such as AHAs or strong cleansers, which can cause further irritation, says Chipps.
Your doctor may advise you to avoid products that contain a peeling agent such as benzoyl peroxide (although in some cases, a doctor may suggest using a tretinoin product that contains benzoyl peroxide), salicylic acid, and sulfur, according to Mayo Clinic.
Is Tretinoin Safe to Use During Pregnancy?
While topical retinoids, such as tretinoin, may not have as strong an impact on the body as an oral retinoid such as isotretinoin (which should not be taken by women who are pregnant, may become pregnant, or are nursing), there have been no studies to confirm that tretinoin is safe during pregnancy. Therefore, doctors recommend against using retinoic acids such as tretinoin if you’re trying to conceive and during pregnancy, says Schwartz.
“Oral systemic retinoids, such as isotretinoin [which used to be sold under the brand name Accutane], are absolutely contraindicated during pregnancy because they are known to be associated with severe birth defects,” explains Schwartz.
It’s also a good idea to speak to your doctor before considering using tretinoin while breastfeeding, according to MotherToBaby, a service of the nonprofit Organization of Teratology Information Specialists, which works to provide research and information about the risk of medications and other exposures during pregnancy and breastfeeding.
Tretinoin Alternatives
If you’re looking for a tretinoin alternative, you may want to consider these other retinoids.
Retinol
This retinoid is a gentler, but much less potent, version of tretinoin, says Dr. High. It’s a common ingredient in many OTC acne and anti-aging products.
Research shows that retinol is effective in reducing fine lines and wrinkles and improving skin discoloration and roughness. Retinol is also more easily accessible and more affordable than prescription retinoids such as tretinoin, and causes fewer side effects such as skin irritation and dryness.
Adapalene
Another topical retinoid, adapalene used to be a prescription-only drug for acne but it is now available OTC in a lower strength, according to High. “The adapalene molecule is very similar to tretinoin, but it is less irritating,” he notes. “Besides having a use in acne, adapalene is probably useful in the other ways that tretinoin is, such as reversing solar damage, improving fine lines, and building collagen, but it is less studied in these regards.”
While OTC adapalene isn’t as strong, it can still cause redness and skin irritation, and you should discuss any side effects of this medication with your doctor, says Massick.
Tazarotene
This retinoid is stronger than tretinoin, and may cause more adverse side effects of redness, peeling, and irritation, says Massick.
“Tazarotene is so strong that it cannot be used by women who can become pregnant, as it may cause birth defects, just like oral isotretinoin,” says High.
How to Add Tretinoin to Your Skin-Care Routine
When you first begin using a retinoid, says Massick, “I recommend starting low and going slow.” First, apply a little bit of the gel, lotion, or cream to a test area to make sure you don’t have any sensitivity or allergy to the product. Do this every day for a week or two, and then if all goes well, you can likely use tretinoin on your entire face, she says. And be sure to keep your dermatologist posted about how it’s going as you use this product.
While an allergy to tretinoin is very rare, the irritating and drying effect of the medication is experienced by nearly everyone who uses topical retinoids, says High. To prevent and combat skin irritation, peeling, and dryness, Massick suggests using a moisturizer containing hyaluronic acid, niacinamide, or other moisturizing agents.
As for how much product you should be using, Schwartz cautions against overdoing it. “Use just enough to cover your face — too much might irritate your skin,” she says. She recommends using a pea-size amount for the whole face, taking care to avoid the areas around the eyes, mouth, and inside your nose.
Where Tretinoin Should Fall Into Your Skin-Care Routine
Retinoids should be used in the evening because they can make you more sensitive to the sun, says High. “Retinoids can thin the top layer of the skin, making you more prone to sunburn,” he explains.
According to Chipps, “It’s very important when people are using tretinoin, to be very cautious about sun exposure and sun protection.” She recommends that anyone using tretinoin be vigilant about using sunscreen every day, avoiding direct sunlight, and wearing a hat when you do go out.
How Often Should You Use Tretinoin?
“Consistency in a skin care regimen is more important than frequency,” says Massick. So instead of following a complicated, multistep program every night, you may find that using a retinoid three times a week works just as well and prevents the dryness that comes with daily application.
Schwartz suggests easing into it by using tretinoin every other night at first so that your skin can adapt to it and develop a tolerance. Then, if you and your doctor decide that you might need to use it more frequently, you can apply tretinoin daily.
Is Tretinoin Suitable for Use in the Morning or Night?
Not only is tretinoin likely to make you more sensitive to sunlight, but it can become less effective in the sun, says Schwartz. This is another reason why doctors recommend using tretinoin at night rather than during the day.
Should You Increase the Concentration of Tretinoin?
Because tretinoin and other retinoids can be drying and irritating, especially if someone is using it for the first time, doctors usually have patients start with a lower percentage tretinoin product and have them use it less frequently, and then build up the dosage and frequency over time, says Chipps.
“It depends on the patient and their type of skin — people who have more oily skin can handle a stronger concentration and more frequent application than people with very dry skin,” she notes. “Also, the formula matters; somebody with oily skin might do better with a gel, while someone with drier skin might do better with a cream or lotion.” Chipps advises working with your dermatologist to maximize your results and minimize any irritation.
The Takeaway
Tretinoin is a prescription skin-care product used to treat acne and reduce the signs of aging, such as fine lines and wrinkles. It does this by increasing cell turnover and building collagen. Using tretinoin can cause dryness and irritation, especially when you first start using it. To get the best results and minimize side effects, gradually introduce tretinoin into your skin care routine, and always use a good moisturizer and sun protection.
