Medically reviewed by Joni Gunzburger, MSN, FNP-C on November 10, 2022
If you don’t love looking in the mirror because you see skin issues like acne or signs of sun-related aging staring back at you, then your medical provider may prescribe a topical retinoid called tretinoin cream as a fine line, dark spot or acne treatment. You may also hear topical tretinoin cream called retinoic acid, (or see it sold as the brand name Retin-A, Avita, Renova, and Atralin, among others in the U.S.). It’s a form of synthetic vitamin A that helps your body speed up the creation new skin cells that replace your old, damaged ones.
It may sound crazy, but tretinoin cream actually works by causing skin irritation, more so in those with sensitive skin. That’s why you should only use it when prescribed by a medical provider – especially if you’re using other topic retinoids in your skin care routine.
Think you might want to try Retin-A tretinoin for your fine lines and aging? Let’s take a closer look at this helpful cream to see if it might be the solution you’ve been dreaming of.
Nurx offers prescription treatment for acne, anti aging, melasma and rosacea for as little as $0 with insurance or $15 per month without insurance.
Skin Concerns That Are Addressed by Tretinoin
Topical tretinoin is typically prescribed to fight photodamaged or aging skin. It works wonders for reducing fine wrinkles, dark spots, and rough skin patches. It can also be used for acne treatment and to help some of the hyperpigmentation of acne scars. Many people deal with acne and aging skin at the same time, so this can be an excellent all-in-one solution.
What Effect Does Tretinoin Have on the Skin?
Tretinoin is a gentle exfoliant that helps to unblock pores and peel away dead skin cells, and increases cell turnover, helping your face grow newer, healthier skin cells that aren’t as inflamed or damaged. It also boosts your body’s production of collagen and hyaluronic acid to help your skin look smoother and more hydrated, and boost your glow.
You may be thinking… tretinoin sounds similar to retinol. Are they the same thing?
Not quite. While they’re both vitamin A-based retinoids that exfoliate the skin and promote faster cell growth, tretinoin is a lot stronger. That’s why you can buy retinol and other vitamin A topical retinoid compounds over the counter, while tretinoin is prescription-only. Your doctor may recommend retinol over tretinoin if you have sensitive skin that might not handle irritation well.
What Does Tretinoin Do for Aging Skin?
In addition to being an acne treatment, retinoic acid also works well to reduce signs of aging related to sun exposure. After using tretinoin, you may see a reduction in your fine wrinkles, as well as an improvement in your skin’s texture.
As your topical retinoid clears away dead skin cells, you may experience some skin irritation. But as your skin adjusts and you produce new skin cells — along with collagen and hyaluronic acid — you should see an improvement.
Which Skin Conditions Respond Well to Topical Tretinoin?
A topical retinoid like tretinoin can help reduce the visibility of a number of skin conditions, including acne scarring, wrinkles, sun damage, roughness, large pores, and uneven skin pigmentation. Some people use it to treat stretch marks or other post-pregnancy skin conditions (though Nurx does not prescribe it for this).
Unfortunately, it doesn’t help with actinic keratoses — pre-skin cancer hyperpigmented lesions that you can develop from too much sun exposure. Any unusual bumps or spots on your skin should always be examined by a medical provider to rule out skin cancer or precancer.
How to Use Tretinoin
If a medical provider prescribes you tretinoin cream, it will be accompanied by explicit instructions on how you should use it.. But here are a few recommendations on using tretinoin based on standard guidelines.
Steps to Using Tretinoin
First, you’ll want to wash your face with a gentle cleanser to help clear any impurities on your skin. Make sure your skin is completely dry before using the product, as any residual dampness could cause irritation.
When you’re ready, apply about a pea-sized amount of tretinoin topical cream to your face. Rub it gently on the affected areas, such as your fine lines or acne. You’ll complete this process once a day, usually at nighttime.
Should You Put Tretinoin on Before or After Moisturizer?
If your skin care routine involves moisturizer — and it should! — we generally recommend you put it on after your tretinoin. This should help acne-prone skin from drying out too much. The best moisturizer products to use with tretinoin are gentle and don’t include any other vitamin A compounds. You may want to try one with hyaluronic acid.
What If You Miss a Dose of Tretinoin?
If you forget to apply tretinoin before going to bed, it’s no big deal — simply resume treatment the next night. Because tretinoin increases your skin’s photosensitivity, most medical providers do not recommend morning application. For the same reason, you should be extra-responsible with sun protection when using tretinoin. Keep your face shielded by a hat when in the sun, apply sunscreen with an SPF of 30 or higher every morning, and reapply throughout the day.
Skin Care Products You Should Avoid Using In Combination With Tretinoin
To promote healthy skin, avoid products containing benzoyl peroxide, salicylic acid, sulfur, astringents, and resorcinol. These ingredients can dry out your face, and dry skin is already a side effect of tretinoin creams.
You’ll also want to avoid things like waxing or hair removal products on your treated skin. If you shave, avoid shaving creams, or after-shave lotions that contain ingredients listed above.
Hair care products, such as hair straightening and curling products can cause irritation if they drip onto the treated area.
You may find that some types of makeup, soaps, or cleansers amplify the temporary drying effect of the product. You may need to stop using them until the drying subsides.
Results From Tretinoin
Though results will vary based on the individual, there are certain things you can do to maximize results and effectiveness of tretinoin treatment.
How Do You Get the Best Results From Tretinoin?
To maximize your tretinoin results, consistency is key, so make sure you keep using the cream daily. If your skin is acne-prone, there is a high probability that your skin will get worse before it gets better. But according to the FDA, this is actually a sign that the treatment is working. While you may be tempted to stop treatment as unseen lesions come to the surface, the situation will pass with time (and patience).
With consistent use, you should notice some positive change within two to three weeks. More noticeable results in reducing acne and fine lines take about eight to 12 weeks, following the cycle of skin cell turnover.
Stay consistent, keep using moisturizer and other gentle skin care products, and always use SPF to boost the appearance of your treated skin.
What Percentage of Tretinoin Treatments Are Effective?
Because tretinoin is used for everything from cystic acne to atopic dermatitis, it’s hard to nail down an exact effectiveness percentage. That said, while vitamin A retinoids won’t work for everyone, they’re an amazing tool for many people. In fact, one study found that tretinoin could reduce microcomedones (small acne blemishes) by as much as 80%.
Retin-A aka tretinoin is just one of many acne scar medications, and while it may lighten some of the discoloration of acne scars, it probably won’t improve deep pock marks– so if it’s not working for you, there are other skin care products or in-office procedures a medical provider can recommend.
What Kind of Results Can You Expect From Tretinoin?
In general, the results of tretinoin use are overwhelmingly positive. One study found that patients with photodamaged skin saw an 80% increase in collagen formation when using tretinoin. Since photodamaged skin typically has 56% less collagen than skin protected from the sun, this is a huge step toward getting better skin texture and tone and fewer wrinkles.
Who Should Use Tretinoin & Who Should Avoid Tretinoin?
In each of the below cases, you’ll want to consult a medical provider to weigh any risks versus reward for your personal health situation.
According to the FDA, ongoing research is needed to determine if this product is safe for those under 12 years of age. Medical providers can, and do, prescribe it for younger children, but with caution.
It has also not been sufficiently tested on those 65 or over. Older and younger individuals may respond differently to many medications. This does not mean that tretinoin is necessarily dangerous for them; it’s just an unknown.
There is currently not enough research on pregnant people to say if it is safe for breastmilk or a potential future baby. This is true of many non-essential medications, as a controlled study on pregnant people may not be ethical. Because of this, it’s generally recommended that you avoid tretinoin during pregnancy.
Those who have known allergies to the ingredients should not use it, so discuss any allergies, including food allergies, with a medical provider. Also, those with fish allergies (as well as vegans) should know that some versions of the product contain a substance derived from fish. However, this doesn’t have to stop you from using this topical tretinoin, as not all tretinoin products contain fish ingredients.
Those who have eczema, dermatitis, or dandruff should consult a medical provider before use since tretinoin can cause irritation and potentially exacerbate those conditions.
Are There any Alternatives to Tretinoin?
If you decide you shouldn’t use tretinoin, you do have some other options. However, none pack the anti-aging punch that this treatment does – certainly not over-the-counter.
Alternatives for acne (not all-inclusive):
- Acanya (clindamycin/ benzoyl peroxide topical)
- Aklief (trifarotene topical)
- Arazlo (tazarotene topical)
- Amzeeq (minocycline topical)
- Benzamycin (erythromycin/ benzoyl peroxide topical)
Alternatives for fine lines and wrinkles:
- Chemical peels and topical acid treatments
- Laser treatment
Safety Considerations When Using Tretinoin
Before you start using topical tretinoin, it’s best to learn all about its side effects and other skin safety considerations.
What Are Some Important Precautions With Tretinoin Use?
Make sure you tell your medical provider if you have any vitamin A allergies. You’ll also want to avoid spending too much time in the sun, as your skin will be more sensitive than usual. Actively tanning outside or in a tanning booth should be completely eliminated. You should also wear sunscreen (SPF 30 or greater), even for casual sun exposure and avoid 10AM to 4PM sun when possible. Wear a hat and protective clothing. If you do get sunburned, don’t use tretinoin again until your skin has healed.
Your sensitive skin may also have sensitivity to wind and cold, so be sure to bundle up when heading outside.
The good news is that you can keep using other hyperpigmentation treatments like vitamin C at the same time as tretinoin, as they don’t work in the same way. However, since they’re both acidic, just make sure you don’t apply them right after one another. Using one at night and one in the morning gives your skin time to react to the effects of both compounds.
Avoid any other retinoid treatments, including over-the-counter creams like retinyl palmitate and retinaldehyde.
Take care when applying tretinoin to avoid areas like the mouth, nose and eyes. It shouldn’t come in contact with your mucous membranes — the soft tissues found in places like the inside of your mouth, nose, and eyes — as are more absorbent than your “normal” skin, allowing a higher dose of retinol into the body. For the same reason, you should also avoid using tretinoin on skin that is scraped, torn, sunburned, or overly irritated.
What Are the Possible Side Effects of Tretinoin Use?
The Mayo Clinic notes the main side effects of tretinoin are itchiness, peeling, dryness, and redness. These should get better in a few weeks.
More serious side effects (ones you should tell your medical provider about right away) include skin blisters, swelling and burning, and discoloration. Your doctor may decide to:
- Closely observe the side effects for a few days, if they’re not too severe
- Stop using the tretinoin cream
- Reduce the strength or switch you to a different type of medication. Dosages of topical tretinoin are 0.1%, 0.08%, and 0.04%, so you can look to see what strength you’re using.
A very, very small percentage of people may experience a significant allergic reaction such as swelling of the face, neck, or throat plus dizziness or trouble breathing.
Don’t confuse your tretinoin side effects with rosacea. If you find your skin redness and irritation isn’t going away after several weeks, your medical provider may see if you meet the diagnostic criteria for rosacea and suggest treatment accordingly.
How Long Should You Use Tretinoin?
How long you should use tretinoin depends on what you’re using it for. If you’re using acne lesions, sun damage, or fine lines and wrinkles you can keep using tretinoin until you’re happy with your results, or keep using it on an ongoing basis if your medical provider gives you the go-ahead..
Once you have achieved a desired result, you can typically maintain those improvements in acne and fine lines with less frequent application or higher dosages. You should discuss this maintenance stage with your medical provider.
If you’re looking to add tretinoin to your skincare routine, get started here by filling out a skincare questionnaire.