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A medication that reduces wrinkles, clears acne, and evens out skin tone? Sounds too good to be true, doesn’t it? It’s not—these are just a few of the benefits of tretinoin. This golden child of the dermatology world helps with many skin conditions, but it does have side effects. Read on to learn more about tretinoin and its many uses and benefits.
What is tretinoin?
Tretinoin (see Important Safety Information) is a member of the drug family known as retinoids. The retinoid family includes vitamin A (retinol) and drugs derived from this vitamin (including tretinoin, retinoic acid, etc.).
Retinoids play an essential role in many of your body’s processes, including inflammation, vision, and skin health (NIH, 2021). Dermatologists use tretinoin for various skin conditions, including acne, skin discoloration, fine wrinkles, and sun-damaged skin.
Tretinoin is a generic medication (brand name Retin-A) and is only available by prescription; other retinoids, like retinol, are available over-the-counter but are not as effective as their prescription counterparts. You can only get tretinoin cream with a prescription—it is strong and can cause serious side effects (Zasada, 2019).
Benefits of tretinoin
Tretinoin has been used by dermatologists to treat skin conditions for years. Why? Because it has many benefits when it comes to improving your skin’s appearance, including (Leyden, 2017; Yoham, 2020; Zasada, 2019):
- Increasing cell turnover
- Promoting collagen production
- Decreasing inflammation
- Minimizing pore size
- Reducing skin oil (sebum) production
Forms of tretinoin
Topical tretinoin comes in different dosage forms, so you and your dermatologist can decide which strength is best for you to maximize efficacy while minimizing side effects—0.01% is the lowest dose and 0.1% is the highest, with several options in between. It can also come as a lotion, cream, or gel. Some people find one form more tolerable than another (Leyden, 2017).
There is also an oral form, called isotretinoin (brand name Accutane), available by prescription. While very effective, it comes with a higher risk of side effects. We will focus on topical tretinoin for now.
What is tretinoin used for?
Tretinoin can help improve several skin conditions, including acne, sun-damaged skin, fine wrinkles, and skin discoloration.
Tretinoin plays a significant role in treating acne, a common skin condition that affects over 80% of teenagers, along with 3% of men and 12% of women over the age of 25. Acne starts when one of your skin pores gets clogged with oil and dead skin cells. This clogged pore creates an environment for skin bacteria to multiply, leading to an inflammatory reaction and the characteristic “zit” or comedone (Leyden, 2017).
Tretinoin treats acne by unclogging pores, decreasing oil production, and reducing the inflammatory response. It’s a mainstay of acne treatment because it works against acne eruptions and encourages the maintenance of clear skin (Leyden, 2017).
Adult acne: symptoms, causes, and treatments
Photoaging (sun-damaged skin)
Photoaging (also called premature aging) refers to skin damage that occurs due to sun exposure. During this process, the skin loses cells, collagen, and its ability to turnover normally. Sun damage causes the skin to become coarse, thin, and loose. It also causes discoloration, scattered brown spots, visible small blood vessels, and—in severe cases—early skin cancers (Guan, 2021).
Tretinoin helps with photoaging by affecting how the skin cells respond to damaging ultraviolet (UV) rays. It blocks the collagen and cell protein breakdown usually triggered by UV light (Riahi, 2016). Several studies have shown that tretinoin can help improve the elasticity (tightness) and the appearance of sun-damaged skin (Yoham, 2020; Zasada, 2019).
Of course, if you are trying to improve sun-damaged skin with tretinoin, it is vital that you also use adequate sunscreen (at least SPF 30) and wear protective clothing when outside to prevent ongoing photoaging.
Loss of collagen, sun damage, and years of smiling and frowning can cause fine lines and wrinkles on your face. Tretinoin helps your skin cells replenish their collagen, improves the texture of your skin, evens out your skin tone, and increases the tightness of your skin (Yoham, 2020; Zasada, 2019).
The darker your skin, the more melanin (pigment) in your cells. Some people with medium to dark skin can have discoloration or dark patches because something triggers their skin cells to make even more melanin than usual. This discoloration, called hyperpigmentation, may appear after healing skin inflammation (like from a pimple, a cut, or eczema), otherwise known as post-inflammatory hyperpigmentation (PIH) (Lawrence, 2021).
In some people, hyperpigmentation occurs with hormonal changes, like during pregnancy or oral contraceptive use; this is sometimes called melasma. Melasma can also appear in response to sun exposure.
Tretinoin can help dark spots fade, allowing you to have a more even skin tone. It decreases the amount of melanin in your skin cells (Zasada, 2019). When used for discoloration, tretinoin is usually combined with other skin-lightening products, sometimes in the form of a chemical peel (Lawrence, 2021).
How long does it take to see results?
It takes several weeks of tretinoin use before you start to see results. In the first 1–2 weeks, you may notice skin irritation; this is a normal skin reaction to tretinoin (Leyden, 2017). At about 2–4 weeks, the irritation starts to resolve, and it may take 12–15 weeks for you to see significant improvement in your skin (Leyden, 2017).
Side effects of tretinoin
The side effects of topical tretinoin are most noticeable during the early stages of treatment and include the following (Yoham, 2020):
- Burning or stinging sensation
- Dry skin
- Skin redness
- Increased sensitivity to sunlight and increased risk of sunburns
In many people, these side effects improve after a few weeks. Because of the increased risk of sunburns when using tretinoin, you should apply sunscreen (at least SPF 30) to your face, wear protective clothing, and avoid excessive sun exposure.
How to use tretinoin: is it safe to use every night?
Lastly, if you are pregnant or breastfeeding, you should stop using topical tretinoin. Until now, there have been no cases of tretinoin causing harm to the fetus. However, other retinoids (such as isotretinoin) can cause fetal problems.
According to the U.S. Food and Drug Administration (FDA), oral tretinoin is pregnancy category C—this means that there are no adequate and well-controlled studies in pregnant women. It should only be used during pregnancy if the potential benefit to the mother outweighs the potential risk to the fetus. In most cases, the general recommendation is to avoid using tretinoin if you are pregnant or breastfeeding (Yoham, 2020).
Talk to your dermatologist or healthcare provider to see if you should be using tretinoin to treat your acne, sun-damaged skin, fine wrinkles, or discoloration. Be sure to tell them if you have any other skin diseases or medical problems and if you are taking any other medications, including medicated creams or lotions.
How to use tretinoin
Your healthcare provider will give you instructions regarding the strength and frequency of tretinoin, along with a skincare routine that is right for you. While you should always follow your provider’s medical advice, here are some additional tips for using topical tretinoin:
- Wash your face with a mild cleanser and gently pat (do not rub) dry. Harsh soaps can irritate your skin, so stick with gentle cleaners.
- Apply a thin layer of tretinoin at night. Dab a bit onto the affected areas and gently spread the product around your face, taking care to spread it away from the corners of your mouth, eyes, and nose.
- Using more product will not speed up your facial skin changes and may worsen skin irritation, so only use the amount recommended by your provider.
- To help with the initial skin irritation, apply a good moisturizer afterward.
- Tretinoin may cause drying, and you may see peeling skin; start by applying 2–3 times a week and increasing as tolerated.
- Make sure to moisturize adequately and always wear sunscreen (SPF 15+). If you plan on being in the sun for an extended period, use SPF 50+ lotion, and reapply every two hours.
- It may take up to 16 weeks for the treatment to take full effect, so be patient.
- Do not use tretinoin if you are pregnant, trying to get pregnant (including if you’re on fertility treatment or undergoing IVF), or unsure if you are pregnant.
- Lawrence, E. & Al Aboud, K. M. (2021). Postinflammatory hyperpigmentation. [Updated Oct. 9, 2021]. In: StatPearls [Internet]. Retrieved on Oct. 11, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK559150/
- Leyden, J., Stein-Gold, L., & Weiss, J. (2017). Why topical retinoids are the mainstay of therapy for acne. Dermatology And Therapy, 7(3), 293-304. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28585191/
- National Institutes of Health (NIH) – Office of Dietary Supplements. (2021, Mar). Vitamin A- Health professionals. Retrieved on Oct 7, 2021 from https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/
- Riahi, R. R., Bush, A. E., & Cohen, P. R. (2016). Topical retinoids: therapeutic mechanisms in the treatment of photodamaged skin. American Journal of Clinical Dermatology, 17(3), 265–276. doi: 10.1007/s40257-016-0185-5. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26969582/
- Yoham, A. L. & Casadesus, D. (2020) Tretinoin. [Updated Dec. 5, 2020]. In: StatPearls [Internet]. Retrieved on Oct. 11, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK557478/
- Zasada, M. & Budzisz, E. (2019). Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments. Advances in Dermatology and Allergology, 36(4), 392–397. doi: 10.5114/ada.2019.87443. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31616211/
Dr. Mike is a licensed physician and the Director, Medical Content & Education at Ro.