Tretinoin for Acne: How to Use It, Efficacy, Side Effects, and More

• Tretinoin is a derivative of vitamin A and a prescription medication for the treatment of acne
• This is a topical medication available in cream, gel and lotion formulas
• Tretinoin is indicated for mild-to-severe inflammatory and noninflammatory acne
• Treatment will vary depending on acne severity and the skin’s response

Acne is a very common skin disease among both adolescents and adults that develops when hair follicles become clogged with dead skin cells, debris and sebum (oil). Acne can present as mild pimples, blackheads and whiteheads or more severe cysts and nodules. While there are a wide range of options, tretinoin for acne is considered a first-line treatment and a mainstay in acne management.

What Is Tretinoin?

Tretinoin is an FDA-approved retinoid shown to be very effective against acne. Derived from vitamin A, this medication effectively clears pores of acne-causing debris and stimulates rapid skin cell turnover, resulting in the production of fresh, new cells.

These properties make it valuable for treating a host of skin concerns including fine lines, sun damage, roughness and hyperpigmentation – conditions that can all be effectively improved from the effects of rapid skin cell turnover.  

There are several brand names to choose from including Retin A Micro, Altreno and Refissa.

Does Tretinoin Work for Acne?

Yes, tretinoin has a number of powerful qualities to enable this medication to not only treat existing acne blemishes but to help prevent future outbreaks. It can safely and effectively be used for both mild to severe cases of noninflammatory and inflammatory acne. 

As a comedolytic agent, it acts as a powerful exfoliant. Once applied to the treatment area, it works to clear plugged pores of oil, debris and dirt, and encourages old skin cells to slough off. 

Importantly, combination therapy is proven to be more effective than using either drug alone. Utilizing two drugs with different mechanisms of action offers a stronger approach in acne management. For example, combining benzoyl peroxide with tretinoin can kill acne-causing bacteria. 

In addition, by clearing skin cells, tretinoin boosts the performance of other acne medications, such as antibiotics, by enabling them to more deeply penetrate into cells to kill acne-causing bacteria.

Tretinoin for acne scars

Acne scars are a common long-lasting reminder of past acne breakouts. They can either be hypertrophic (raised) of atrophic (depressed), mild or severe.

Tretinoin can be an effective solution for atrophic scars, as it accelerates skin cell turnover to help flatten and reduce the appearance of scars.

When used in a procedure called iontophoresis, a procedure that uses a mild electrical current to enable better absorption of the medication, it has been shown to be effective in reducing the appearance of atrophic scars. One study reported a significant decrease in scar depth in 94% of test subjects. 

Tretinoin in combination with other known therapies has also been shown to be efficacious. Microneedling, a noninvasive procedure that causes micro wounds in the skin, provides two benefits: it stimulates collagen production and allows for better penetration of topical agents such as tretinoin. 

The synergy of these two therapies reduces the appearance of acne scars by resurfacing the skin and enhancing tretinoin absorption.

Who Should Use It? 

Tretinoin is a first-line treatment for both inflammatory and noninflammatory acne, and is prescribed alone or in combination with other medications. It is prescribed as short-term or long-term therapy depending on your acne severity and response.

Unless otherwise specified by your dermatologist, it is important to avoid certain topical medications when using tretinoin, as they can cause severe adverse reactions. These include benzoyl peroxide, sulfur and salicylic acid.  

For those who are pregnant or thinking of becoming pregnant, this medication must be avoided. Lastly, ensure your dermatologist is aware of any other skin conditions such as eczema or dermatitis to avoid exacerbating irritation.

Tretinoin Products for Acne 

Tretinoin is available in gel, cream, foam and lotion formulas in three strengths: 0.1%, 0.05% or 0.025%.

Creams typically contain the highest concentration of medication but work more slowly. Both creams, gels and foams have the effect of drying skin.

Gels have a lighter structure than creams to better and more quickly penetrate into skin. The gel formula has the advantage of reducing facial shine, a common complaint of acne patients.

Lotions are a relatively new addition to the tretinoin family, and were FDA-approved in 2018. They can counteract the drying effects of tretinoin medications as they contain hyaluronic acid and collagen. 

How to Use Tretinoin for Acne

Your dermatologist will provide you with specific instructions as to how often you should apply tretinoin and for how long. It is important to adhere to a consistent skin care regimen in order to achieve best results. In general:

1. Wash your face with a gentle cleanser, pat dry and allow to dry thoroughly 
2. Apply a thin layer of tretinoin to affected areas, avoiding the delicate eye area
3. Wash your hands thoroughly
4. Allow the product to be absorbed completely into the skin, then continue with your regular skin care routine

Tretinoin Side Effects

Tretinoin causes skin to be sensitive to sunlight as it has a significant drying effect; it is important to apply sunscreen and avoid direct sunlight for the duration of your treatment.

Associated side effects range from mild to severe. It is advised to monitor for any adverse effects and to contact your dermatologist should any uncomfortable or alarming symptoms develop. These include:

• Burning and stinging
• Peeling or scaling
• Redness and irritation
• Scaling and peeling
• Severe dryness
• Severe sunburn 
• Skin discoloration
• Swelling
• Worsening of acne

The tretinoin purge

Skin purging is a term coined to describe what occurs after application of a new topical product. 

Because tretinoin accelerates skin cell turnover, within 2 weeks you may experience what appears to be an increase in acne lesions. This is actually the medication effectively working and shedding skin cells, oil and debris at a faster-than-normal rate. 

While there is no set rule, this typically resolves within 1–2 months.

Takeaway 

Tretinoin is a topical treatment proven to effectively treat the symptoms of both inflammatory and noninflammatory acne. This medication is available by prescription in various formulas and strengths. 

It is a first-line therapy that can accelerate skin cell turnover, control sebum production and increase collagen production. As a powerful exfoliant, it not only treats acne, but is effective in reducing the appearance of acne scars.

Tretinoin is associated with a number of side effects including irritation, significant dryness and increased sun sensitivity. Be sure to follow your dermatologist’s instructions and notify them should you experience any negative changes to your skin.