Tretinoin, the Superstar of Skin Renewal

Tretinoin is known for its exceptional ability to turn back the hands of time. With its prowess in stimulating collagen production and promoting skin cell turnover, tretinoin effortlessly diminishes fine lines and wrinkles, leaving behind a rejuvenated and resilient complexion.

Used correctly, tretinoin can make a big difference in skin health and well-being for many people. Here’s what you need to know about how it works, if it suits you, and how to use it.

What Is Tretinoin and How Does it Work?

First approved by the FDA as a treatment for acne 40 years ago, it quickly became apparent that tretinoin went beyond acne treatment to make the skin as a whole significantly smoother, brighter, and less wrinkled.

Tretinoin is a biologically active form of vitamin A that is extensively proven in treating acne and sun-induced skin aging.

It is a type of retinoic acid already found in the human body. When used as a pharmaceutical, retinoic acid binds to switches inside skin cells called retinoid receptors. This triggers the receptor to change how genes in the cell express themselves.

So retinoids “reset” the cell to start acting normally again if it’s been off doing something stupid like producing too much oil or making the skin wrinkle.

Tretinoin Brand Names

Tretinoin is the active ingredient in the prescription products Retin-A and Renova. In the United States, tretinoin is available only by prescription. Non-prescription beauty creams may contain retinol, which is a relative of tretinoin but does not have the same efficacy.

Retinoid Types

The most established anti-aging actives are retinoids, a group of compounds derived from vitamin A.

Over the decades, retinoids have been the subject of well-designed medical studies showing all kinds of compound uses. They can reduce the number and depth of fine lines and wrinkles. They can prevent acne. They can fade hyperpigmentation and acne scars. They can unclog pores and reduce the appearance of pores. They can treat psoriasis and keratosis pilaris. And they are even used to treat certain types of skin cancer and precancerous cells.

From weakest to strongest, retinoids are:

Retinyl Palmitate

Retinyl palmitate is a common OTC. It is the weakest but the safest form of vitamin A. It is suitable for daily use, with very little irritation, but is generally not used in high enough concentrations to significantly impact skin concerns. Many products labeled “retinol treatments” use retinyl palmitate instead, so check the ingredients list.

Hydroxypinacolone retinoate

Hydroxypinacolone retinoate (HPR), found in “Granactive Retinoid” mixes, might be an effective acne treatment and anti-aging ingredient. It is a generally well-tolerated OTC retinoid that should be easy to introduce. However, most clinical studies combined HPR with other retinoids, making it difficult to tell how significant the effects of HPR are ^8-12.

1. The Ordinary Granactive Retinoid 2% in Squalane
2. The Ordinary Granactive Retinoid 5% in Squalane
3. The Ordinary Granactive Retinoid 2% Emulsion
4. Mad Hippie Vitamin A Serum

Retinol

Retinol is a common OTC retinoid that treats acne ¹³ and has anti-aging effects ^14-19 by minimizing fine lines and wrinkles and increasing epidermal thickness.

The difference between retinol-type ingredients and retinoids is that retinol ingredients are not already in retinoic acid form. They have to be turned into retinoic acid by enzymes on the skin before they can trigger all the cool cell action we discussed earlier. Studies have shown retinol is about 20 times weaker than prescription tretinoin ¹.

It can be a volatile ingredient that breaks down when exposed to heat, light, and air. That’s why it’s a good idea to look for products with encapsulated retinol, airless pump packaging, and opaque containers.

1. Superfacialist Anti-Aging Serum (0.01%)
2. Paula’s Choice Resist Intensive Wrinkle Repair Serum (0.1%)
3. Paula’s Choice Resist Skin Smoothing Body Treatment (0.1%)
4. Alpha Skincare Deep Wrinkle Repair (0.15%)
5. SkinPrep 0.5% Retinol (0.5%)
6. The Ordinary 0.2% Retinol
7. The Ordinary Retinol 0.5% in Squalane
8. The Ordinary Retinol 1% in Squalane
9. Paula’s Choice Clinical 1% Retinol Treatment (1%)
10. Peter Thomas Roth Retinol Fusion PM (1.5%)

Retinaldehyde

Retinaldehyde, also called retinal, is an OTC retinoid with anti-aging benefits ²⁰, increases epidermal thickness, increases elasticity, and may treat acne ²¹.

1. Avène RetrinAL 0.05 Cream (0.05%)
2. Avène RetrinAL 0.1 Intensive Cream (0.1%)
3. Mychelle Retinal Serum

Adapalene (Differin)

Adapalene, a newer retinoid, is a less irritating acne-fighter^22-26 than tretinoin. It decreases oiliness ²⁶, although it may not be as effective against wrinkles. It is a retinoid that is OTC in the U.S. but is prescription-only in many other countries.

Whether adapalene is, an efficient anti-aging ingredient like other retinoids comes up quite often. A few studies look promising, although each has limitations, such as a lack of control or an absence of objective measurements. Unfortunately, there doesn’t appear to be enough research to give a decisive answer one way or the other, at least for the time being ^27-28.

Shop Target, CVS.

Tretinoin

Tretinoin, today’s article’s subject, is a well-studied retinoid. Also known as all-trans retinoic acid, tretinoin is a metabolite of Vitamin A. It is produced in the body from other retinoids ingested, such as retinol, retinyl esters, and carotenoids. Tretinoin is prescription-only in the U.S. and most countries, with brand names such as Atralin, Avita, Retin-A, Retin-A Micro, and Renova.
It treats acne ²⁵, hyperpigmentation ^29-36, has anti-aging effects ^29-39, minimizes fine wrinkles, and increases epidermal, dermal, and granular cell layer thickness.
Tretinoin may also reduce pore size ³⁹.

Tazarotene

Third-generation retinoid, Tazarotene, also known under the brand name Avage or Tazorac, is a prescription-only retinoid that treats acne 25, 41, hyperpigmentation 33, 41-42, has anti-aging effects 33, 41-42, and minimizes fine lines and wrinkles.
Tazarotene is stronger than adapalene and may reduce pore size 42.
Tazarotene may be a better wrinkle reducer than tretinoin. It is also potentially more efficacious than tretinoin at treating papules and open comedones and can be used to treat psoriasis. More research is needed.

Isotretinoin

Topical isotretinoin is a retinoid that treats acne ⁴⁴, has anti-aging effects, minimizes fine lines and wrinkles, and increases epidermal thickness ⁴³. It is prescription-only in most countries.

Accutane is taken orally and is extraordinarily effective against acne, although it has serious side effects.

Tretinoin Safety & Side Effects

It is possibly not safe to use while breastfeeding or while pregnant!

Isotretinoin (Accutane) has teratogenic effects meaning it causes birth defects. So with an abundance of caution, medical providers also recommend avoiding tretinoin while pregnant.

Due to the poor absorption of tretinoin from the skin, studies suggest that the risk of malformations in human fetuses after topical application of tretinoin is smaller. Still, it is recommended to err on the safe side and not use tretinoin while pregnant or breastfeeding.

Side effects include skin discoloration, blistering, facial swelling, burning, conjunctivitis, and eye swelling. These side effects are rare and should be treated immediately by a doctor. Serious side effects of tretinoin are rare.

A small percentage of people who use tretinoin may have an allergic reaction. This can cause rashes, swelling, and difficulty breathing. These side effects are rare and should be treated immediately by a doctor.

Benefits of Tretinoin for the Skin

Tretinoin is a fantastic tool that can deliver healthy-looking, beautiful skin, including a host of benefits when used correctly.

Most subjects develop a healthy-looking, so-called “tret glow,” and skin tone irregularities may even out.

Tretinoin has been shown to have scientifically proven effects on the skin:

• treating and preventing acne vulgaris;
• anti-aging effect; Tretinoin is considered the gold standard for treating and preventing fine lines and wrinkles (to an extent);
• lightening effect – anti-yellowish skin;
• PIH – brown-ish hyperpigmentation;
• treating shallow indented scarring;
• reducing oil production
• smoothing;
• tightening; Tretinoin may help reduce the appearance of pores;
• treating photodamage;
• increasing epidermal thickness;
• aid in melasma treatment;
• aid in vitiligo treatment.

Tretinoin for Acne

Tretinoin helps regenerate skin cells and prevents the clogging of follicles (pores). Tretinoin helps prevent blackheads, whiteheads, and inflamed acne lesions by decreasing follicular plugging.

Acne improvement may take at least 12-16 weeks to see full benefits from tretinoin.

Tretinoin for Anti-aging

Tretinoin acts by various mechanisms in skin aging to fight dark spots and wrinkles. Additionally, it has been shown to promote smoother, tighter, and fuller skin by stimulating the production of collagen and glycosaminoglycans.

Visible signs of wrinkles and some coarse wrinkles may improve by 4-6 months.

Tretinoin for Hyperpigmentation

Tretinoin helps with hyperpigmentation. It decreases the darkness of brown spots by reducing epidermal pigmentation. Also, it pinkens sallow skin.

Sun-induced brown spots, mottled hyperpigmentation, and freckles may lighten 4-6 months after treatment.

What Is Tretinoin Not Good For?

• reducing redness – increased vascularity means redness can increase for some;
• Soothing irritation – tretinoin is one of the most irritating ingredients;
• PIE (Post-irritation erythema) is the dilation of the blood vessels. Tretinoin increases vascularity making erythema worse. If you have pale skin, this looks like redness. If you have darker skin, this can look like a “glow.”  If you’re pale, azelaic acid, niacinamide, and vitamin C are better for hyperpigmentation.

How to Use Tretinoin?

When you start tretinoin, it’s best to stop using other active ingredients (other than sunscreen actives, which are especially important now) so you don’t overdo it and irritate your skin.

Tretinoin is pretty powerful and addresses everything from acne to aging, so it’s not a bad idea to strip your routine back at first and then slowly add other actives back in. After about three months of using tretinoin, I was able to reintroduce my weekly mandelic acid peel (though I skipped the retinoid the day before and the day of the peel) without irritation.

If your skin is especially sensitive or dry, you may want to start slowly to ease your skin into the extra-strength skin treatment. My derm advised me that tretinoin is still effective if used every other night or even every third night, so if you’re experiencing redness or irritation, step back to alternating nights to give your skin a break. Give your face some extra TLC on off nights with a gentle cleanser and a heavy, bland moisturizer.

Studies show that moisturizing before applying tretinoin can improve tolerance and does not interfere with effectiveness. If you want to learn more about different ways of applying tretinoin for optimal results, read our guide Tretinoin Skincare Routine – Designed for Absolutely No Irritation.

Morning

1. Holika Holika Good Cera Super Ceramide Mist
2. COSRX – Advanced Snail 96 Mucin Power Essence
3. Moisturize
4. Use a broad spectrum SPF 30+ sunscreen and avoid sunlight if unprotected.

Read more on why you must use sunscreen while on tretinoin.

Evening

1. Cleansing
2. Hydrate
3. Thoroughly moisturize
4. Let face dry
5. Apply a pea-sized amount of tretinoin to the face.
6. Rub lightly into the whole face, but avoid the eyelids.
7. Moisturize

Tretinoin Purging

Starting tretinoin sometimes leads to a phase known as the tretinoin purge (experienced by some users). During this stage, acne, which tretinoin aims to treat, may worsen, resulting in various manifestations, such as occasional whiteheads to more severe breakouts.

If your skin is acne-prone, be prepared for increased acne during the first couple of weeks on tretinoin. This is the “purge” you hear about. The upper layers of your skin are getting sloughed off, bringing underground acne infections to the surface. It should go away soon.

But, if you’ve started tretinoin for anti-aging purposes and don’t usually have acne, you shouldn’t experience purging. Tretinoin brings “brewing” pimples to the surface. If nothing is brewing, there’s nothing to purge.

Please read our Guide on Tretinoin Purging to distinguish between breaking out from irritation and tretinoin purging.

Tretinoin Peeling

One of the biggest culprits of the retinoid “uglies” is dry, flaky skin. As your cell turnover rate increases, expect to see flakes, flakes, flakes for a little bit. It’s normal, and your skin will look fresh and glowy when you’re through with it.

In the meantime, you can eliminate flakes with a mild (I said MILD!) physical exfoliant.

Some good options: a konjac sponge or a gentle exfoliating powder. Use sparingly (I did a quick scrub once a week) and gently slough flakes away without irritating your sensitized skin.

Tretinoin Irritation

When the dose and the concentration of tretinoin are low, such irritation tends to be mild. But, if irritation develops, it could be a sign that you’ve damaged your skin barrier, and you need to stop treatment and take care of your skin barrier.

The most common side effects are:

• irritation;
• erythema;
• redness;
• sun sensitivity (retinoids should be applied at night).

Minor side effects of the drug are usually temporary and can be treated with regular over-the-counter skin care products like facial moisturizer. You may use Aquaphor or Vaseline if irritation occurs at the corners of the mouth or eyes.

After restarting with tretinoin:

• minimize the dose – restart with smaller amounts of cream;
• use it once every 2-3 days;
• minimize the strength – use low-strength tretinoin until your skin is accustomed to the medication’s effects;
• hydrate more
• moisturize more

Tolerance usually improves with continued use in 3-4 weeks. Then you can use tretinoin nightly.

Tretinoin and Sunscreen

Sunscreen is a MUST with tretinoin. If you start tretinoin, this is non-negotiable. I probably don’t have to re-iterate, but tanning is also out of the question.

You must commit to using sunscreen every day. Yes, even if it’s winter, even if you have dark skin or don’t enjoy it. Make-up SPF is not enough.

If you can’t commit to wearing sunscreen daily, tretinoin is not for you.

Tretinoin and Actives

When you’re first starting tretinoin, to avoid more irritation, stop all other actives. Morning AND night.

Unless stated otherwise by your medical provider, stop other actives at least one week before starting tretinoin. That means no:

• BHA;
• AHA;
• benzoyl peroxide;
• Vitamin C. 

You’re the expert on your type of skin and will have to decide what works for you, but please, start slow and be very gentle.

Once you’ve been using tretinoin for 6+ months, you can add these back in as needed.

Hair Removal on Tretinoin

Above all, don’t wax hair off skin treated with tretinoin. It can tear off part of your skin. It is terrible, gross, and painful, and please don’t wax tretinoin-treated skin. I’ve done it. I’m trying to forget it.

Opt for plucking, shaving, or threading instead.

Skin treated with tretinoin may become sensitive to procedures such as peels, waxing, laser, or microdermabrasion. Stop tretinoin for at least 2-3 days before receiving facial treatments. Please inform your aesthetician of your use of tretinoin before receiving these treatments.

Final Thoughts

Remember, your doctor’s instructions trump everything you read on the internet. He or she is best suited to advise you on your skincare regime.

Tretinoin is considered the gold standard in anti-aging technology. New, promising, exciting stuff is always coming out, but the big challenge for these new ingredients is, can they measure up to retinoids? The answer is usually no. Tretinoin works. And it’s affordable, especially with health insurance.

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