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Last updated August 27, 2020. 6 minute read

Should I use tretinoin every night? What's best for my skin?

A number of strengths and formulations of tretinoin are available. A dermatologist or other healthcare professional who prescribes tretinoin will work with you to figure out which is best considering your particular skin type, as well as determine how often to apply the medicine for anti-acne, anti-wrinkle, or other purposes.

Written by Andrea Peirce
Reviewed by Mike Bohl, MD, MPH

What is tretinoin? 

Tretinoin (retinoic acid) is a derivative of vitamin A and part of a group of commonly used medicines called retinoids. One common brand name is Retin-A. It’s used as a powerful anti-acne and anti-aging medicine when applied to the skin. An oral form of tretinoin is also used to treat a type of leukemia called acute promyelocytic leukemia.

Vitals

  • Tretinoin is a powerful retinoid medicine that’s only available by prescription.
  • It’s used topically to treat acne and signs of skin aging, such as wrinkles.
  • It’s okay to use tretinoin every night, but, especially at first, you may not want to because side effects can be intense.
  • To avoid extreme skin irritation, redness, and other side effects, it’s important to only use tretinoin as prescribed.
  • To minimize side effects, put moisturizer on just before and after applying tretinoin.

You can only get tretinoin with a prescription because it’s so strong and can cause serious side effects. Part of this medicine’s power is that it starts working on the skin immediately after you put it on. In contrast, non-prescription (over-the-counter, OTC) “retinol” products are weaker and have to go through a conversion step after being applied to the skin.

Tretinoin first started being used for skin conditions in the 1960s. It helps skin conditions by increasing cellular turnover of the skin. It quickly permeates skin layers and directs cell behavior, such as what job certain cells should do, how fast skin cells should grow, and when the cells should die.

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A number of strengths and formulations of tretinoin are available. A dermatologist or other healthcare professional who prescribes tretinoin will work with you to figure out which is best considering your particular skin type, as well as determine how often to apply the medicine for anti-acne, anti-wrinkle, or other purposes.

Benefits of tretinoin

The overall effect of regular use of tretinoin can be dramatic when it comes to a number of skin issues, but to get it to work for you—and avoid severe, unwanted reactions—follow directions from your healthcare provider carefully.

Benefits of tretinoin include:

Anti-aging effects:

Tretinoin’s anti-aging actions include diminishing fine lines and wrinkles and making skin smoother—the appearance of healthy skin. It does this in many ways, including shoring up the protective action of the skin’s outer layer and encouraging the growth of keratinocytes, which are the proteins that make up our skin, nails, and hair (Babamiri, 2010). 

Tretinoin also helps to keep skin plump and bright by protecting and ultimately boosting collagen production and skin elasticity (Zasada, 2019). A standard treatment dose for removing fine wrinkles is 0.05% tretinoin cream every night, to produce a visible effect in 12 months.

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Anti-acne properties:

Tretinoin works for acne by helping to keep skin pores unblocked. Many studies over the years have shown that it is effective for inflammatory as well as noninflammatory acne. It lessens the stickiness of cells that can clog pores and lead to blackheads, whiteheads, and zits.

Tretinoin also minimizes the size of pores and has anti-inflammatory effects (Leyden, 2017). It also controls the amount of oily sebum produced by the skin’s sebaceous glands (Zasada, 2019).

Decreases hyperpigmentation:

Tretinoin can decrease hyperpigmentation—areas of darkened skin—by accelerating the turnover of skin cells in the area. It can also speed up the clearance of skin discoloration after acne.

Should I use tretinoin every night? 

Yes, you can use tretinoin every night, but you may not want to at first—and some people may never want to. 

Tretinoin can cause skin irritation and peeling, especially when you first start using it. To combat this, it’s often recommended to start slowly—using tretinoin every third night, then every other night, then nightly as your skin tolerates. 

Exactly how quickly you ramp up depends on how you’re tolerating the medication. Your healthcare provider can help you determine what dosing regimen is best for you.

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How to use tretinoin:

Tretinoin is an ingredient in many skincare products, from gels to ointments and creams. The goal with this medicine (for any skin issue) is to strike a good balance between its good and negative effects. In fact, there’s an ongoing debate over prescribing tretinoin formulas with lower concentrations of tretinoin for longer periods of time versus formulas with higher tretinoin concentrations for shorter periods of time—called “rapid retinisation” (Gilman, 2016).

Your healthcare provider will give you guidance and take into consideration factors such as the type of skin you have (oily or dry, for example) and the sensitivity of your skin when writing a prescription for you. They will also tell you whether you should use tretinoin every night or start out by putting it on every other night—or wait even longer intervals.

The American Academy of Dermatology, the NIH’s National Library of Medicine, and other sources recommend doing the following when treating acne with tretinoin:

  •  Be gentle when washing your face. Use a gentle soap or cleanser that doesn’t contain drying ingredients such as alcohol, toners, or exfoliants, which can make acne look worse.
  • Wash with lukewarm water.
  • Put on a thin layer of tretinoin 20–30 minutes after you dry your face.
  • Use just the pea-sized (or other amount) of retinoid your healthcare provider recommended. Applying more won’t help speed things along and may irritate your skin more than necessary.
  • To apply cream or gel, dab a bit into the chin, forehead, and cheeks, and gently spread the product over the whole area. Spread the medicine away from the corners of your mouth, eyes, and nose.
  • To lessen skin irritation with tretinoin, put moisturizer on just after applying the medicine. At night, apply a thick moisturizing cream, preferably one containing natural fats called ceramides.
  • In the morning, use a moisturizer containing SPF 15 or higher. 
  •  Be patient; it will likely be 8–12 weeks before you notice major changes—as your deeper layers of skin are turning over.

Side effects of tretinoin

Tretinoin can cause serious effects, including intense irritation, redness, burning sensation, itching, dryness, and skin flaking. Because these reactions can be especially intense when you first start tretinoin or increase the concentration of tretinoin, you can manage them in part by going slowly and letting your skin adjust to tretinoin over time. 

Over days and weeks of use, your skin will build a level of tolerance to tretinoin. But in the meantime, talk to your healthcare provider for help in adjusting the concentration of tretinoin you’re using or applying it less often for a while. Tretinoin use is not safe during pregnancy and has been associated with birth defects. 

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Things to consider when using tretinoin

  • Apply tretinoin at night; sunlight deactivates the key medicinal effects.
  • Stay out of the sun: Ultraviolet (UV) light not only lessens the power of tretinoin but can make your skin more sensitive and easy to burn. It’s fine to keep using tretinoin in the sunny summer months. Just shield yourself with shade and sunblock. In fact, use sunblock, shade, and sun-protective clothing as much as you can 365 days of the year, even on non-sunny days.
  • Tretinoin can interact in unwanted ways with other skincare ingredients. Stay away from products that tend to dry out your skin while taking tretinoin. Avoid products containing spices, sulfur, lime, resorcinol, astringents, and salicylic acid (National Library of Medicine, 2020).
  • Protect your face from intense wind or cold with a scarf or other face-covering; tretinoin can make you extra sensitive to weather extremes.