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Last updated March 11, 2020. 5 minute read

Tretinoin: what is it and what skin conditions can it treat?

Tretinoin is a member of the drug family known as retinoids. The retinoid family includes vitamin A (retinol) and all of the drugs that are derived (or made from) vitamin A (tretinoin, retinoic acid, etc.). Retinoids play an essential role in many of your body’s processes, including reproduction, growth, inflammation, vision, and skin health. Dermatologists have used tretinoin for various skin conditions since the 1960s, including acne, skin discoloration, fine wrinkles, and sun-damaged skin.

Dr Chimene Richa Md Written by Dr. Chimene Richa, MD
Reviewed by Dr. Mike Bohl, MD, MPH

Tretinoin is a member of the drug family known as retinoids. The retinoid family includes vitamin A (retinol) and all of the drugs that are derived (or made from) vitamin A (tretinoin, retinoic acid, etc.). Retinoids play an essential role in many of your body’s processes, including reproduction, growth, inflammation, vision, and skin health (Mukherjee, 2006). Dermatologists have used tretinoin for various skin conditions since the 1960s, including acne, skin discoloration, fine wrinkles, and sun-damaged skin.

Vitals

  • Tretinoin (brand name Retin-A) is part of the topical retinoid drug family, which includes vitamin A (retinol) and all of the drugs derived from vitamin A.
  • Tretinoin can help treat acne, sun-damaged skin, fine wrinkles, and discoloration.
  • The most common side effects of tretinoin include skin dryness, redness, burning, stinging, peeling, and increased sun sensitivity.
  • When using tretinoin, be sure to wear protective clothing when in the sun and apply sunscreen with an SPF of at least 30.

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. 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.

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Benefits of tretinoin

Tretinoin can help improve several skin conditions, including acne, sun-damaged skin, fine wrinkles, and skin discoloration.

Acne treatment

Tretinoin plays a major role in the treatment of 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 (Leyden, 2017). Acne starts when one of your skin pores gets clogged with oil and dead skin cells. This clogged pore creates an environment for the skin bacteria Propionibacterium acnes to multiply, leading to an inflammatory reaction and the characteristic “zit” or pimple (Leyden, 2017). Tretinoin helps in the treatment of acne by unclogging pores, decreasing oil production, and reducing the inflammatory response. According to the American Academy of Dermatology (AAD), retinoids like tretinoin are the mainstay of topical therapy for acne because they help resolve the acne eruptions as well as help you maintain clear skin (Zaenglein, 2016).

Photoaging (sun-damaged skin)

Photoaging 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 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 (Mukherjee, 2006). Tretinoin helps with photoaging by affecting how the skin cells respond to damaging ultraviolet (UV) rays. It blocks the collagen and cell protein breakdown that is usually triggered by UV light (Mukherjee, 2006). Several studies have shown that tretinoin can help improve the elasticity (tightness) and the appearance of sun-damaged skin (Mukherjee, 2006). Of course, if you are trying to improved 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.

Fine lines and wrinkles

Loss of collagen, sun damage, and years of smiling and frowning can cause fine 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 (Mukherjee, 2006).

Hyperpigmentation

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 of something triggering their skin cells to make even more melanin than usual (AAD, n.d.). This discoloration, called hyperpigmentation, may appear after skin inflammation (like from a pimple, a cut, or eczema) heals; this is called post-inflammatory hyperpigmentation (PIH). 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. Scientists don’t know why, but they believe that tretinoin decreases the amount of melanin in your skin cells (Halder, 2004). When used for discoloration, tretinoin is usually combined with other skin-lightening products, sometimes in the form of a chemical peel (Ghersetich, 2010).

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 reaction of the skin 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).

Potential side effects of tretinoin

The side effects of topical tretinoin are most noticeable during the early stages of treatment and include the following (Mukherjee, 2006):

  • Itching
  • Burning or stinging sensation
  • Dry skin
  • Skin redness
  • Peeling
  • 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 30 SPF) to your face, wear protective clothing, and avoid excessive sun exposure. Lastly, if you are pregnant or breastfeeding, you should stop using topical tretinoin; while there have been no cases of tretinoin causing harm to the fetus, other retinoids (such as isotretinoin) can cause fetal problems (Mukherjee, 2006). According to the U.S. Food and Drug Administration (FDA), tretinoin is pregnancy category C—this means that there are no adequate and well-controlled studies in pregnant women and it should only be used during pregnancy if the potential benefit to the mother outweighs the potential risk to the fetus (FDA, 2014). In most cases, the general recommendation is to avoid using tretinoin if you are pregnant or breastfeeding.

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.