The Definitive Guide to Tretinoin

The skincare universe is full of various products, each promise to deliver major results. One stand out product, that is truly an all-rounder and backed by a lot of research over the decades, is Tretinoin (or Retin-A). This guide aims to provide detailed information on Tretinoin, its uses, benefits, risks and how to properly add it to your skincare routine.

What is Tretinoin or Retin-A?

Tretinoin, also known as Retin-A, is a form of vitamin A. It is a topical treatment that comes in the form of a gel or cream. Tretinoin skincare comes in various strengths. These are most commonly 0.025%, 0.05% and 0.1%. Tretinoin is known for its powerful ability to improve the skin’s appearance. It does this by speeding up skin cell turnover and increases collagen production. It also boosts new blood vessel growth which improves blood flow to the skin.

The journey of Retin-A in skincare began in the late 1960s. This was when the FDA first approved Tretinoin to treat acne. Its role in treating signs of skin ageing was discovered later, in the 1980s, following numerous studies. Since then, it has become a sought after treatment for various skin conditions. Clinical studies have proved Tretinoin’s ability to treat acne, hyperpigmentation and signs of ageing.

What is Tretinoin Used For?

Tretinoin is known for its ability to treat and prevent acne by unclogging pores and reducing inflammation. However, its uses extend beyond just acne prone skin. It can also reduce signs of ageing, like fine lines and wrinkles, by exfoliating the skin and promoting collagen production. Moreover, it can improve skin texture and fade hyperpigmentation, sun spots and melasma. This can make it a potent product in any skincare routine.

Tretinoin Cream vs Tretinoin Gel: What’s the Difference?

There are two commonly used preparations of Tretinoin; cream and gel. Whilst both versions of Tretinoin offer the same benefits, they cater to different skin types. Most people get on well with the cream. However, it is especially better for those with sensitive or dry skin because of its cream base. This can provide more moisture and reduce irritation. The gel version, which has an alcohol base, might be better for individuals with very oily skin or who have allergies to any of the chemicals in the cream formula.

Generic Retin-A vs Branded Tretinoin

Generic Retin-A is effective but brand name versions like Obagi Tretinoin cream or gel are generally more popular. This is mainly because they have name recognition but also a long-standing reputation. Branded products may also offer advanced formulas that make it more stable and better able to penetrate the skin. This can lead to fewer side effects but the results are the same as the active ingredient and strength is the same across all brands and generics.

Retinoid Cream Off-the-Shelf Preparations

Tretinoin is usually best used as a stand alone ingredient such as that offered by generic preparations of Retin-A or brands like Obagi Tretinoin. This allows you to assess your skin’s response to it and reduces risk of irritation that can be caused by other products. It is also easier to adjust the strength of Tretinoin to your skin’s response. This is not possible in compounded products which tend to have a limited range of strengths. That being said, Retin-A is sometimes mixed with other active ingredients to target specific skin conditions. Below is a list of the most commonly used retinoid cream preparations and how they compare with just using Tretinoin on its own.

Tri-Luma Cream

Tri-Luma contains tretinoin 0.05%, hydroquinone 4% and fluocinolone acetonide 0.01%. It is used to treat melasma hyperpigmentation. The combination of tretinoin (for skin cell turnover), hydroquinone (a skin-lightening agent) and fluocinolone acetonide (a mild corticosteroid to reduce inflammation) makes it effective for treating hyperpigmentation. However, there are a number of possible side effects. These include skin redness, peeling, burning, dryness, and itching. Overuse of hydroquinone may also result in a condition known as ochronosis. This is when prolonged use can cause skin to darken whilst corticosteroid overuse can lead to thin skin.

Ziana/Veltin or Treclin

Ziana or Veltin (tretinoin 0.025% and clindamycin 1.2%) and Treclin (tretinoin 0.025% and clindamycin 1%) are mainly used for treating acne. Clindamycin is an antibiotic that fights acne causing bacteria. It is mixed with tretinoin which unclogs pores and reduces inflammation. Some people may experience dryness, redness, burning, or itching. There is also a risk of getting antibiotic resistance with the long-term use of clindamycin.

Solage

Solage (tretinoin 0.01% and mequinol 2%) is used to treat solar lentigines, also known as age spots or liver spots. The combined effect of mequinol (a skin-lightening agent) and tretinoin makes it effective to reduce these forms of hyperpigmentation. Side effects may include skin burning, itching, dryness and redness. It can also cause the skin to be more sensitive to the sun.

In the UK, Tretinoin is usually used as a stand alone product. The above commercial brands (except for Treclin) are not available due to EU and UK restrictions and regulations. However, combinations with other medicines can be prescribed by a dermatologist with experience in using compound medications. They will normally do this if they feel that using single therapy is not working. Generally, they will send the prescription to a specialist compounding pharmacy who will make the cream.

Compatible Skincare Products

There are a number of skincare products that boost the effects of Tretinoin. Some of these can be found in compounded formulations. Depending on your needs, your prescriber will determine whether it is best to use them in combination or as single active ingredient products.

Tretinoin and Hydroquinone

Tretinoin and Hydroquinone work well together to treat hyperpigmentation and melasma. They fade dark patches of pigmentation and provide a more even skin tone. This duo can be found as a compounded product or as separate products. We often use both Tretinoin and Hydroquinone as part of our anti-ageing, melasma and hyperpigmentation treatments to help brighten the skin and treat fine lines as well as wrinkles. This duo is also great for people with acne, acne scars and post inflammatory hyperpigmentation.

Tretinoin and Benzoyl Peroxide

This combination is effective for treating acne. Benzoyl peroxide kills acne-causing bacteria whilst Tretinoin reduces inflammation, smooths skin and unclogs pores. However, these two ingredients can sometimes reduce the activity of each other. As such, they do not usually come in a single formulation like Epiduo (Adapalene and Benzoyl Peroxide). We normally recommend using them at different times of the day (Retin-A at night and Benzoyl Peroxide in the morning) or leaving a gap between using them.

Tretinoin and Niacinamide

Niacinamide is a form of Vitamin B3 that offers numerous skin benefits, including improved skin barrier function, reduced inflammation and reduced hyperpigmentation. Combining Tretinoin with niacinamide can provide a powerful blend to target acne, ageing and hyperpigmentation while supporting skin health. You can find this as a compounded formulation but for more control we recommend using them as separate products.

Tretinoin and Azelaic Acid

The combination of tretinoin and azelaic acid is highly effective at treating wrinkles, acne and hyperpigmentation. Azelaic acid reduces inflammation, kills the bacteria that may cause acne and can lighten skin pigmentation. Tretinoin can help clear acne by exfoliating at the cell level to prevent clogging of pores. Both compliment each other with regards to reducing the appearance of fine lines and wrinkles. This duo are available as a compounded formula or used as separate products for greater control. Unfortunately, both tretinoin and azelaic acid can cause skin irritation. Hence, they must be used properly under the guidance of a doctor or other skincare professional. They may advise starting with a lower concentration or less regular application and slowly building up as your skin adjusts. Furthermore, it’s vital to add a broad-spectrum sunscreen into your routine. Both these skincare products can make your skin more sensitive to the sun.

When Will I Start Seeing Results from Using Tretinoin?

Like any topical treatment, Tretinoin doesn’t provide overnight results. It’s a product that requires patience and consistency. Typically, users might start seeing initial gains, such as reduced acne or hyperpigmentation within 6-8 weeks. For more significant changes like a reduction in fine lines and better skin texture, it could take 3-6 months. It’s important to use it consistently for optimal results.

How to Use Tretinoin: A Step-by-Step Guide

  1. Cleanse Your Skin: Use a gentle hydrating cleanser to remove dirt and makeup then wash and dry your skin.
  2. Apply Tretinoin: Use a pea-sized amount for your entire face. Dab it on your forehead, cheeks, nose, and chin, then massage it evenly over the skin.
  3. Apply Moisturiser: To reduce dryness and peeling, apply a hydrating and emolliating moisturiser after the Tretinoin has fully absorbed.
  4. Use Sunscreen in the Morning: Retinoids can make your skin more sensitive to the sun. Always wear a broad spectrum sunscreen during the day even when you’re indoors or it’s not sunny!

Remember to start slow to avoid irritation. Typically, most people start using Tretinoin 2-3 times a week, and increase frequency as their skin gets used to it.

Side Effects & Skin Purging

Tretinoin is powerful so when you get start using it it can sometimes lead to ‘purging’. This is a temporary increase in acne breakouts or skin irritation as the skin adapts to the treatment. This process is normal and often goes away within 4-6 weeks. Your doctor will likely adjust your skincare protocol during this period to speed up getting over the skin purging period.

Other side effects can include redness, peeling and increased sensitivity to the sun. These can be managed by using a gentle cleanser, moisturiser and broad-spectrum sunscreen. You can also of course suffer an allergic reaction to Tretinoin although this is rare. Always remember to perform a patch test before using any new skincare product. Contact your doctor immediately if you suspect you have an allergy or any other side effects.

Precautions and Contraindications for Retinoid Use

While Tretinoin can provide significant skin benefits, it’s not suitable for everyone. Certain individuals and circumstances may make Tretinoin use inappropriate or require extra caution.

Who Should Not Use Tretinoin

  • Pregnancy and Breastfeeding: Due to potential risks to the fetus, retinoids are not recommended for pregnant women or those who are planning to become pregnant. Women who are breast feeding should also avoid Tretinoin, as it is unclear whether it could pass into breast milk.
  • Sensitive Skin or Eczema: Individuals with sensitive skin, eczema, or rosacea may find retinoids too irritating. Always consult with a medical professional before starting Tretinoin if you have these conditions.
  • Sunburn or Open Wounds: Do not apply Tretinoin to sun burnt skin, open wounds or areas of the skin with a flare up of eczema.

Interactions With Medications

Certain medications may react badly with Tretinoin. If you are taking or using any of the following, it’s important to inform your medical provider before using:

  • Tetracyclines such as Lymecycline: Using tretinoin at the same time as oral tetracycline antibiotics may increase the risk of raised intracranial pressure known as pseudotumor cerebri. Whilst rare this is a serious condition.
  • Topical Medications with Resorcinol, Sulfur, or Salicylic Acid: These ingredients may cause skin dryness and irritation when used with Tretinoin.
  • Medications Increasing Sensitivity to Sunlight: Certain medications, including some antibiotics, can increase your skin’s sensitivity to sunlight, as can Tretinoin, making you more likely to get sunburn.
  • Hair Removal Treatments: Waxing, chemical hair removers, laser treatments, or other hair removal methods can irritate the skin and Tretinoin may worsen this reaction.

Remember, it’s crucial to be honest about all the medications, supplements and skincare products you’re currently using to your medical provider before starting Tretinoin or any other prescription treatment. They can help you determine the safest and most effective approach to adding Tretinoin into your skincare routine.

Tretinoin vs Other Retinoids

While Tretinoin is a type of retinoid, it’s important to distinguish it from others like Retinol or Adapalene. Tretinoin is a prescription strength retinoid, making it more potent and effective but also possibly more irritating than over-the-counter retinols or gentler prescription retinoids like Adapalene. Each retinoid is unique, and the choice between them should be based on your specific skin needs and tolerance.

Where to Get Tretinoin in the UK

In the UK, Tretinoin is a prescription only medication. You can get it from a dermatologist or an aesthetic doctor following a consultation if they believe it’s appropriate for your skin concerns and needs. These have in the past been available only through physical appointments. However, it is now possible to get Tretinoin online in the UK from a number of online skin care services which offer personalised skincare where appropriate such as our online skin clinic.

How We Can Help You 

Tretinoin is a potent and effective skincare ingredient with a variety of benefits. At City Skin Clinic we provide online consultations for personalised skin treatments with prescription strength skincare and use powerful ingredients such as Tretinoin where we deem it appropriate. We deliver skincare treatments to your home. Your doctor will then continue you to provide you with ongoing advice and after care to ensure that you get the most out of your treatment. Book your virtual appointment or use our online skin consultation form today to start your journey to great skin!

Frequently asked questions

Yes, Tretinoin is safe to use for most people. However, like any skincare product, it can cause side effects like redness, peeling, and increased sun sensitivity.

Yes, but you need to be careful about what you combine it with. Avoid using Tretinoin with products that can irritate your skin, like certain astringents, cleansers and cosmetics. Always consult with a skincare professional if you're unsure.

Tretinoin is classified as a category C drug, meaning its safety in pregnant women is unclear. The same applies to breastfeeding. If you're pregnant or plan to become pregnant, its best to avoid all Retinoids. Consult with your doctor for further advice.

Both Retinol and Tretinoin are retinoids, derivatives of vitamin A, and used in skincare for their powerful anti-ageing, hyperpigmentation fading and acne-fighting benefits. The primary difference lies in their strength and the way they are processed by the skin. Tretinoin, also known as Retin-A, is a prescription-strength retinoid, up to 20x more potent than Retinol and directly acts on the skin. On the other hand, Retinol, which is available over-the-counter, needs to be converted into Retinoic acid by the skin first to be effective. This makes it less potent but also less irritating.

This depends on your skin's tolerance. Tretinoin can initially cause dryness and irritation, so it's often recommended to start using it a few times a week and gradually increase to daily use. Always follow the instructions provided by your healthcare professional.

Yes, typically Tretinoin is applied all over the face, avoiding the sensitive areas like the corners of the mouth and eyes.

Ideally, you should apply Tretinoin to clean and dry skin. Once the Tretinoin has been absorbed into the skin, you can then apply moisturiser. This can help reduce the irritation tretinoin sometimes causes.

Yes, it's typically recommended to apply tretinoin in the evening and leave it on overnight for the best results if your skin is tolerating it.

Yes, it's advisable to cleanse your face in the morning to remove the tretinoin before applying your morning skincare products and sunscreen.

The skin on the neck is thinner and more sensitive, so it may not tolerate tretinoin well, causing irritation. However, if you want to address signs of ageing on your neck, you may benefit from using tretinoin there. To avoid irritation, start with a lower frequency on your neck and build up as your skin tolerates it. Always consult your healthcare provider first.

Tretinoin can help reduce fine lines and wrinkles around the eyes. However, the skin in this area is very delicate, so you need to be cautious. Some people find that applying a thin layer of moisturiser or vaseline in this area before the tretinoin helps to reduce irritation. Do not apply tretinoin to the eyelids or directly under the eyes unless instructed by your healthcare provider.

Sources

Authored by:

Dr Amel Ibrahim
Aesthetic Doctor & Medical Director
BSC (HONS) MBBS MRCS PHD
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611

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