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Reviewed by Dr Yasmin Aghajan, MD
Information last reviewed 07/02/19
Tretinoin is a topical treatment predominantly used to relieve acne by inhibiting the growth and severity of acne pimples as well as accelerating the time it takes for existing pimples to heal.
Derived from vitamin A, Tretinoin belongs to a class of medications known as retinoids which are also proven to treat other skin conditions including fine lines and wrinkles, dark spots and rough skin resulting from sun damage. Available in both gel and cream form, its brand names include Retin-A, Rejuva-A, Stieva-A and Tretin-X.
Tretinoin essentially works by increasing the rate at which the skin regenerates itself. It has the unique ability to speed up the skin’s natural exfoliation process by shedding dead skin cells which, in turn, increases the turnover of healthy cells, promotes new collagen and slows the breakdown of existing collagen.
As the shedding process is more difficult in acne-prone skin, this treatment helps to keep skin pores clear. It effectively eliminates comedonal acne caused by blackheads, whiteheads and bumpy skin by forcing out trapped oil, bacteria and dirt that clog skin follicles and cause inflammation.
Tretinoin is available in two forms: gel and cream, which come in varying strengths. The most suitable medication for you will depend on the sensitivity and severity of the skin condition as well as your reaction to the treatment. Your doctor can alter your dosage and treatment if the problem persists or gets worse.
The active ingredient in Tretinoin gel is tretinoin, a form of retinoic acid, also known as vitamin A acid. Tretinoin gel is available in 5 distinct strengths depending on what proportion of the gel is the active ingredient: 0.01%, 0.03%, 0.04%, 0.05% and 0.10% by weight.
The inactive ingredients in Tretinoin are 90% butylated hydroxytoluene, hydroxypropyl cellulose and alcohol.
The active ingredient in Tretinoin cream is tretinoin, a form of retinoic acid, also known as vitamin A acid. Tretinoin cream is available in 3 distinct strengths depending on what proportion of the cream is the active ingredient: 0.03%, 0.05% and 0.10% by weight.
The inactive ingredients in Tretinoin cream are stearic acid, isopropyl myristate, polyoxyl 40 stearate, stearyl alcohol, xanthan gum, sorbic acid, butylated hydroxytoluene and purified water.
If you have a serious allergic reaction to this cream/gel, you should get immediate medical help to treat your symptoms. While an allergic reaction to it is unlikely to occur, the symptoms to look out for are facial swelling, hives or a rash, dizziness and trouble breathing. Both the gel and cream contain alcohol which can initially cause irritation or burning but this sensation should fade after the first couple or uses.
The amount you use depends on your doctor’s instructions and is determined by:
The following information covers the average dose of the medicine. Individual doses recommended by your doctor should not be changed unless otherwise instructed.
Make sure to use just a pea-sized amount of Tretinoin and use fingertips to apply in a thin layer over clean, dry skin - preferably at night. The medication needs to be used regularly in order to achieve desired results, however, using the product excessively or too frequently can increase redness, swelling and discomfort.
Application can be reduced to every other night if you find it too harsh on the skin. As the skin naturally adjusts to the treatment, its application can then be increased accordingly. Refer to the label directions, information leaflet or your doctor if you have any questions.
In case of a missed dose, apply the medicine as soon as you remember. If you do not remember until the next day, it is best to wait until the next scheduled dose.
Adopting a protective skin care regimen whilst using Tretinoin is essential in achieving optimum visible results. Be sure to thoroughly cleanse the skin both morning and night, preferably exfoliating with a mild facial scrub or washcloth once a day to get rid of any noticeable flaking as a result of the medication. It is important to refrain from using any drying or abrasive skin products alongside Tretinoin as this will only further aggravate sensitive skin.
Moisturising the skin is essential to reduce the appearance of flaky skin and combat the drying effect of the medicine. In addition, applying an effective SPF on a daily basis is advised alongside avoiding prolonged periods of time in the sun. Due to increased sensitivity, the skin becomes more susceptible to sunburn and excessive sun exposure can also cause achieved results to rapidly fade.
It can take anywhere from 12 weeks up to 6 months or more to see any visible results in the improvement of acne. Usually, in the first 2 to 4 weeks of application skin conditions may appear to have worsened in the form of more severe acne, increased redness, flakiness and irritation.
This period is where the skin is essentially purging the pimple-forming substances from the deeper layers of the dermis. Despite this, it is important to persevere with the treatment in order to gain its complete benefits.
Once the purging period subsides, noticeable improvement in the overall condition of the skin can be detected fairly quickly. However, if the irritation becomes too severe or if there are no visible improvements in the condition after 8 to 12 weeks then you must consult your doctor who may prescribe an alternative treatment or dosage.
Tretinoin is intended as a long-term treatment for acne by removing existing pimples as well as proactively working to prevent further breakouts. The amount of time it takes for the treatment to take effect is influenced by a number of factors including: severity of the acne, strength of the cream, consistency of treatment, skin sensitivity, level of sun exposure and use of other skincare products. It is recommended that you persist with treatment for around 1 year to attain maximum results.
Many of the common side effects associated with the topical use of Tretinoin include:
Such symptoms may occur during the first 2 to 4 weeks of application and should subside with continued use as well as through moisturising daily.
You must inform your doctor if side-effects persist, worsen and/or become unbearable. If you notice any other effects not listed above, it is important you seek medical treatment immediately.
Always disclose the following information to your doctor prior to using Tretinoin:
It is important to avoid any unnecessary skin exposure to sunlight, wind and cold weather as the skin is particularly prone to sunburn, dryness and irritation during use. Using SPF of at least 15 along with protective clothing will ensure maximum protection for your skin.
Take care not to apply medication on broken skin or near the eyes, nose or mouth and refrain from washing the skin for at least 1 hour after use.
Tretinoin must always be used in accordance with your doctor’s instructions. The recommended dosage is based on your health, medical history and severity of the condition and should not be changed without consulting your healthcare professional.
You must seek emergency medical assistance if you suffer an allergic reaction from using Tretinoin. Symptoms indicative of a skin reaction include:
Unless informed otherwise by your doctor, it is especially important to avoid using any other topical medications and/or any medicated or abrasive soaps and cleansers whilst using Tretinoin.
Soaps and cosmetic products that have a strong drying effect, high concentration of alcohol, astringents, spices or lime should be used with caution due to possible interactions with Tretinoin.
Particular caution must also be exercised in using formulations containing sulfur, resorcinol or salicylic acid. It is also advised that the patient’s skin is rested until the effects of such ingredients subside before using Tretinoin.
Acne is the most common skin condition in the United States, affecting up to 50 million Americans annually. Approximately 85 percent of people between the ages of 12 and 24 experience at least minor acne.
Its ability to accelerate the skins cell turnover rate and significantly promote the production of collagen is why Tretinoin is widely considered by healthcare professionals as the prevailing solution in the correction, improvement and prevention of acne as well as its considerable anti-aging effects.
The main difference between the two agents is the texture. The gel form contains more alcohol and thus produces a more drying effect on the skin. For this reason, it is intended more for oily, acne-prone skin types. It is advised to use a hydrating moisturiser around 20 minutes after applying the gel to offset any dryness.
The cream-based solution is gentler and better suited for dry and aging skin. It is also recommended for use among patients during the winter months where weather conditions can be harsh for the skin.
Always consult with a doctor or certified dermatologist before deciding which treatment to use.
Tretinoin is one of the most widely-used and effective treatment options for acne currently available on the market. In spite of this, the treatment is not necessarily the best choice for everyone and it does come with side effects; some can be fairly common while others are reported rare. For this reason, it may be useful to consider other treatment options in the event of an adverse reaction or undesired effect.
While both treatments are a derivative of vitamin A which effectively stimulates skin renewal, Tretinoin is proven to be considerably more aggressive.
Retinol needs to be converted into retinoic acid by enzymes in the body before it can directly affect skin cells whereas Tretinoin does not need to go through such conversion as it is already acid.
Retinol is available to purchase over the counter at lower strengths and is deemed more soothing than its prescription counterpart, primarily owing to its moisturising and soothing ingredients.
Although Retinol contains fewer side-effects, ultimately Tretinoin appears to provide a better shot at combating acne and other skin-related issues.
The components of Tretinoin essentially work by affecting the growth of skin cells while Clindamycin, in contrast, is an antibiotic that prevents the growth of acne-forming bacteria. Oftentimes, the two treatments are used in conjunction to efficiently treat severe acne.
Many of the side-effects are similar to that of Tretinoin including redness, itching, burning and worsening of acne in addition to the potential risk of diarrhea should the medication enter into the bloodstream.
Both Adapalene and Tretinoin have been proven to produce dramatic reductions, marked improvements and, in some cases, total clearance of acne.
Due to the severity of skin irritation produced by Tretinoin, many patients discontinue use before the treatment can take full effect. Adapalene offers comparable efficacy to Tretinoin while causing considerably milder side-effects and thus represents a good alternative in the treatment of acne.
In addition, there have been no reported problems in relation to Adapelene use and pregnancy-related complications while Tretinoin is considered unsafe for pregnant or nursing women. It is still important to consult with your doctor before using Adapalene whilst pregnant or breastfeeding.
In the United States, Tretinoin is only available via prescription and cannot be bought over the counter. Medzino is able to offer first and repeat prescriptions for those who are interested in using Tretinoin as an acne treatment. Through our online consultation service, our doctors will assess your skin and subsequently advise you on the most suitable treatment and dosage.
Tretinoin is prescribed as a long-term treatment intended for consistent use over several months or years until the desired results are achieved. Studies show that it is safe and effective to use Tretinoin long-term for those with moderate to severe photo-damage. No negative effects have been found from long-term Tretinoin use over the course of 2 to 4 years.
Some brands of topical Tretinoin are not approved for use in anyone under the age of 18. Many doctors and dermatologists avoid prescribing retinoids for preteen acne due to the lack of FDA-approved indication in this young age group. The majority of topical retinoids approved for acne treatment are indicated only down to 12 years of age, with the exception of Atralin gel (0.05%) which is approved in children as young as 10.
It is best to use products that are hypoallergenic, dermatologically tested and non-comedogenic alongside Tretinoin. This is particularly important to prevent further inflammation and irritation as well as increase moisture in the skin. Ensure that products are fragrance-free as well as free from benzoyl peroxide or alcohol as these will exacerbate dry skin conditions. Ingredients such as the vitamins niacinamide, panthenol and tocopheryl acetate can complement Tretinoin and provide improved results from the treatment.
The best time to apply Tretinoin is at night, shortly before bedtime to attain maximum absorption by the skin without any risk of wind, sunlight or dust particles coming into contact with skin. If your doctor recommends using Tretinoin at a different time, it is best to stick with their instructions.
Patience and perseverance is key when it comes to treating acne with Tretinoin. In the majority of cases it takes at least 6 to 8 months of consistent use to achieve noticeable results – once the ‘purging’ period subsides. If you are still not satisfied with your results, it is best to consult with your doctor or dermatologist to discuss treatment options that best suit your needs.
Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.
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