Topical tretinoin is a powerhouse ingredient beloved by skincare aficionados of all stripes—its pore-clearing, collagen production-boosting benefits make it a great option for both anti-acne and anti-aging skincare.

What is tretinoin? 

Tretinoin—brand names Retin-A, Refissa, or Tretin-X—is the gold standard in prescription acne and anti-aging treatments (so if you’re searching for the best topical treatment for acne, fine lines, or wrinkles, look no further). Derived from vitamin A, tretinoin is a potent retinoid. It stimulates the growth of healthy new cells while helping to repair skin damage.¹ 

In 1971, the FDA approved tretinoin for acne. While using it for acne treatment, patients also saw an unexpected improvement in the overall condition of their skin.² In its gel or cream form, tretinoin’s strengths are its powerful ability to treat acne and signs of aging. If you want to address acne, firmness, texture, pigmentation changes (dark spots), or all of the above skin conditions, tretinoin might be right for you.

How does tretinoin help with acne?

Skin cells naturally turn over. Old ones die, and new ones replace them. Tretinoin helps clear out old dead skin cells more quickly and promotes their replacement with fresh ones. Acne can strike when your skin doesn’t efficiently sheds dead cells,³ leading to blocked pores, blackheads, whiteheads, cysts, and other types of acne. Tretinoin fights back in the following ways: 

• Boosts cell turnover

• Stabilizes the cell regeneration process

• Calms inflammation

• Diminishes dark spots (PIH from healed acne lesions)

• Unclogs pores

How does tretinoin treat signs of aging?

Many of the acne-fighting effects of tretinoin also improve signs of aging, but its ability to promote collagen production⁴ helps create that “glow” in aging skin—as well as improve other signs of aging. Tretinoin anti-aging benefits include: 

• Promotes collagen production

• Evens skin tone 

• Improves fine lines, wrinkles, and skin texture

• Reduces the appearance of dark spots

What’s the best way to apply tretinoin? 

You’ll want to apply a small amount of tretinoin over most of your face. If you’re using your prescription Curology formula with tretinoin, apply enough to cover your face and neck in a thin layer. Pair your tretinoin prescription with a good moisturizer for extra hydration. Here’s more information on how to adjust to tretinoin. 

Here are a few more tips to make sure adjusting to tretinoin goes smoothly: 

• Avoid sensitive areas of your face, including above your eyes and eyelids, nostrils, and lips. (In general, you can apply it under your eyes cautiously.)

• Decrease application to every other night (or less) if irritation occurs. You can start using it nightly later.

• Mix moisturizer with your tretinoin to slow absorption (equal parts, 50/50).  

Sunscreen application is super important, but if you’re using tretinoin, you’ll want to be extra vigilant. That’s because tretinoin may increase your skin’s sun sensitivity.⁵ This is typically mild (if noticed at all!), but be sure to apply sunscreen with SPF 30 or higher, re-apply every two hours of sun exposure, and cover up with sun-protective clothing. 

How long does it take for tretinoin to work?

It may take six to eight weeks to see noticeable tretinoin benefits when treating acne. For anti-aging results, you could see improvement in as little as a few weeks or as long as a year.⁶ Of course, this varies from person to person! 

You’ll know tretinoin is working if you notice an improvement in skin texture, hyperpigmentation/dark spots, and breakouts. And remember, people will still develop signs of aging while using tretinoin, but they tend to be milder and not occur as quickly as they would have without treatment.

Remember, it can take time for your skin to regenerate on a cellular level—you may need to go steady with tretinoin for the long haul. But your skin will stay happy and healthy with consistency, patience, and diligent sun protection. 

How strong should my tretinoin dosage be?

In short, there’s no simple answer to how potent your tretinoin dosage should be. Gels and creams range in strength—in many cases, they have a concentration between 0.01%-0.1% (although Curology providers can prescribe lower and even higher strengths!). For example, your provider may prescribe a tretinoin 0.02% cream to start. Though you may want to ramp up to the highest concentration possible right away, that’s usually not the best idea! Work with your dermatology provider to determine what’s right for your skin.

Because your skin needs time to adjust to tretinoin, it’s generally best to stick to the dose your skin tolerates best. Once you’re confident you can handle it, you can talk to your licensed dermatologist or dermatology provider about increasing your formula’s tretinoin concentration. 

So, while it’s true that stronger tretinoin may lead to more significant results, this isn’t the case if it’s causing dryness and skin irritation. A lower concentration is better in that situation. Keep in mind that everyone’s skin is unique. Your skin may benefit from a low dose of tretinoin cream and even thrive. 

What are the side effects of tretinoin? 

Tretinoin is powerful, but with great power comes great responsibility. It’s not unusual to experience these side effects⁷ when starting tretinoin or bumping up to a higher strength: 

• Increased skin sensitivity (potentially increased sensitivity to the sun!)

• Dry skin

• Redness

• Temporary irritation or peeling

When you first start on tretinoin, you might experience something called “purging.” Though it may look like tretinoin is making your skin worse, these temporary breakouts are actually a sign it’s working. 

Tretinoin increases your cell turnover rate—in other words, it speeds up the way your skin regenerates. As this process starts clearing out your pores, you might see some new pimples. Though we know that breakouts are never fun, stick with it—getting through those first six to eight weeks can pay off.

Keep in touch with your prescribing provider while adjusting to tretinoin; they can help you tweak your routine to help prevent side effects. No matter what treatment you choose, remember that acne won’t disappear overnight!

By the way, it’s not recommended that you use tretinoin if you’re pregnant or breastfeeding,⁸,⁹ so skip this topical and talk to your OBGYN about the safest skincare ingredients for you! 

Tretinoin and other skincare ingredients

How does tretinoin stack up compared to other retinoids like adapalene or retinol? And when it comes to the rest of your skincare, what are the dream team ingredients to pair with tretinoin, and what should you avoid at all costs? We’re here to help demystify this skincare ingredient with the facts. What’s the difference between tretinoin and retinol?

Tretinoin vs. retinol: What’s the difference?

One of the main differences between tretinoin and retinol is how quickly it works on your skin. Retinol needs to be converted by enzymes into a usable form before it can be used by your skin cells.¹⁰ Tretinoin, on the other hand, gets right to work because your skin can process it immediately. While they do have many similarities, these two ingredients are not the same: 

Retinol: 

• A derivative of vitamin A.

• Tends to work more slowly and not proven effective in treating acne.

• Tends to be easier on the skin—it’s milder and less irritating.

• Is available as a non-prescription, over-the-counter topical medication.

Tretinoin:

• A derivative of vitamin A.

• Tends to be more effective and work more quickly, and it’s proven in treating acne. 

• Is stronger than retinol—potentially up to 20 times (although more research is needed).

• Is only available with a prescription.

Adapalene vs. tretinoin: What’s the difference?

Adapalene and tretinoin are both topical retinoids that treat acne. While tretinoin treats acne and signs of aging, adapalene is only proven to treat acne. That said, some studies show that tretinoin is more effective in treating acne than adapalene.¹¹

Here are their differences: 

• Adapalene is only proven to treat acne. 

• Adapalene tends to be easier on the skin and may be less irritating. 

• Tretinoin treats acne and anti-aging concerns. 

• Tretinoin may be stronger but can be more irritating.

What ingredients can be used with tretinoin?

Your Curology provider may prescribe tretinoin alongside other active ingredients like azelaic acid, clindamycin, and tranexamic acid in your personalized formula, depending on your skin and skin goals.

Here are some other ingredients that can pair well with a tretinoin-focused skincare routine:

• Niacinamide. Like tret, niacinamide helps with hyperpigmentation and can reduce the appearance of fine lines and wrinkles.

• Vitamin C. Use tret at night and vitamin C in the morning—it can give you an extra boost against the damaging effects of UV rays. 

• Hyaluronic acid. This deep hydrator binds moisture to the skin to help it look brighter and plumper. 

What ingredients should you avoid when starting tretinoin? 

In general, you’ll want to skip any potentially pore-clogging or irritating ingredients, whether you’re using tretinoin or not. But if you are using tretinoin, you may want to tread lightly when building the rest of your skincare routine. Your skin may be more prone to dryness and irritation, so it’s often best to keep things simple. 

Once you've adjusted to tretinoin, you may be able to tolerate ingredients like salicylic acid without issue. And benzoyl peroxide can be added to your routine if used properly—talk to your provider for specific instructions! 

Here’s what to consider when using your tretinoin formula: 

• Benzoyl peroxide. If you use a leave-on benzoyl peroxide treatment, use it in the morning and your tretinoin at night. Using a rinse-off benzoyl peroxide cleanser should be fine after you’ve adjusted to tretinoin. 

• Certain types of facial hair removal (specifically waxing and sugaring). You may want to stop using tretinoin for at least five to seven days before getting these procedures—talk to your healthcare provider for the best medical advice. 

• Exfoliants like AHAs (like glycolic acid), BHAs (like salicylic acid), and physical varieties (like rotating brushes). You can typically start using these skincare products with these ingredients again when your skin fully adjusts to tretinoin.

Where can I get tretinoin?

Curology is one of the easiest ways to get prescription skincare designed for your unique skin. While we can’t guarantee you’ll be prescribed tretinoin—it depends on your skin and medical history—you will receive professional recommendations from our licensed dermatology providers. Getting started is as simple as answering a few questions and uploading some selfies. If Curology is right for you, we’ll pair you with one of our in-house licensed dermatology providers, who will be with you every step of the way of your skincare journey.

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P.S. We did our homework do you don’t have to:

1. Mukherjee1, Siddharth, et al. Retinoids in the treatment of skin aging:an overview of clinical efficacy and safety. Clinical Interventions in Aging. (December 2006).

2. Baldwin, H.E., et al. 40 Years of topical tretinoin use in review.Journal of Drugs in Dermatology. (June 2013).

3. Sutaria, Amita H., et al. Acne Vulgaris.StatPearls Publishing. (January 2022). 

4. Mukherjee, S., et al. Retinoids in the treatment of skin aging: An overview of clinical efficacy and safety.Clinical Interventions in Aging. Ibid.

5. American Academy of Dermatology. Retinoid or retinol? (n.d.).

6. Harvard Health Publishing. Do retinoids really reduce wrinkles? Harvard Medical School. (2019 October 22).

7. Baldwin, H.E., et al. 40 Years of topical tretinoin use in review.Journal of Drugs in Dermatology. Ibid.

8. National Center for Biotechnology Information. Tretinoin. U.S. National Library of Medicine. (2021 September 20).

9. Mukherjee, S., et al. Retinoids in the treatment of skin aging: An overview of clinical efficacy and safety.Clinical Interventions in Aging. Ibid.

10. Mukherjee, S., et al. Retinoids in the treatment of skin aging: An overview of clinical efficacy and safety.Clinical Interventions in Aging. Ibid.

11. Jain, S. Topical tretinoin or adapalene in acne vulgaris: An overview.Journal of Dermatology Treatment. (July 2004).

This article was originally published on September, 2022, and updated on November, 2022.

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Written by

Curology Team

Medically reviewed by

Nicole Hangsterfer, PA-C