Do you know about the vast skin benefits that come with using tretinoin? For decades, experts have said that tretinoin is the gold standard of acne treatment. 

This powerhouse ingredient is available only by prescription—and you can find it in some of Curology’s personalized prescription formulas.

Outside of those formulas, tretinoin commonly comes in two formula types: gel and cream. Here, Curology’s licensed dermatology providers will explain what exactly tretinoin is, what it can do for your skin and whether its gel or cream form might be the right choice for you.

What is tretinoin?

A vitamin A derivative, tretinoin, also known as a topical retinoid, has been around for a long time helping to treat various skin conditions. Though it may sound a little like retinol, these two ingredients are close cousins, both part of the retinoid family. 

Retinol can be found in many over-the-counter products, yet tretinoin requires a prescription. 

Tretinoin has been around since the 1960s and is a topical ingredient used to treat various skin conditions including acne. Over the years, research has shown it’s beneficial for a number of other skin conditions, including certain types of scarring and hyperpigmentation. Tretinoin was also the first in its class to be approved by the U.S. Food and Drug Administration (FDA).¹ 

Also known as all-trans retinoic acid (ATRA), tretinoin can do many helpful things for the skin that include but are not limited to:² 

• Increasing collagen production.

• Increasing cell turnover.

• Unclogging pores.

• Reducing inflammation.

• Reducing uneven pigmentation.

Tretinoin can be used as a single treatment, or it may be used along with other oral or topical medications that treat the skin simultaneously.³ Many factors influence the dosage and combination of medications and topical treatments that may be used alongside tretinoin. 

It’s a prescription-only medication, so a licensed dermatology provider can determine whether or not it’s a good option for you based on the condition of your skin, age, medical history, and other medications you might be using.⁴ 

What is tretinoin used for?

This vitamin A derivative has been around for quite some time and has gained popularity for all of its benefits for the skin. Though a prescription is needed to use it, tretinoin can treat acne, photoaging, help improve acne scarring, and more. 

Tretinoin for acne

Tretinoin is the preferred first line of treatment for acne vulgaris.⁵ Evidence has shown that tretinoin increases skin cell turnover and increases the rate at which new cells form. 

This topical medication not only helps to decrease the total amount of acne lesions and reduce skin inflammation, but it also helps maintain healthy skin without allowing bacterial resistance.⁶

Topical tretinoin is often prescribed with other acne treatments, such as clindamycin (an antibiotic). Individually, each of these ingredients did show positive results for acne therapy, but combined, the improvement was even better.⁷ 

Another popular ingredient in skincare products is benzoyl peroxide and there have even been special formulations made to accommodate the benefits of each ingredient.⁸ 

Tretinoin for photoaging

Photoaging is a term that describes the skin damage caused by prolonged exposure to ultraviolet rays (UV).⁹ This can often lead to signs of premature aging, such as wrinkles, leathery appearance, hyperpigmentation (dark or sun spots), and even skin cancer. 

In terms of photoprotection, the UV rays to be concerned about are UVA and UVB rays.¹⁰ The damage caused by UVB rays includes immunosuppression, sunburns, and DNA damage. UVA rays cause damage to the deeper levels of the skin. Interestingly, women are more prone to wrinkles, while men are more prone to pigment changes.¹¹

Increased cell turnover, increased collagen production, prevention of collagen loss, and evening of pigmentation are all benefits offered by topical tretinoin, as shown by evidence for over a decade.¹² Collagen provides structural integrity, shape, and tensile strength to the skin.¹³ Increased production of collagen and the prevention of collagen loss help the skin resist the signs of photoaging like wrinkles. 

Differences between tretinoin gel and tretinoin cream

The decision to go with tretinoin cream or gel may depend on provider preference or your personal preference. 

Creams are emulsion formulas that contain water. Creams help provide moisture, spread on the skin easily, and are less greasy compared to ointments.¹⁴ 

Topical gels contain a gelling agent to make them a thicker solution. But they dry to form a thin film and generally don’t provide much hydration. However, they tend to dissipate through sweating and if they contain alcohol, they may sting on inflamed or open wounds on the skin. Gels are generally recommended for use on hairy and oily areas, such as the face.¹⁵ 

Tretinoin in a gel formulation may blend into the skin more easily. However, the alcohol based gels may cause more of a drying effect, making gels the more common option for treating acne versus wrinkles. There’s also some evidence that tretinoin gels have the potential to reduce facial shine more than tretinoin creams.¹⁶

Cream vs gel: Why choose one over the other

A dermatology provider may prescribe a tretinoin gel instead of a cream for a variety of reasons, including availability, pricing, personal preference, as well as the patient's skin type or concern. 

For example, adolescents who have concerns with oily skin may benefit from a gel since it can have a drying effect. Whereas an older patient with concerns about photoaging and wanting to reduce the appearance of wrinkles might benefit more from a tretinoin cream, given its potential hydrating effects. 

Tolerability also comes down to the concentration of tretinoin. It’s been found that patients generally experienced better tolerability with lower concentrations of the drug, as well as having normal skin vs. more sensitive skin.¹⁷ 

Side effects of tretinoin

A topical tretinoin prescription—or retinoids, in general—may carry some side effects such as skin irritation, redness, or dryness. Luckily, these side effects usually last a week or two and should subside. Everyone is different and some may tolerate tretinoin better than others.¹⁸

As with any prescription, your provider should discuss the possible side effects of tretinoin use. Most (if not all) should explain that redness, peeling, or irritation might occur, but if it becomes intolerable, cease its use and follow up with a provider.

However, the severity of the side effects varies by the individual, their skin type, additional medications, and their unique biochemistry. 

Other side effects may include:¹⁹

• Itchy skin (pruritus).

• Skin pain/sensitivity.

• General skin irritation.

• Redness (erythema).

• Increased sensitivity to sun exposure.

Most of these symptoms revolve around general skin irritation. Symptoms may be localized to a specific area, such as around the nose, cheeks, or chin. Your dermatology provider may suggest a moisturizer to counteract the dryness and irritation. However, they’ll also be monitoring you for hypersensitivity to tretinoin. 

If you are hypersensitive to tretinoin, your provider may recommend a different topical treatment. It’s also possible to have or develop an allergy to tretinoin or another ingredient in the formulation, which can be more severe.

Photosensitivity—which refers to sensitivity to sunlight—may occur while using tretinoin. It’s a good idea to use sunscreen daily, even when not using tretinoin, but it’s even more important when using this medication. 

Ready to personalize your skincare?

Tretinoin can be valuable to an effective skincare routine. Curology’s licensed dermatology providers will work with you one-on-one to formulate a personalized prescription formula that addresses your skin concerns.

Get your personalized skincare routine with Curology

Get your personalized skincare routine with Curology

Start your skin quiz

Whether that’s acne, aging, or hyperpigmentation, tretinoin might be part of a successful treatment plan. Sign up with Curology* today! 

P.S. We did the research, so you don't have to: 

1. Baldwin, H.E., et al. 40 Years of Topical Tretinoin Use in Review. Journal of Drugs in Dermatology. (June 2013). 

2. Baldwin, H.E., et al. 40 Years of Topical Tretinoin Use in Review. Journal of Drugs in Dermatology. Ibid.

3. Baldwin, H.E., et al. 40 Years of Topical Tretinoin Use in Review. Journal of Drugs in Dermatology. Ibid.

4. Baldwin, H.E., et al. 40 Years of Topical Tretinoin Use in Review. Journal of Drugs in Dermatology. Ibid.

5. Baldwin, H.E., et al. 40 Years of Topical Tretinoin Use in Review. Journal of Drugs in Dermatology. Ibid.

6. Baldwin, H.E., et al. 40 Years of Topical Tretinoin Use in Review. Journal of Drugs in Dermatology. Ibid.

7. Baldwin, H.E., et al. 40 Years of Topical Tretinoin Use in Review. Journal of Drugs in Dermatology. Ibid.

8. Baldwin, H.E., et al. 40 Years of Topical Tretinoin Use in Review. Journal of Drugs in Dermatology. Ibid.

9. Sitohang, I.B.S., et al. Topical tretinoin for treating photoaging: A systematic review of randomized controlled trials. International Journal of Women’s Dermatology. (2022, March 25). 

10. Wilson, B.D., et al. Comprehensive Review of Ultraviolet Radiation and the Current Status on Sunscreens. J Clin Aesthet Dermatol. (September 2012).

11. Sitohang, I.B.S., et al. Topical tretinoin for treating photoaging: A systematic review of randomized controlled trials. International Journal of Women’s Dermatology. Ibid. 

12. Sitohang, I.B.S., et al. Topical tretinoin for treating photoaging: A systematic review of randomized controlled trials. International Journal of Women’s Dermatology. Ibid. 

13. Ricard-Blum, S. The Collagen Family. Cold Spring Harbor Perspectives in Biology. (January 2011).

14. Barnes, T.M., et al. Vehicles for Drug Delivery and Cosmetic Moisturizers: Review and Comparison. Pharmaceutics. (2021, November 26). 

15. Barnes, T.M., et al. Vehicles for Drug Delivery and Cosmetic Moisturizers: Review and Comparison. Ibid.

16. Nyirady, J., et al. A comparative evaluation of tretinoin gel microsphere, 0.1%, versus tretinoin cream, 0.025%, in reducing facial shine. Cutis. (August 2000). 

17. Leyden, J., et al. Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatology and Therapy. (2017, June 5).

18. Leyden, J., et al. Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatology and Therapy. Ibid.

19. Yoham, A.L. and Casadesus, D. Tretinoin. StatPearls. (2020, June 4).

20. Buhse, L.F., et al. Topical drug classification. International Journal of Pharmaceutics. (June 2005).

Elise Griffin is a certified physician assistant at Curology. She received her Master of Medical Science in physician assistant studies from Nova Southeastern University in Jacksonville, FL.

*Cancel anytime. Subject to consultation. Results may vary.

Written by

Curology Team

Medically reviewed by

Elise Griffin, PA-C