How to adjust to tretinoin and azelaic acid in your skincare routine

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Tretinoin might be the ultimate hat trick in skincare: it’s pore-cleansing, acne-busting, and anti-aging. Ultra-hyped in the dermatology field, it’s a prescription-strength topical retinoid that works double-time to bring out your inner glow. 

If you want to use tretinoin, you should know that this ingredient is known for having an adjustment period. As frustrating as side effects can be, some (like "purging," a temporary uptick in breakouts) can actually be a sign your tretinoin is working. 

So, stick with it! A few routine tweaks in how you use tretinoin can help you get through the adjustment period so you can finally enjoy the results. But first, what is this mysterious form of retinoic acid?

Tretinoin: Who is she? ​​​​

Tretinoin (aka Retin-A) is an FDA-approved ingredient used to treat acne and anti-aging skin concerns.¹ It's a vitamin A derivative that many dermatology providers call the gold standard for treating breakouts and photoaging.  

Prescription-only tretinoin is stronger than its over-the-counter little sister, retinol.² Tretinoin is proven to treat acne and signs of aging, which is different from retinol, which is only proven to treat signs of aging. If you’re looking for acne medication, adapalene³ is a prescription-strength retinoid like tretinoin, often mild enough for sensitive skin. One form of adapalene (Differin) can also be found over the counter! 

How tretinoin works 

• Increases your skin’s cell turnover rate and promotes the skin regeneration process, stimulating cell growth and collagen production⁴ 

• Improves skin texture by reducing the appearance of fine lines and hyperpigmentation and supporting the normal structure of your skin

• Clears pores by shedding dead skin cells more rapidly 

Possible tretinoin side effects

Tretinoin can have some common side effects,⁵ including: 

• Skin sensitivity, including increased sensitivity to the sun (that’s why it’s important to use tretinoin at night and wear sunscreen with SPF 30 during the day) 

• Dry, flaking skin that may become red and irritated 

• The temporary uptick in breakouts (aka the tretinoin purge)

Follow your prescriber's medical advice while adjusting to tretinoin; they can help you tweak your routine to be more comfortable.

Getting started with tretinoin

Learning how to apply tretinoin begins with the right technique, which can ease side effects when you’re starting out. Wondering if you can use tretinoin every night? You can—but maybe not right away. Many people experience an adjustment period when starting tretinoin, so it’s best to start low and go slow. You should also temporarily stop using other potent active skin care ingredients, like salicylic acid and benzoyl peroxide, until your skin adjusts. Here’s one way to ease into tretinoin:

• Weeks 1-2: Apply Monday, Wednesday, and Friday night

• Weeks 3-4: Apply every other night

• Weeks 5-6: Apply every night 

This is just one possible timeline that might work for you, but everyone is unique, so reach out to your dermatology provider for recommendations that make sense for your unique skin.

How to apply tretinoin 

If you follow these simple guidelines, you’re likely to have a smoother transition, minimizing tretinoin side effects. First, you just need the basics: cleanser, moisturizer, and SPF that are non-comedogenic (meaning they won’t clog pores)

• Cleanse. Moisten your face with lukewarm water. Apply cleanser using your fingertips. Rinse and pat dry with a soft cloth—you may need to wait 10-20 minutes for any remaining water to evaporate. 

• Apply tretinoin cream at night to a fully dry face. Damp skin is more permeable (meaning it’ll absorb product more quickly), which isn’t necessarily a bad thing, but it can increase the intensity as your skin adjusts. Where you apply tretinoin depends on your target areas for the ingredient’s anti-aging and acne-fighting benefits. Generally, it’s on the face and neck.

• Moisturize. Wait a few minutes for your tretinoin cream to absorb before applying a thin layer of moisturizer. If you want a moisturizer that will help keep dryness at bay, look for one with ingredients like petrolatum, dimethicone, and allantoin. These help hydrate and seal in moisture. 

Pro tip: If you’re still experiencing skin sensitivity after following this routine, use your moisturizer to dilute the tretinoin cream. Either mix moisturizer and tretinoin in equal parts before application or apply your moisturizer before your cream. It won’t render tretinoin any less effective. 

And remember, use tretinoin at night and a broad-spectrum SPF 30+ sunscreen in the morning. 

How to deal with the tretinoin purge 

When you begin tretinoin, you’re giving your skin a kickstart. And as this process starts clearing out your pores, you might see a temporary increase in pimples. 

This is actually a sign that the tretinoin is working. These temporary breakouts, sometimes called “purging,” can range from smaller to deeper pimples. There’s no sugar-coating it—breakouts are never fun. The idea of using a product that can actually cause breakouts might seem totally counterintuitive. But remember that acne won’t disappear overnight, no matter what treatment you choose. The short-term effects of tretinoin can lead to long-term payoffs—you just need to stick with it. 

In the meantime, Curology’s emergency spot patch contains no harsh active ingredients and can help heal and conceal angry blemishes in a pinch. You can also try soaps with zinc pyrithione.

How to deal with dryness and flaking 

If you’re experiencing particularly dry skin (even oily skin types can get dry skin!), try plain petroleum jelly (like Vaseline). This non-comedogenic occlusive moisturizer creates a protective barrier around your skin that seals in hydration. 

Tretinoin and sun sensitivity

Practice sun safety, especially when using a product like tretinoin. Its exfoliating properties cause your skin to shed dead skin cells—which is good, but new skin cells can be more sensitive to UV ray damage. Use the two-finger rule to ensure you’re using enough protection. For more info, read our handy guide to sunscreen.

Waxing and tretinoin 

While using tretinoin, it’s best to skip certain facial hair removal techniques because waxing and sugaring, for example, take some skin cells along with the hair. Stop using tretinoin in the area being waxed five to seven days prior to waxing, and wait one to two days afterward to resume tretinoin.

Lip care with tretinoin

The skin on and around your lips is sensitive, so if you accidentally apply tretinoin in this area, you might get dry, chapped lips. Here are some tips to soothe and protect them: 

• Don’t lick! Licking your lips actually makes them dryer, which can make scaling, redness, and chapping worse.

• Use lip balm. A lip balm with hydration-sealing occlusive ingredients (like the lip balm by Curology) will help seal moisture into the skin.  

• Wear sun protection. A lip balm with sunscreen (like ours) will protect your skin from sun damage, which can make dryness worse. 

In rare instances, extremely dry lips can be a sign of underlying skin issues. If your lips are still dry after trying all these tips, you may want to see an in-person dermatology provider.

What is azelaic acid?

Azelaic acid is a topical ingredient used to treat acne, rosacea, and hyperpigmentation. It’s a naturally occurring acid but is synthetically formulated for its use in skincare, and it’s available over the counter or by prescription. It works by blocking tyrosinase, an enzyme necessary for producing melanin (which gives skin, hair, and eyes their color).⁶ It’s also an anti-inflammatory, antibacterial, and anti-keratinizing ingredient, making it effective in treating and helping to prevent clogged pores.⁷ 

Combining azelaic acid and tretinoin

Just because some skincare ingredients are like magic on their own doesn’t mean they’ll produce double the magic when combined with other medications. In fact, combining certain topicals can lead to skin irritation, begging the question: What to use with tretinoin? Answer: azelaic acid. These two make the perfect pair. 

Combine tretinoin and azelaic acid for better results

Pairing these two ingredients can give better results—tretinoin may enhance the effects of azelaic acid when treating hyperpigmentation (such as melasma).⁸ Together they help with the treatment of acne, hyperpigmentation, and certain anti-aging concerns. 

What goes on first, tretinoin or azelaic acid?

Formulations with these ingredients are often similar. If you’re using two separate products, apply the one with the thinnest consistency first—following the general rule of thumb of applying from thinnest to thickest. 

Azelaic acid + tretinoin purge

Using these ingredients together can also cause a “purge”—but not always. Follow the same guidelines as you would if you were only adding tretinoin to your nightly routine.

Patience and persistence 

We’ll be honest—better skin doesn’t happen overnight. Think of your skincare routine like exercise: you’re building your skin’s strength every day. Some days will be easier than others, and there’s no quick fix. But if something isn’t working for you, you can always reach out to your Curology provider for product recommendations or formula tweaks.

Get your personalized skincare routine with Curology

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We’re here to take the guesswork out of your skincare routine—licensed dermatology providers work with you to examine your skin, assess your skincare goals, and provide custom treatment options. Curology uses proven ingredients like tretinoin, azelaic acid, and clindamycin in its acne treatment formulas. We’ll also recommend other products to try, like the acne body wash or emergency spot patch. 

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P.S. We did the homework 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. Zasada, M. and Budzisz, E. Retinoids: Active molecules influencing skin structure formation in cosmetic and dermatological treatments.Advances in Dermatology and Allergology. (August 2019).

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

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

5. Mukherjee S, et al. Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety.Clin Interv Aging. (December 2006).

6. Schulte BC, Wu W, Rosen T. Azelaic Acid: Evidence-based Update on Mechanism of Action and Clinical Application.J Drugs Dermatol. (September 2015).

7. Zaenglein, Andrea L., et al. Guidelines of care for the management of acne vulgaris.Journal of the American Academy of Dermatology. Ibid.

8. Breathnach, A.S. Melanin hyperpigmentation of skin: Melasma topical treatment with azelaic acid, and other therapies.Cutis. (1996).

Meredith Hartle is a board-certified Family Medicine physician at Curology. She earned her medical degree at Kirksville College of Osteopathic Medicine in Kirksville, MO.

* Subject to consultation. Subscription is required. Trial is 30 days. Results may vary. 

This article was originally published on March 12, 2021, and updated on December 22, 2022.

Medically reviewed by

Meredith Hartle, DO