Skin Health Acne Treatment What to Know About Topical Retinoids for Acne By Heather L. Brannon, MD Heather L. Brannon, MD Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years. Learn about our editorial process Updated on March 15, 2022 Medically reviewed by Casey Gallagher, MD Medically reviewed by Casey Gallagher, MD Casey Gallagher, MD, is board-certified in dermatology and works as a practicing dermatologist and clinical professor. Learn about our Medical Expert Board Print KidStock / Getty Images Table of Contents View All Table of Contents What They Are Uses Before Using Dosage Side Effects Warnings Topical retinoids are prescribed to control blackheads and whiteheads, or comedonal acne. They also called retinoic acid or vitamin A acid. This article looks at topical retinoids and how they work as an acne treatment. It also discusses side effects and precautions for using this medication. What Are Topical Retinoids? Topical retinoids promote the exfoliation of dead skin cells and boost the production of new skin cells. The new cells push dead cells and excess oil out of blocked pores. Retinoids also have anti-inflammatory properties. Two retinoids are prescribed for acne: Retin-A (tretinoin topical), also prescribed under other brand names including Avita Tazorac (tazarotene topical), also prescribed under the brand name Fabior Both are available in generic formulations. Retinoids are also available in different forms, including: GelsOintmentsCreamsFoams Differin (adapalene) is another acne medication that works like a retinoid but is gentler. It is available by prescription in a 0.3% formulation and over the counter in a 0.1% formulation. Topical retinoids are not the same as retinols. Retinoids are stronger and available only by prescription. Retinols can be purchased over the counter. They are typically found in anti-aging products. Retinoids may be prescribed on their own or in combination with other acne therapies, such as: Antibiotics Benzoyl peroxide What Are Topical Retinoids Used For? Topical retinoids are approved by the Food and Drug Administration (FDA) to treat whiteheads, blackheads, and acne lesions. They can be used by adults and children age 12 and older. Topical retinoids are also prescribed to help reduce signs of aging, including: Hyperpigmentation or dark spots on the skin Fine lines and wrinkles Retinoids sold for anti-aging purposes may have different brand names, such as Renova (tretinoin) and Avage (tazarotene). Retinoids are also sometimes used to treat other skin conditions such as keratosis pilaris and psoriasis. Recap Topical retinoids are used to treat acne and certain other skin conditions. They are also used to reduce the signs of aging. Before Using Topical Retinoids Retinoids are typically prescribed only after other acne products have failed. Your dermatologist will want you to try other remedies before prescribing a retinoid. These may include products with ingredients like: Salicylic acid Benzoyl peroxide Sulphur Other active ingredients and/or antibiotics Your doctor will also want to know about your medical history. If you have eczema, for example, you may not be able to use topical retinoids. If you are pregnant, planning to become pregnant, or breastfeeding, you should also avoid this medication. This is because the oral form of retinoic acid, isotretinoin (formerly sold as Accutane), is known to cause severe birth defects. Recap Topical retinoids are usually only prescribed if other acne medications haven't worked for you. You should not use them if you're pregnant, breastfeeding, or planning to become pregnant. Topical Retinol Dosage Topical retinoids came in various strengths depending on the formulation: Tretinoin Available as a cream in three strengths: 0.025%, 0.05%, and 0.1% Available as a gel in 0.01% and 0.025% strengths Available as a liquid (the most potent) in a 0.05% strength Available as Retin-A Micro 0.1%, a slow-release option that is less irritating to the skin Tazarotene Available as a gel in 0.05% and 0.1% strengths Differin Available as a prescription gel in 0.3% strengthAvailable as an OTC gel in 0.1% gel These dosages come from the drug manufacturers. Always check your prescription and talk to your doctor to make sure you're taking the right dose for you. Oral Retinoids Oral retinoids are available by prescription only. Isotretinoin is formerly known as Accutane. It is an oral retinoid sometimes prescribed for severe acne. Because it is associated with miscarriage and birth defects, it should never be taken while pregnant, breastfeeding, or during the month prior to conception. How to Take and Store Topical retinoids for treating acne are applied directly to affected areas. The skin should be clean and completely dry. Apply in a very thin layer with clean hands. Most dermatologists direct patients to use retinoids once a day, in the evening. A retinoid should not be used on broken, infected, or sunburned skin. It should not be applied to the eyes, nose, mouth, or genitals. Potential Side Effects Topical retinoids are generally regarded as safe. Like all medications, though, they may have some side effects. Common You may experience mild side effects when you first start using a retinoid. These usually subside after two to four weeks. Side effects may include: A warm sensation on the skinMild skin irritation such as itching, peeling, scaling, and burningWorsening acne that usually resolves in a couple of weeksDarkening of small areas of irritated skin, called retinoid dermatitisIncreased sensitivity to cold and heat The most important side effect of retinoids is an increased sensitivity to ultraviolet rays. This can lead to severe sunburn. When using a retinoid it is very important to be vigilant about sun exposure. Use sunscreen, wear hats and sunglasses, and stay out of direct sunlight as much as possible. Rare Worsening acne that does not subside after two to four weeks of useEczema or contact dermatitis caused by an allergic reaction Severe It is possible to have a severe allergic reaction to this medication. Seek immediate medical care if you have any of these symptoms: StingingBurningExtreme drynessSwellingItchingPeelingBlisteringDifficulty breathing Recap Most side effects are mild and resolve in a few weeks. In rare cases, topical retinoids can cause a severe allergic reaction. Seek immediate medical care if you have symptoms like blistering or trouble breathing. Warnings and Interactions Retinoids should not be used with certain other acne treatments. Combining a retinoid with a product containing salicylic acid, for example, can result in irritation, redness, and peeling. Retinoids and benzoyl peroxide can sometimes be used together. Certain concentrations of benzoyl peroxide, though, may degrade the retinoid. This could make it less effective. Always talk to your doctor before adding other medications to your routine, even OTC ones. Summary Topical retinoids are a prescription acne treatment. They help unclog pores by boosting the production of new skin cells. These medicines are usually only prescribed after other acne treatments have failed. They may have side effects like mild skin irritation. They can also make you more prone to sunburn. Don't use topical retinoids if you are pregnant, breastfeeding, or plan to become pregnant. 11 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. US Food & Drug Administration. Highlights of prescribing information DIFFERIN® (adapalene) gel, 0.3%. American Academy of Dermatology Association. Psoriasis treatment: a retinoid you apply to the skin. US Food & Drug Administration. RETIN-A. Latter G, Grice JE, Mohammed Y, Roberts MS, Benson HAE. Targeted topical delivery of retinoids in the management of acne vulgaris: current formulations and novel delivery systems. Pharmaceutics. 2019;11(10). doi:10.3390/pharmaceutics11100490 US Food & Drug Administration. TAZORAC. US National Library of Medicine. Tretinoin Topical. Dellavalle RP. United States skin disease needs assessment, an issue of dermatologic clinics (volume 30-1) (The clinics: dermatology (volume 30-1)). Elsevier Health Sciences; 2011. US Food & Drug Administration. ATRALIN. US Food & Drug Administration. Highlights of prescribing information: FABIOR. Nikalji N, Godse K, Sakhiya J, Patil S, Nadkarni N. Complications of medium depth and deep chemical peels. J Cutan Aesthet Surg. 2012;5(4):254-60. doi:10.4103/0974-2077.104913 Sacchidanand SA, Lahiri K, Godse K, et al. Synchronizing pharmacotherapy in acne with review of clinical care. Indian J Dermatol. 2017;62(4):341-357. doi:10.4103/ijd.IJD_41_17 By Heather L. Brannon, MD Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years. 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