What to Know About Topical Retinoids for Acne

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:

• Gels
• Ointments
• Creams
• Foams

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.

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.

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.

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% strength
• Available 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.

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 skin
• Mild skin irritation such as itching, peeling, scaling, and burning
• Worsening acne that usually resolves in a couple of weeks
• Darkening of small areas of irritated skin, called retinoid dermatitis
• Increased sensitivity to cold and heat

Rare

• Worsening acne that does not subside after two to four weeks of use
• Eczema 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:

• Stinging
• Burning
• Extreme dryness
• Swelling
• Itching
• Peeling
• Blistering
• Difficulty 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.