How to Use Tretinoin Cream (Retin-A)

Instructions, What It Does, and Possible Side Effects

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Understanding how to use tretinoin will help you get the best results with fewer side effects. It's important to make sure you cover all your problem areas, but without using too much medication. Apply lightly over your skin's problem areas and rub in gently.

Tretinoin is effective but it can cause dryness, itchiness, redness, and other skin concerns. Using this medication as directed can help reduce your risk of these issues.

This article walks you through how to use tretinoin and get the best results. It also explores exactly why tretinoin works and the possible side effects it can cause.

Starting and Using Tretinoin, Step by Step

How to Start Applying Tretinoin Cream
Verywell / Brianna Gilmartin

Tretinoin cream is commonly applied at night before bed.

Follow these step-by-step instructions for how to use tretinoin cream:

  • Step 1: Wash your skin with a mild soap or cleanser and warm water. Allow skin to dry completely. 
  • Step 2: Apply just enough medicine to cover the affected area lightly. A pea-sized amount will cover your full face.
  • Step 3: Gently rub it into the treatment area. 
  • Step 4: Wash the medicine off your hands. 
  • Step 5: Wait 20 minutes, then apply moisturizer.
  • Step 6: In the morning, wash your face with a mild facial scrub or soft washcloth. This will help reduce the noticeable flaking.
  • Step 7: Allow skin to dry, then apply a good water-based moisturizer. 

When you first start using tretinoin, plan to apply it every other night or every third night. Skin flaking and irritation are usually the worst in the first two weeks, and this will allow your skin some time to adapt to the medicine.

As it does, you can apply it more frequently, as directed.

Some additional things to know:

  • A small amount of tretinoin cream goes a long way. Using more will not get you better or faster results.
  • Tretinoin makes you more susceptible to sunburn. Try using a moisturizer that also contains sunscreen or apply sunscreen any time you spend time in the sun, even if it's for just a bit. If you do get a sunburn, wait for your skin to recover before using the medication again. If you don't, irritation and discomfort will worsen.

Don't Give Up

If you notice an increase in irritation or flaking, it's OK to take a break from using tretinoin for a couple of days. Just don't stop using it completely without consulting your healthcare provider.

Some people give up on tretinoin after a couple of days or weeks, assuming it didn't work. In actuality, their skin just needed time to adjust to the medication.

What Tretinoin Does and How Soon It Works

Acne usually begins when a pore (a hair follicle) becomes clogged with dead skin, bacteria, and oil. This causes a bump called a comedone.

Tretinoin works by increasing the production and shedding of skin cells (called cell turnover), which forces the plugged material out of the pore. It also prevents the formation of new comedones.

It's important to realize that tretinoin works well on blackheads and whiteheads, but it may take six to nine weeks of use to see a noticeable difference in acne.

This is a short wait compared to how long it takes to see a noticeable difference in wrinkles: at least six months. In fact, you'll get the greatest benefit from tretinoin if you use it for at least a year.

Side Effects to Look Out For

Side effects of tretinoin can occur in anyone, but are particularly common in those with sensitive skin.

Possible side effects include:

  • Red, swollen, blistered, or crusted skin
  • Burning, warmth, stinging, tingling, itching, dryness, peeling, or irritation where the medicine is applied
  • Changes in skin color (darker or lighter)

Diligent use of a quality moisturizer may help you avoid or minimize some of these.

Tell your healthcare provider if you experience any of these side effects. You may need to stop using tretinoin.

Is Tretinoin Safe for Everyone?

Retin-A may negatively interact with other topical medications, especially those containing sulfur, resorcinol, or salicylic acid.

To prevent dangerous interactions, make sure to tell your healthcare provider about all the medications—topical, oral, over-the-counter, and prescription—that you use.

As tretinoin makes skin more sensitive to the sun, it may not be a good choice for those who are already sun-sensitive for other reasons.

Little tretinoin is absorbed into the bloodstream when you use it topically, so breastfeeding when using the medication is generally considered safe.

Talk to your healthcare provider about how to use the medication if you're pregnant or thinking about becoming pregnant. They may advise you to hold off because too little is known about the effects of tretinoin on unborn babies.

Summary

Tretinoin cream is the go-to choice for treating acne and reducing the appearance of wrinkles. But this is one treatment that requires patience. To see results from acne, it takes about six to nine weeks. For wrinkles, it takes at least six months to a year.

Initially, the medication can cause the skin to turn red and flake. Take it slow, follow all of the instructions on how to use tretinoin properly, and speak to your prescriber if you have persistent side effects.

Frequently Asked Questions

  • Do you put tretinoin on before or after moisturizer?

    Before. Put tretinoin cream on freshly washed skin. Allow the medicine to soak into the skin for at least 20 minutes before applying moisturizer.

  • Do I need to wash tretinoin off in the morning?

    Yes, tretinoin should be applied at night and washed off in the morning.

  • Is tretinoin a steroid?

    No, tretinoin is a retinoid, not a steroid. A retinoid is a derivative of vitamin A. Steroids are manmade hormones that mimic natural hormones in the body.

  • What's the difference between retinol and tretinoin?

    Retinol is a natural form of vitamin A, while tretinoin is synthetic form. Tretinoin is stronger than retinol and is only available with a prescription. Retinol is milder and available over the counter. 

4 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.
  1. Cleveland Clinic. Tretinoin cream.

  2. Baldwin HE, Nighland M, Kendall C, Mays DA, Grossman R, Newburger J. 40 years of topical tretinoin use in review. J Drugs Dermatol. 2013;12(6):638-42.

  3. Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Tretinoin.

  4. Mayo Clinic. Tretinoin (topical route).

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.