What to Know About Retin-A (Treitinoin)

A prescription topical drug used to treat acne

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Retin-A (tretinoin) is a prescription drug that is applied topically, or to the skin, to treat acne. It can be effective in treating inflammatory acne and works especially well on comedonal acne, which is the type that involves blackheads or whiteheads.

Available as a gel, cream, or liquid, Retin-A belongs to a group of medications derived from vitamin A called topical retinoids. It works by kickstarting a process that increases the rate of skin cell production, which reduces the blocking of pores.

In addition to brand name Retin-A products, there are low-cost generics sold under the name "tretinoin topical."

This article reviews uses for tretinoin, things to consider before using it, potential side effects, recommended dosages, and more.

Uses

Retin-A is approved by the U.S. Food and Drug Administration (FDA) for the treatment of acne vulgaris. This is the most common form of acne characterized by inflammatory and non-inflammatory skin lesions, including blackheads, whiteheads, and pimples.

Retin-A is usually prescribed when over-the-counter medications and optimal skincare fail.

Retin-A is comedolytic, meaning that it prevents the blockage of pores. It does so by binding to receptors on a type of skin cell called a keratinocyte. This blocks the effects of hormones that regulate the shedding of cells.

As a result, the rate of skin cell production increases, pushing older cells to the surface instead of allowing them to build up and clog pores. Retin-A also makes existing blackheads less "sticky," thereby promoting the movement of the plugs to the surface.

This prevents the formation of comedones, the origins of all pimples.

Recap

Retin-A is a prescription drug applied to the skin to treat acne. It works by increasing the speed by which skin cells are produced and shed. By doing so, the cells are less likely to clog pores and cause pimples.

Because Retin-A stimulates new cell growth and has an exfoliating effect, it can give the skin a more even texture and make enlarged pores look smaller.

Superficial acne scars may look less obvious, and darkening of the skin caused by inflammation (known as hyperpigmentation) may be reduced as well.

With that said, the effects of Retin-A are usually not enough to reduce depressed, pitted, or raised acne scars. These may require specialist scar treatment procedures.

Off-Label Uses

Retin-A is embraced by some as an anti-aging product. It is said to reduce fine lines and wrinkles while making the complexion looking brighter and smoother.

Lab studies involving human skin samples suggest that it not only increases cell turnover but also activates a cell type responsible for secreting collagen, a protein that gives skin its elasticity.

Studies in humans have shown that it may increase thickness of the outer skin layer (epidermis) and help minimize facial wrinkles after 12 weeks of use. These benefits may be greatest in people who experience photoaging, the premature aging of the skin caused by excessive exposure to UV radiation.

Because of its potential for skin irritation, Retin-A is typically used to treat conditions like hyperpigmentation or photoaging, rather than for aesthetic purposes. It is also often used in combination with hydroquinone and topical corticosteroids.

As such, Retin-A may not be the best option if you're simply looking for an anti-aging cream.

Are Retin-A and Retinol the Same Thing?

No. Retinol, found in many over-the-counter creams and serums, is vitamin A in topical form. Retin-A is a synthetic derivative of vitamin A that is stronger and requires a prescription. While gentler on the skin, retinol has only mild anti-acne effects and is not as effective in reducing wrinkles as tretinoin and other retinoic acids.

Before Taking

Retin-A should be used under medical supervision as part of a comprehensive acne treatment plan. This should include using of an effective sunscreen (minimum SPF 15), wearing sun-protective clothing, and avoiding excessive sunlight exposure.

If you use another over-the-counter or prescription acne remedy, let your doctor know before starting treatment. More is not necessarily better when it comes to treating acne. In some cases, you may need to take a break from your current acne medications before starting Retin-A.

You should also walk your doctor through your daily skincare routine. Because Retin-A can cause skin irritation, your dermatologist may recommend a change like using a different cleanser, astringent, or exfoliant.

Precautions and Contraindications

You will need to avoid Retin-A if you have a known hypersensitivity to tretinoin or any other ingredient in the product.

Retin-A should should also be avoided in people with eczema (atopic dermatitis) or sunburned skin, as it can cause severe irritation.

Retin-A should not be prescribed to children under 12 in whom the safety has not been established and the drug may be too harsh.

Although there's no clear evidence that topical tretinoin causes birth defects, oral tretinoin has been linked to this risk. It is not known whether the drug is excreted in breast milk.

People who are breastfeeding or pregnant should only Retin-A if the benefits outweigh the possible risks. An in-depth conversation with a doctor is needed to make an informed choice.

Recap

Retin-A should be used with caution in people who are pregnant or breastfeeding and ideally after consultation with a dermatologist. Do not Retin-A on children under 12.

Other Related Drugs

There are other tretinoin-based topical drugs used to treat acne. The choice of drug may be based on the severity of your acne and the condition of your skin.

There are two similar drugs approved for use by the FDA:

  • Renova (0.05% tretinoin cream), a milder formulation made with an emollient cream base
  • Retin-A Micro (tretinoin gel microsphere), a slow-release version of Retin-A that may reduce the risk of skin irritation

A related drug called Accutane (isotretinoin) is taken by mouth and used to treat severe inflammatory acne.

Dosage

Retin-A is applied to the skin daily and delivers the best results when used consistently. The drug is available in three forms:

  • Cream: 0.025%, 0.05%, and 0.1% strength
  • Gel: 0.01% and 0.025% strength
  • Liquid: 0.05% strength

It generally takes two to three weeks before you begin to see the benefits of Retin-A treatment. In some cases, it can take six weeks or more.

How to Use and Store

Retina-A is used once daily before bedtime. Apply enough to cover the affected area lightly. Putting on a thick layer will not improve results and may only increase skin irritation.

Avoid applying Retin-A around the corners of the eyes, nose, or mouth. You should not apply it to open wounds, as this can cause pain and inflammation.

Protect your skin from the sun, wind, and cold, as it will be more sensitive to the elements for several months after starting tretinoin. Daily sunscreen is advised.

Retin-A cream, gel, and liquid can be stored safely at temperatures under 80 degrees F. The medication does not require refrigeration but can be refrigerated if there is a risk of excessive heat exposure. (Refrigerated Retin-A can also be soothing to the skin.)

Retin-A gel is flammable. Keep the gel well away from open flames, and do not expose it to temperatures over 120 degrees F.

Keep the tube tightly sealed and out of the reach of children. Discard any expired drugs.

Side Effects

As with all drugs, Retin-A may cause side effects. While some of the initial side effects may resolve as your body adapts to treatment, others may be severe and require temporary or permanent discontinuation of the medication.

Possible Side Effects of Retin-A Treatment
Verywell / Emily Roberts 

Common

Common side effects of Retin A include:

  • Burning or stinging (usually mild)
  • Skin redness
  • Skin dryness
  • Skin flaking, scaling, or peeling
  • Lightening or darkening of the skin (usually temporary)

Retin-A is prescribed at the lowest effective dose to avoid side effects.

Worse Before It Gets Better

When first starting treatment, it may seem as if your acne is getting worse. This is not uncommon and is due to the effects of the drug on pimples developing deep beneath the surface of the skin. Do not stop treatment as these symptoms will eventually improve.

Severe

Retin-A causes sun sensitivity (photosensitivity) by stripping away the outer layer of skin cells called the stratum corneum. This exposes the underlying cells to the effects of UV radiation.

Side effects can become severe if you are out in the sun too long, such as for work or while playing sports. You can minimize these effects by using sunscreen, though they may still occur to some degree.

Severe side effects of Retin-A include:

  • Skin swelling and redness
  • Blistering, oozing, and crusting
  • Skin pain

Treatment should be temporarily stopped if these side effects develop. Once the skin has healed, a lower dose should be prescribed. If the severe side effects return, other treatment options should be considered.

On rare occasions, allergic contact dermatitis has been known to occur after applying Retin-A. Severe allergic reactions, such as anaphylaxis, can sometimes occur with oral tretinoin drugs, but they rarely do with topical drugs like Retin-A.

Warnings and Interactions

Retin-A can interact with certain medications, cosmetics, and skincare products. Chief among these are topical products that contain alcohol, sulfur, resorcinol, or salicylic acid. Using Retin-A with any such products can increase skin dryness.

If products like these are being used, it is usually best to stop them and let the skin rest before starting Retin-A.

Tretinoin was once available as an oral drug called Vesonoid used for the treatment of acute promyelocytic leukemia (APL). The drug has since been discontinued due to safety and efficacy concerns.

Summary

Retin-A (tretinoin) is a prescription cream used to treat acne. It is an option your dermatologist may recommend when over-the-counter medications and proper skincare fail to provide relief.

Applied once nightly before bedtime, Retin-A will generally improve acne symptoms within several weeks, although there may be skin drying, flaking, and the temporary darkening of the skin. Breakouts may also temporarily worsen before skin starts to clear.

Retin-A should only be used in adults and children over 12.

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14 Sources
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