Do you have to have acne to use tretinoin?

Question

To aid in reducing my PIH, I was prescribed tretinoin 0.025% and Azelaic acid 15% topical cream. Is it worth it to take the risk with tretinoin, or should I just stick with Azelaic acid? I would like something to smooth the dull texture of my skin and erase hyperpigmentation. My skin is slightly sensitive and when my acne does occur, I experience small comedones and textural irregularities.

Erin Smith, MD · Answer

This is a great question. Tretinoin (generic for retin-a) is a safe topical medication which is great for acne, wrinkles, hyperpigmentation, and many other issues. It is not recommended if you are pregnant or nursing but is otherwise safe. The more serious drug is the oral drug Isotretinoin (aka accutane). This is a drug that can cause birth defects if you get pregnant, and for that reason you have to be on 2 forms of birth control when you are on this medication. For tretinoin, there are varying strengths. The 0.025% is a low dose. I recommend starting using it 1-2x per week at first and working up to 5-6x per week. Once you get used to that dose, you can increase your strength to a higher dose. This is often used in conjunction with a hydroquinone cream for hyperpigmentation. With tretinoin, you can expect some redness/irritation/peeling when you start it. However this is a normal reaction, not a side effect. This will improve the more you use it. For co-existing acne, you can use with azelaic acid, but at first this may be very drying if used together.

Douglas M. Stevens, MD · Answer

Tretinoin is not only used for acne. It is very well known for the use of anti-aging, improvement in skin texture, pigmentation and correction of sun damage. In our practice we encourage almost every patient to use a retinol cream. To specifically treat hyperpigmentation, we recommend hydroquinone. In regards to your sensitive skin, this is a very low dose of tretinoin, so there should be too much irritation.

Susan Fox, DO, RPVI · Answer

Hello, tretinoin is prescribed for different purposes.  Although it was initially prescribed for acne it also helps reduce fine lines and wrinkles and improve the texture of the skin as well as help with hyperpigmentation.  I think you will notice an improvement with your skin while using it.

Do you have to have acne to use tretinoin?

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