Treatment with Retin-A (tretinoin) should be individualized with factors such as age, skin type, degree of photodamage, and presence of other skin conditions taken into consideration. Therapy should start with a lower concentration to minimize irritation and redness. Tretinoin cream is available in three different strengths: 0.025%, 0.05%, and 0.1%. For treatment of wrinkles and sun-damaged skin, I recommend beginning with the mildest strength, tretinoin cream 0.025%. It should be applied in the evening to clean, dry skin at least 20 to 30 minutes after washing. The affected area is covered lightly and evenly. Temporary warmth or stinging may be felt. Sensitive areas to be avoided include around the eyes, nose, and mouth. Spot treatment should be avoided due to reduced efficacy and blotchiness. Patients are warned to expect temporary irritation with peeling that usually lasts up to 6 weeks. If the irritation becomes excessively bothersome, a several day break from treatment can be done. Maximum effects will be seen after 6 to 12 months. Maintenance application is 2 to 3 times per week after the maximum results have been achieved.