RETIN-A

“First, it increases cell turnover, so dead skin cells are shed faster. This evens out skin tone and brightens the skin,” explains Dr. Dana Goldberg, a plastic surgeon in Jupiter, Florida. “Second, Retin-A stimulates collagen growth,” which minimizes fine lines and smooths the skin’s texture.

Pros

• This medical-grade topical skin care option is easy to use at home.
• Most patients report minimal side effects.
• Decades of research have proven that tretinoin is effective at delivering exceptional improvements in skin quality with consistent use. 
• Starting tretinoin early means big benefits from boosted collagen, both now and in later years. 
• Many of the RealSelf members who say it’s Worth It report dramatic improvements in their skin.

Cons

• Results take time and commitment to develop: you’ll need to use it regularly for four to six weeks to start seeing results. Many people give up midway, but it’s important to keep going.
• Retinoids are irritating to the skin when you first start them. According to Dr. Reichel, they need to be used with caution for people with overly sensitive skin or inflammatory skin conditions, such as rosacea. 
• When you start using tretinoin, you can expect tight, dry skin with some flaking and redness—a sign that it’s working. Use a gentle cleanser and moisturizer to help your skin adjust.
• The effects of retinoids are superficial, so they can’t treat acne scars or other depressed scars.

• Average Cost:
• $35

• Range:
• $10 - $140

Your cost will depend on whether your prescription is for a medical condition like acne, which may be covered by insurance (with a co-pay), or for anti-aging concerns.

The average retail price of generic Retin-A (Tretinoin) at a pharmacy is $140 a month. Online coupon sites like GoodRx and Nurx offer savings that can reduce the price to as little as $30, even for concentrations of 0.1%. Nurx and similar sites also offer free online prescriptions and free shipping.

See our complete guide to Retin-A costs

The best time to use Retin-A is in the evening, before you head for bed. Here’s how to do it:

• Clean your skin and allow it to dry completely before applying a pea-size amount of product. (Do not apply to wet skin—this can increase irritation.)
• Dab it on your forehead, cheeks, and chin with your fingertips, then spread it evenly in a thin layer.
• Finish with a gentle moisturizer to offset any dryness. 

During the first few weeks, your skin may get flaky, dry, and irritated. Your provider may recommend starting every third or fourth day. “However, I have found that using it consistently every other night from the start yields the best results,” notes Dr. Reichel. “You can decrease the potency by putting on a moisturizer first, using less than a pea size, or mixing it with a moisturizer. I tell patients to not stop using it even if you will be in the sun or on vacation. You need to be careful with sun exposure, but this does not mean stop using it. If you stop, you will go through the irritating effects all over again,” Dr. Reichel cautions.  

For the most part, prescription retinoids can be easily integrated into your existing skin-care routine, but use caution or avoid layering active ingredients like salicylic acid, benzoyl peroxide, and alpha hydroxy acids.

Related: Mixing These Skin-Care Ingredients Can Do Serious Damage to Your Skin

However, combining it with a topical vitamin C could improve your results. The key to avoid irritation is to use Retin-A at night and vitamin C as part of your morning routine. Some dermatologists also say that using a glycolic lotion in the morning can help exfoliate and reveal fresh, glowing skin.

Sunscreen is crucial while you’re using any kind of retinoid; your skin will be more sensitive to the sun as newer cells are revealed. Retinoids are also photo-inactivated, so exposure to sunlight makes them less effective. To get the best results, apply a broad-spectrum sunscreen daily, with an SPF of 30+. “If you can avoid sun exposure on your face by wearing a hat or seeking shade, that is the best,” notes Dr. Reichel. 

Related: 7 Tricks Derms Swear By for Getting the Best Results with Retin-A

While you're taking Retin-A, it's best to avoid:

• Simultaneous use of other topical medications that could interfere or react with tretinoin, such as strong acids.
• Medicated or abrasive soaps and clarifying cleansers that could further irritate your skin, especially those containing sulfur, resorcinol, or salicylic acid. 
• Cosmetics that have a strong drying effect, such as “mattifying” makeup or products that reduce excess oil.
• Facial products with high concentrations of alcohol, like astringents or toners with alcohol as the main ingredient. Even those created with citrus fruits (lime, lemon, orange, grapefruit, etc.) that have high levels of vitamin C should be used with caution, and only in the morning.

If you’ve been using any of the above ingredients, doctors recommend giving your skin a rest before beginning the use of a retinoid: about 10 days, with most ingredients, or up to 30 days if you’ve been using more potent, astringent products.

Skin irritation is the most common side effect of tretinoin.

• You can mitigate burning, itching, and redness by gradually increasing the potency and amount of tretinoin you put on your skin.
• Avoid applying it to skin that has been cut, sunburned, or recently treated with a laser, chemical peels, or other skin resurfacing procedures. Wait until it’s fully healed to resume use.
• Some people with very sensitive skin, rosacea, or eczema may find that prescription retinoids  are too irritating. For these patients, “using an OTC retinol may be the answer,” says Dr. Reichel. 

Sunburns will be more likely when you’re using tretinoin, which makes the treated skin more sun-sensitive.

• As we mentioned above, daily use of a broad-spectrum sunscreen with SPF of at least 30 is essential.
• Protective clothing, such as a broad-brimmed hat, are recommended.

Retinoid burns are rare but possible.

• When you apply Retin-A, you may feel a stinging, warm, or burning sensation, and your skin may look flushed; this is normal and should subside after a few minutes.
• If you feel a burning sensation that’s beyond your comfort level or lasts longer than a few minutes, wash your face with a gentle cleanser, stop using the product, and ask your doctor if you should switch to a lower dose.
• If you see blisters, crusting, swelling, or discoloration in the affected area, contact your doctor right away. Here's how to prevent and heal burns.

Allergic reactions are also unlikely but possible.

• Seek medical attention if you develop a rash, severe itching, or swelling in or around the treated area, or if you have trouble breathing.

People who are pregnant or breastfeeding shouldn’t use Retin-A.

Related: These Are the Next-Best Ingredients to Use If You Can't Tolerate Retinol, According to Derms

Dermatologists often recommend Retin-A Micro over the traditional formulation.

Its Microsponge system releases small amounts of tretinoin over time, so it’s safer and less irritating for sensitive skin. It also reduces shine, so it’s an especially good choice for oily skin.

The downside? Retin-A Micro can be more expensive, depending on your insurance coverage.

Typically, people first see results within six weeks, but results vary from patient to patient, depending on the severity or type of problem, as well as the formula used. 

Dr. Amy Y. Paul, a dermatologic surgeon in Grand Junction, Colorado, says that “it can take months to see improvement in acne, and you may need additional medications to speed up the process.” 

The key to improving and maintaining your results is consistent use for at least four months. Your results will continue to improve for as long as you continue using it.

Retin-A and other tretinoin products do lose potency with time, so you’ll want to toss expired tubes. 

Store your tube in a cool, dark place and always replace the cap after use, to help maintain its effectiveness. Exposure to air, light, and heat can compromise the chemical structure of the product.

“In regards to cosmeceutical products, the expiry relates to the active ingredients and vitamins within the product,” explains Dr. Chien Kat, a plastic surgeon in Birmingham, England. “You will not see the full benefits from the product due to the ingredients not being as fully active as they once were.” 

Applying Retin-A past its expiration date won’t harm your skin, but you won’t reap as many benefits of it either.

Over-the-counter (OTC) products that include retinol (or retinal, retinyl palmitate, retinyl acetate, retinyl linoleate) are far less potent than prescription-strength tretinoin, so results will take longer to achieve and probably won’t be comparable. However, OTC retinol creams produce of Retin-A, such as redness or peeling, and can still have benefits like brightening, softening, and smoothing.

These vitamin-A derivatives available with a prescription should deliver more comparable results.

• Renova, another tretinoin, works much in the same way as Retin-A to address the signs of aging—like dryness, uneven texture, fine lines, and hyperpigmentation—but it’s enhanced with moisturizers to minimize the risk of irritation. It’s not a good choice for treating acne.
• Isotretinoin is classified as a retinoid, but it’s an oral prescription medication for those patients with severe, cystic acne that shrinks the sebaceous glands. It’s commonly known by the brand names Absorica, Accutane, Amnesteem, Claravis, Myorisan, Sotret, and Zenatane. 
• Tazarotene is a topical foam or gel (0.1% of the vitamin A derivative tazarotene) used to treat acne, fine lines and wrinkles, hyperpigmentation, and psoriasis. Available only by prescription, it’s sold under the brand names Tazorac, Fabior, and Avage. Tazarotene tends to be stronger than tretinoin. If you easily tolerate the highest prescription strength of tretinoin, ask your doctor if tazarotene is right for you.
• Differin (a form of tretinoin called adapalene at 0.1%) treats acne, reduces oil production, and significantly reduces inflammation (and inflammatory acne) on the skin after 12 weeks. It has fewer side effects than Retin-A, and it’s now available over the counter at major retailers.

You might also consider the plant-based retinol alternative bakuchiol. Derived from the flower of the babchi plant, the ingredient is increasingly available in over-the-counter skin-care products. It’s been shown to have retinol-like anti-aging effects, though studies are limited.

Laser resurfacing can also effectively smooth out fine lines and wrinkles, rejuvenating the overall tone and texture of your skin and reducing the appearance of such conditions as acne scars, age spots, and hyperpigmentation. Dr. Goldberg says, “For deeper scars that extend into the deep layer of skin—called the dermis—lasers, excision, chemical peels, or dermabrasion are needed to get the best improvement.” 

Related: Can You Eat Your Retinol?

Varani, James, et al. “Vitamin A Antagonizes Decreased Cell Growth and Elevated Collagen-Degrading Matrix Metalloproteinases and Stimulates Collagen Accumulation in Naturally Aged Human Skin1.” Journal of Investigative Dermatology, vol. 114, no. 3, Mar. 2000.

Bouloc, Anne, et al. “A Double-Blind Randomized Study Comparing the Association of Retinol and LR2412 with Tretinoin 0.025% in Photoaged Skin.” Journal of Cosmetic Dermatology, vol. 14, no. 1, Jan. 2015.

Chaudhuri, R. K., and K. Bojanowski. “Bakuchiol: a Retinol-like Functional Compound Revealed by Gene Expression Profiling and Clinically Proven to Have Anti-Aging Effects.” International Journal of Cosmetic Science, vol. 36, no. 3, June 2014.

Mukherjee, Siddharth, et al. “Retinoids in the Treatment of Skin Aging: an Overview of Clinical Efficacy and Safety.” Clinical Interventions in Aging, vol. 1, no. 4, Dec. 2006.

Pullar, Juliet M, et al. “The Roles of Vitamin C in Skin Health.” Nutrients, vol. 9, no. 8, Aug. 2017.