Retin-A: What You Should Know
What is Retin-A?
Dermatologists consider Retin-A (aka tretinoin or retinoic acid) the go-to skin-care product to improve skin tone, smooth fine lines, reverse sun damage, and treat acne. A potent form of vitamin A, it can be prescribed by your doctor or dermatologist as a cream, gel, or liquid, in dosage strengths ranging from 0.01% to 0.25% tretinoin.
The product was initially developed—and approved by the U.S. Food and Drug Administration (FDA)—as an acne treatment, but doctors soon realized that it had other anti-aging benefits. “With more than 30 years of scientific studies and evidence, Retin-A is by far the most effective topical cream for preventing fine lines that we know of—other than sunscreen,” says Dr. Faiyaaz Kalimullah, a dermatologist in Chicago.
Many over-the-counter (OTC) skin-care products contain retinol, which has some of the same benefits but doesn’t yield the same results you’d get with prescription-strength topical tretinoin.
This FDA-approved topical option is easy to use at home.
Most patients report minimal side effects.
Decades of research have proven it’s effective, delivering exceptional results with consistent use.
Starting tretinoin early means big benefits from boosted collagen, both now and in later years.
RealSelf members who said it was Worth It saw dramatic improvements in their skin.
Results aren’t apparent at first; you’ll need to use it regularly for four to six weeks. Many people give up midway, but it’s important to keep going.
Retinoids are not recommended for people with overly sensitive skin.
When you start using tretinoin, 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.
You shouldn’t use Retin-A if you are nursing, pregnant, or planning to get pregnant.
“First, it increases cell turnover, so dead skin cells are shed faster,” says Dr. Dana Goldberg, a plastic surgeon in Jupiter, Florida. “This evens out skin tone and brightens the skin. Second, Retin-A stimulates collagen growth,” which minimizes fine lines and smooths the skin’s overall texture.
“If I could get everybody whose skin can tolerate it to start using Retin-A in their 30s, they’d have such better skin in their 60s."
Every night, 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). Divide it by dabbing 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.
For the most part, prescription retinoids can be easily integrated into your existing skin-care routine. Cleanser, moisturizer, and facial oils can be applied as usual. However, use caution or altogether avoid layering active ingredients (i.e., salicylic acid, benzoyl peroxide, alpha hydroxy acids).
UV protection is crucial while you’re using retinoids. Your skin will be more sensitive to the sun as newer cells are revealed. Plus, retinoids are photo-inactivated, which means that exposure to sunlight makes them less effective. For best results, apply a sunscreen daily that protects you from broad-spectrum UVA and UVB rays, with an SPF of 30 or higher, and apply Retin-A at night, before bed.
Dermatologists may also suggest applying a topical vitamin C to improve your results. “If you’re using sunscreen and vitamin C in addition to Retin-A, it will help prevent wrinkles and fine lines from forming because you’re practicing preventive skin care,” says Las Vegas dermatologist Dr. F. Victor Rueckl.
The way to apply them is simple, says Austin, Texas, plastic surgeon Dr. Randy Buckspan. “Just use Retin-A at night and vitamin C in the morning—never together,” since that can lead to more irritation. Dr. Buckspan also recommends using a glycolic lotion in the morning to exfoliate and help reveal fresh, glowing skin.
Any other topical medication, which could interfere or react with tretinoin
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
Face and body 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
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 is fine, with most ingredients,” says Dr. Rueckl. “But if you’ve been really aggressive with drying and astringent products, then it may take even 30 days or so before moving to a retinol treatment.”
When you apply Retin-A, you may feel a stinging, warm, or burning sensation, and your skin may get pink. This is normal and should go away after a few minutes. However, if you have 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.
During the first few weeks of using a retinoid, your skin may get flaky and dry, and it can look red and irritated. To minimize this, Minneapolis plastic surgeon Dr. Richard Tholen recommends applying it “maybe every third or fourth day at first, allowing your skin to recover between Retin-A exposures. As you tolerate the effects better, you can increase to every other day and eventually to daily use.”
Still, skin irritation can continue to be a problem for some. “If you have very sensitive skin, eczema, or rosacea-prone skin, you may not be a good candidate,” says Dr. Michelle Green, a dermatologist in New York City. “There are many patients who can’t tolerate the side effects.”
Dermatologists often recommend Retin-A Micro over the traditional formulation. Its Microsponge system releases small amounts of tretinoin over time. They say it delivers more even results with less irritation, so it’s safer for sensitive skin. It also reduces shine, so it’s great for oily skin. (Note: Retin-A Micro can be more expensive, depending on your insurance coverage.)
Typically, people see first results in four to six weeks, but results vary from patient to patient, depending on the severity or type of problem.
“Most of my patients take about six weeks to several months to … see changes in the skin,” says Dr. Amy Y. Paul, a dermatologic surgeon in Grand Junction, Colorado. “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 over time. Dr. Emily Altman, a dermatologic surgeon in Berkeley Heights, NJ, explains that “It takes close to four months of consistent Retin-A use to really see results. The good news is that results continue improving for as long as you continue using them.”
“The tretinoin cream has helped smoothed my overall skin texture and has also minimized some fine lines."
To maintain its efficacy, you should take care to store your tube in a cool, dark place and always replace the cap after use. Exposure to air, light, and heat can compromise the chemical structure of the product. Tretinoin also loses potency with time, so you’ll want to toss expired tubes.
“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 the benefits of it either.
According to RealSelf members, Retin-A costs about $125 per month, on average. Your costs will depend on whether your prescription is for a medical condition like acne, which would likely be covered by insurance, or for cosmetic concerns.
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 few or none of the uncomfortable side effects 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. It’s sold under the brand names Tazorac, Fabior, and Avage and is available only by prescription.
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.”
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.
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.