Can I use BHA and tretinoin?

Do you need both?

Tretinoin is a prescription retinoid, a type of medication that clears pores and treats blackheads, whiteheads and some pimples. Salicylic acid also opens clogged pores and exfoliates the skin. Their jobs overlap, so having clogged pores does not automatically mean you need both. Dermatologists sometimes use several topical medications to address different causes of acne. Two treatments can belong in one plan, but a crowded bathroom shelf is not a treatment plan.3

Can you alternate nights or use BHA in the morning?

Do not treat morning versus evening, or alternating nights, as permission to combine them. The precaution concerns using both on the same treated skin, not just applying them in the same sitting. Ask your prescriber whether to include salicylic acid at all, which product to use and how often. Salicylic acid directions vary by product and strength; there is no single schedule that fits every cleanser, liquid or gel.1

How to follow an approved routine

1. 1Confirm the plan before starting BHA. Tell your prescriber about your other topical treatments and any previous retinoid irritation.
2. 2Test a new salicylic acid product on one or two small affected areas for three days. If no reaction or discomfort occurs, follow its label and your doctor's directions.
3. 3Cleanse gently without scrubbing. Follow your own tretinoin directions: for example, the 0.08% microsphere gel requires patting skin dry, then applying a thin layer across the affected area once daily in the evening. Keep it away from eyes, mouth and nose creases.
4. 4Use moisturizer every day to help tolerate drying treatments. Your dermatologist can advise whether applying moisturizer before tretinoin would help, and whether to change the amount or frequency of tretinoin.
5. 5Protect exposed skin with sunscreen offering broad spectrum protection, SPF 30 or higher and water resistance. Seek shade and wear protective clothing.

Choose a moisturizer labelled noncomedogenic, meaning unlikely to clog pores, or oil free. Moisturizer has a practical job here, rather than being the supporting cast that never gets a speaking part.4

What should you expect?

Allow at least six to eight weeks for an acne treatment plan to start producing fewer breakouts. Salicylic acid can take several weeks or longer for its full benefit. Tretinoin can initially worsen inflammatory breakouts; if treatment is otherwise tolerated, that alone is not a reason to stop. Using extra tretinoin does not speed up results and can cause marked irritation.123

When should you stop or get help?

If irritation develops, withhold BHA and contact your prescriber about the routine. Stop tretinoin for severe irritation. Do not apply salicylic acid to broken, red, swollen or irritated skin, or tretinoin to eczema or sunburn. Get medical advice for persistent or severe stinging. Stop salicylic acid and seek emergency help for difficulty breathing, throat tightness, faintness or facial swelling. Discuss salicylic acid with your doctor if pregnant, planning pregnancy or breastfeeding. See a doctor for deep painful spots, scarring or acne that is not improving with treatment.125