Can you exfoliate while using tretinoin?

Why adding an exfoliant can backfire

Tretinoin increases production of new skin cells and unclogs pores. It can also cause dryness, stinging and peeling. Exfoliation removes dead cells from the skin's outer layer, but it is not a compulsory extra on the skincare shopping list. Scrubs and brushes remove cells physically; chemical exfoliants, including alpha and beta hydroxy acids, dissolve them. Adding either method to irritated skin is not a useful way to deal with tretinoin flakes.12

Should you use acids, scrubs or a washcloth?

If you use tretinoin for acne, choose gentle cleansing rather than exfoliation. Scrubbing with washcloths, sponges or other tools can irritate skin and make acne worse. Gentle cleansing uses fingertips rather than scrubbing tools, so the bathroom does not need an equipment upgrade. Ask your prescriber before adding salicylic acid or another topical medication. Do not assume that an acid is suitable simply because it is sold without a prescription.234

If you still want to exfoliate

1. 1Discuss the exact exfoliant with your prescriber, especially if it contains a medication. Keep tretinoin on its prescribed schedule rather than changing the dose to accommodate another product.
2. 2Avoid strong chemical or mechanical exfoliation if you have darker skin or develop dark spots after irritation. Aggressive exfoliation can increase pigmentation. Dry or sensitive skin also needs a gentler approach.
3. 3Do not exfoliate sunburned skin, open cuts or wounds. If tretinoin has left your skin dry, peeling or sensitive, leave exfoliation out rather than trying to scrub the flakes away.
4. 4If exfoliation is appropriate, apply a scrub or rinse off chemical exfoliant gently with small circular motions for about 30 seconds, then rinse with lukewarm water. Follow the product's directions rather than applying that timing to a leave on acid.
5. 5Apply moisturizer immediately afterward. Frequency depends on skin type and method; stronger exfoliation needs less frequent use. There is no universal weekly schedule to add to a tretinoin routine.

What should your routine include instead?

Wash with a mild cleanser, let skin dry as directed and apply a thin layer of tretinoin at bedtime exactly as prescribed. A moisturizer can help with dryness. Outdoors, use broad spectrum, water resistant SPF 30 or higher, protective clothing and shade. Acne treatment takes several weeks to a few months to show a difference; adding exfoliation is not a substitute for giving treatment time.23

When should you contact your doctor?

Contact your doctor if dryness, burning, peeling, redness or swelling is severe or does not go away. Call immediately for a rash, hives or pain at the treatment area. Discuss pregnancy, plans to become pregnant or breastfeeding with your prescriber; call your doctor if you become pregnant while using tretinoin.2