How is tretinoin different from retinol?

What actually changes?

Both belong to the retinoid family, a group of vitamin A based ingredients. Retinol converts first to retinaldehyde and then to tretinoin. Tretinoin skips those conversion steps. That difference means a retinol percentage is not an equivalent tretinoin strength.12

Tretinoin has the strongest clinical evidence for treating signs of skin aging, so the longer cosmetic product name does not win by default. It improves wrinkles and uneven pigmentation associated with photoaging, meaning premature aging caused by ultraviolet exposure. Retinol also has useful effects, but evidence for cosmetic retinol formulations is less robust.15

Which should you choose?

For mild fine lines, uneven pigmentation or texture, start with the least intense retinoid formula rather than going straight to tretinoin. Choose a low strength retinol if available.2

For acne that is not improving with self treatment, or spots that are deep, painful or leaving scars, see a doctor rather than repeatedly changing cosmetic serums. Tretinoin is one prescription option; more severe acne can need other treatments.6

How do you start?

1. 1For retinol, test a small patch first and watch for redness or itching over a couple of days. For tretinoin, follow your prescribed starting schedule.
2. 2At bedtime, wash gently and let your skin dry. Do not scrub.
3. 3Apply a thin layer. General retinol guidance uses about a pea sized amount for the face, avoiding the eyes, mouth and nose. For tretinoin, use the amount prescribed and keep it away from those areas.
4. 4Start retinol every other night, or less often if needed, and build up gradually. Tretinoin is usually used daily at bedtime, but your prescription takes priority.
5. 5Use moisturizer to help with dryness. During the day, use sunscreen, protective clothing and shade.

Before combining tretinoin with other topical medicines, including benzoyl peroxide or salicylic acid, ask your prescriber. Avoid preparations containing lots of alcohol or menthol, which can sting treated skin.4

How long do results take?

Retinol takes several weeks to show visible improvement, and changes in wrinkles usually take several months. With tretinoin, acne can worsen initially, then improve after 2 to 3 weeks, sometimes taking more than 6 weeks. Fine wrinkle improvement takes 3 to 4 months, sometimes up to 6 months. Benefits can gradually fade after stopping tretinoin.34

Who should be careful?

Both can cause dryness, redness, peeling and burning. If you already have substantial dryness, skin allergies or persistent redness, discuss alternatives before starting. In darker skin, irritation can trigger dark marks, making a slow introduction and moisturizer particularly useful.23

Do not use retinoids during pregnancy. Tretinoin should also be avoided when planning pregnancy. Discuss either product with your clinician if you are breastfeeding; call your prescriber if you become pregnant while using tretinoin.2347

Do not apply tretinoin to sunburned skin or areas affected by eczema. Contact your doctor if irritation is severe or persistent. Call immediately for rash, hives, or pain or discomfort at the treatment area.4