Tretinoin cream for acne

Does tretinoin cream help with acne?

Yes. Acne develops when oil and dead skin cells form plugs inside hair follicles. These plugs produce blackheads and whiteheads, and inflammation can lead to red bumps and spots containing pus. Tretinoin helps skin cells inside the follicle separate and turn over, reducing the formation of small plugs and helping existing plugs clear. Washing alone does not remove the blockage inside a follicle. Tretinoin belongs to the retinoid family of vitamin A based treatments, and topical retinoids have a strong recommendation for acne treatment.1345

Which strength should you use?

Use the strength your prescriber chooses, rather than moving straight to the highest percentage. General retinoid guidance favors starting with a less intense formula and building up slowly. Tretinoin comes as cream, gel and lotion; the directions below concern cream, and your own prescription instructions take priority.25

How do you apply tretinoin cream?

1. 1Wash your hands and the affected skin with mild soap and water. Avoid medicated, abrasive or drying cleansers.
2. 2Let your skin dry as directed in your prescription instructions.
3. 3Use clean fingertips to spread a thin layer over the affected area.
4. 4Keep the cream away from your eyes, mouth, ears, nose corners and other sensitive openings. Do not apply it to sunburned skin or areas affected by eczema.
5. 5Apply at bedtime on the schedule your prescriber gives you. Do not use more cream or apply it more often than prescribed.

Daily bedtime use is the usual schedule, but general retinoid guidance suggests starting every other night and gradually increasing use to limit irritation. Ask your prescriber which schedule fits your cream. If irritation develops, your clinician can advise less frequent application, a temporary break or stopping treatment.245

What should the rest of your routine look like?

Wash gently with a mild cleanser and lukewarm water, without turning cleansing into a polishing service. Avoid scrubbing and repeated washing. Use a water based moisturizer if acne treatment leaves your skin dry or peeling. A fragrance free moisturizer is a useful choice for dry skin. During the day, use sunscreen and protective clothing, seek shade and avoid tanning beds. If your skin is sensitive, consider a sunscreen containing zinc oxide or titanium dioxide.357

Choose water based cosmetics described as noncomedogenic, meaning less likely to block pores. That label does not rule out breakouts from a particular product, so stop using cosmetics that make your acne worse. Avoid rubbing alcohol and very drying toners, which add drying products to a routine that already contains an acne medicine.37

Can you combine tretinoin with other acne treatments?

A clinician can combine different acne treatments for better results, including retinoids, benzoyl peroxide and antibiotics. That does not mean you should add them yourself. Check before combining tretinoin with other topical medicines, particularly benzoyl peroxide, salicylic acid, sulfur or resorcinol products. Hair removal preparations also need checking. If another treatment has already irritated your skin, allow that irritation to settle before starting tretinoin. Strongly drying cosmetics, abrasive cleansers and products containing high concentrations of alcohol also need caution.126

How long does tretinoin take to work?

Acne can initially worsen during the first 7 to 10 days, with more spots, redness and scaling. Spots can start improving after 2 to 3 weeks, although improvement sometimes takes more than 6 weeks. Acne treatments can take up to 3 months to work. Early worsening is not a reason to increase the dose, and painful or severe irritation needs medical advice rather than being treated as something to endure. Improvement can gradually disappear after tretinoin is stopped.23

Is tretinoin cream good for acne?

Tretinoin is an established option, especially when blocked pores are part of the problem. Mild acne can be suitable for a topical retinoid, while more widespread inflamed acne can need a combination of treatments. Severe acne, or acne that has not responded to standard treatment, needs a medical review; oral isotretinoin is a separate medicine used in those situations. A cream alone should not delay getting help for deep, painful nodules, cysts or developing scars.135

Tell your prescriber about skin allergies, marked dryness, eczema or other skin conditions before starting. Tretinoin can severely irritate skin affected by eczema. People with darker skin should watch irritation closely because inflammation can trigger dark marks, called hyperpigmentation. Starting slowly and using moisturizer helps reduce that risk. Acne associated with menstrual changes, new hair growth or substantial scarring deserves a dermatologist's assessment before trying a retinoid.45

Can you use tretinoin during pregnancy?

Do not use retinoids during pregnancy. Tell your prescriber if you are planning pregnancy or breastfeeding so your acne treatment can be reviewed. If you become pregnant while using tretinoin, call your doctor.25

When should you stop or contact your doctor?

Dryness, peeling, redness, burning and stinging can occur. Contact your doctor if symptoms are severe or persistent. Stop using the cream if you develop a reaction suggesting allergy or significant chemical irritation. Call your doctor immediately for rash, hives or pain at the treated area. Do not apply tretinoin to sunburned skin until it has fully recovered. Wind and cold can also irritate treated skin.26

Arrange a medical review if acne remains uncontrolled after several months, is getting worse, causes scarring or is affecting your emotional wellbeing. Moderate or severe acne needs medical treatment, and nodules or cysts need proper assessment to reduce the risk of permanent scars. Avoid picking or squeezing spots, which can worsen them and cause scarring.37

What if you miss an application?

Apply the missed dose when you remember, unless it is almost time for your next dose. In that case, skip it and return to your normal schedule. Do not apply extra cream to make up for a missed application.2