Tretinoin side effects

Can acne get worse before it improves?

Acne can worsen during the first 7 to 10 days, with more spots and red, scaling skin. Spots can start improving after 2 to 3 weeks, although improvement sometimes takes more than 6 weeks. Early worsening alone is not a reason to abandon treatment, but pain or a rash needs medical advice.1

For acne treatment generally, allow at least 6 to 8 weeks before expecting fewer breakouts. Judge progress over weeks rather than after each application. Follow the treatment plan instead of adding more products whenever a spot appears.2

How should you apply tretinoin?

1. 1Wash your hands and the treatment area with a mild, nonmedicated cleanser and water. Let the skin dry as directed.
2. 2Use clean fingertips to spread a thin layer over the affected area. Avoid the eyes, ears, mouth and corners of the nose. Do not apply to sunburned skin or eczema.
3. 3Apply at bedtime on the schedule prescribed. Do not use extra tretinoin to make up for a missed application.

How can you reduce irritation?

Tell your dermatologist if tretinoin irritates your skin. Irritation does not usually mean you are allergic, and a retinoid can still be an option. Your dermatologist can recommend a smaller amount, fewer applications or moisturizer before tretinoin. Make those changes with their help rather than choosing a new schedule yourself.2

For acne prone skin, wash no more than twice daily with a mild cleanser and lukewarm water. Frequent washing can make irritation worse. If dryness is a problem, use a fragrance free, water based moisturizer.3

If you wear makeup, choose water based products described as noncomedogenic, meaning less likely to block pores, and remove makeup before bed. Cleanser and moisturizer have useful jobs in an acne routine, which does not require a bathroom shelf with its own management team.3

Do not add benzoyl peroxide, salicylic acid, hair removers or other topical medicines without your doctor's approval. Products high in alcohol or menthol can sting. Tell your prescriber about medicines and supplements you already use.1

Protect treated skin from the sun

Retinoids can make skin more sensitive to sunlight. Seek shade, wear protective clothing and apply sunscreen to uncovered skin. Choose broad spectrum, water resistant sunscreen with SPF 30 or higher. For sensitive skin, look for sunscreen containing zinc oxide or titanium dioxide.24

Who needs extra care?

Discuss existing dryness, skin allergies or substantial redness and inflammation with a dermatologist before starting a retinoid. People with darker skin should watch closely for irritation because it can trigger dark marks, called hyperpigmentation. Starting slowly and using moisturizer can reduce that risk; agree on the starting schedule with your prescriber.4

Do not use retinoids during pregnancy. Discuss plans for pregnancy or breastfeeding with your prescriber. If you become pregnant while using tretinoin, call your doctor.14