Which tretinoin strength should you use for acne?

How should you choose a strength?

General retinoid guidance favours starting with a less intense formula and introducing it gradually. For prescription tretinoin, agree on the strength and schedule with your dermatologist instead of setting your own escalation plan. The percentage on the tube is only one part of a treatment plan, not a performance review.3

If irritation develops, your dermatologist can recommend a smaller amount, less frequent application or moisturizer before the medication. Make those changes with their help. Previous irritation does not automatically mean you are allergic or that every retinoid is unsuitable. For darker skin, irritation deserves particular attention because it can trigger dark marks.13

When is tretinoin a useful acne treatment?

Tretinoin is a prescription retinoid, a medicine in the vitamin A family that helps prevent clogged pores. Topical retinoids treat blackheads, whiteheads and some pimples, and can also be used to maintain clearer skin after acne is controlled. Your dermatologist can combine treatments to address different causes of acne rather than relying on one medication alone.13

Tretinoin comes as a cream, gel or lotion, which are alternative forms rather than a collection your bathroom needs to complete.2

How do you apply tretinoin?

1. 1Wash your hands and the affected skin with a mild 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, mouth, ears, nose corners, sunburn and areas affected by eczema.
3. 3Apply at bedtime on your prescribed schedule. Standard directions are daily use, but your dermatologist can adjust frequency for irritation.
4. 4Do not apply extra medication to compensate for a missed dose.

Do not add benzoyl peroxide, salicylic acid or other topical medicines unless your doctor directs you. For dryness, a fragrance free, water based moisturizer is an option. During the day, seek shade, wear protective clothing and use a noncomedogenic sunscreen, meaning one formulated not to clog pores, with broad spectrum protection, SPF 30 or higher and water resistance.124

How long should you wait before reassessing?

Tretinoin works slowly, and acne can worsen during the first 7 to 10 days. Some improvement can begin after 2 to 3 weeks, although it sometimes takes more than 6 weeks. Broader acne treatment plans commonly need at least 6 to 8 weeks before fewer breakouts appear, and treatments can take up to 3 months to work. An early lack of improvement is not, by itself, a reason to increase the strength.124

When should you contact your doctor?

Contact your doctor for severe or persistent dryness, burning, peeling, swelling or blistering. Call immediately for rash, hives, itching or pain at the treatment area. Do not use retinoids during pregnancy; discuss pregnancy plans or breastfeeding before treatment, and call your doctor if you become pregnant while using tretinoin.23

Deep, painful spots, scarring, acne that is not improving with treatment, or acne affecting your mental health need medical review. These are reasons to reassess the treatment plan, not simply shop for a higher percentage.5