Tretinoin vs isotretinoin: What's the difference?

How do tretinoin and isotretinoin compare?

Which treatment fits your acne?

Topical tretinoin fits acne with blackheads and whiteheads and can also reduce inflamed spots with continued use. Discuss isotretinoin with a dermatologist if you have deep, painful nodules or cysts, particularly when other treatments have failed. Seek medical help for acne causing scars or affecting your mental health rather than repeatedly changing skincare.345

Tretinoin can reduce fine wrinkles; oral isotretinoin's role here is severe acne. Reducing fine wrinkles is not the same as removing them, a distinction that skincare marketing rarely puts in large type.12

How do you use each treatment?

For topical tretinoin:

1. 1Wash your hands and the affected skin with a mild cleanser, then let the skin dry as directed.
2. 2Apply a thin layer over the affected area, not just individual spots.
3. 3Keep tretinoin away from eyes, mouth and nose corners. Do not apply it to sunburned skin or eczema.
4. 4Follow your prescription's frequency. A minimal amount on alternate nights initially can reduce irritation; use moisturizer for dryness.

Swallow isotretinoin capsules whole and follow the dose and food instructions on your packet. Your clinician adjusts treatment to your response and side effects. Keep regular appointments and blood tests. In the United States, isotretinoin requires enrollment in iPLEDGE REMS and monthly follow up.2467

How long do results take?

Tretinoin works gradually: acne can worsen during the first 7 to 10 days, with improvement after 2 to 3 weeks or sometimes more than 6 weeks. Fine wrinkle improvement takes months. Isotretinoin also takes several weeks or longer to show its full benefit. Courses last several months and are tailored individually. Acne can continue improving after the course ends, and clearance can be permanent for some people.146

Tretinoin's improvement can gradually disappear after stopping, so an empty tube is not necessarily a graduation certificate.1

What should you change in your routine?

Both treatments can cause dryness and sun sensitivity. During isotretinoin treatment, moisturize damp skin, use petroleum jelly on dry lips and wear broad spectrum SPF 30 or higher sunscreen. Avoid salicylic acid, benzoyl peroxide, chemical peels and waxing. With tretinoin, add other acne medicines only as directed by your prescriber. Tell the isotretinoin prescriber about all medicines and supplements, especially doxycycline, tetracycline and vitamin A.1237

What about pregnancy and breastfeeding?

Do not use topical tretinoin during pregnancy. Discuss pregnancy plans or breastfeeding before starting. Oral isotretinoin must not be taken during pregnancy or breastfeeding. Pregnancy prevention starts at least one month before treatment and continues for one month afterwards. US requirements include pregnancy tests and two acceptable forms of birth control or abstinence. Stop isotretinoin and contact your doctor immediately if you think you are pregnant.12367

When should you get medical help?

Contact your doctor promptly for painful tretinoin irritation, hives or rash. During isotretinoin treatment, report mood changes immediately. Get urgent help for severe abdominal pain, breathing difficulty, seizures or thoughts of harming yourself. Discuss persistent or troublesome side effects with your clinician rather than changing the isotretinoin dose yourself.127