What is Tretinoin

Dr Jason Thomson

Written By

Dr Jason Thomson

MBBS, MRCP (UK), MSc

GMC:7139760

Tretinoin is a prescription strength topical cream used to treat acne, hyperpigmentation, sun damaged cells and fine lines and wrinkles. It belongs to a family of synthetic and naturally occurring compounds called retinoids that are all derived from Vitamin A. Tretinoin works directly on the retinoic acid receptors found on your skin cells, making it the most powerful retinoid available. Tretinoin was first used in 1962 and has over 50 years years of scientific evidence resulting from clinical use to support its efficacy.

Tretinoin is a prescription strength topical cream that belongs to a family of synthetic and naturally occurring compounds called retinoids that are all derived from Vitamin A.

What is Tretinoin used for?

Tretinoin works to accelerate new skin cell growth, speeding up the removal of dead cells and debris that can block pores. It also works to repair sun-damaged cells, and boosts the production of collagen; a protein that acts like scaffolding for your skin.

Tretinoin in the treatment of:

  • sun damaged cells
  • acne
  • making pores appear less visible
  • fine lines and wrinkles
  • texture
  • pigmentation
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What is the history of Tretinoin?

Tretinoin was the first topical retinoid introduced in 1962 and has been the mainstay of acne treatment for decades (1). Numerous trials have demonstrated Tretinoin is effective as monotherapy in mild-moderate comedonal or inflammatory acne where it significantly reduces both comedones and inflammatory lesions (1, 2, 3). Initial response to Tretinoin is observed 2-3 weeks into treatment, but substantial clinical improvement can be observed at 4-6 weeks and maximum improvement occurs after 3-4 months (4).

The anti-ageing effects of Tretinoin initially came from observations in the 1980s from post-adolescent females with persistent acne applying topical Tretinoin. In addition to treating acne, they often reported smoother, less wrinkled skin. Since then many studies have been conducted into Tretinoin and anti-ageing and randomised trials have confirmed its efficacy in slowing the progression as well as reversing the signs of ageing. Tretinoin works in the epidermis stimulating cell renewal and enhancing the cell layer, reducing pigmentation and normalising sun-damaged cells. It also works in the dermis to increase collagen, elastin and glycosaminoglycans which thickens the dermal layer and makes the skin appear plump.

Tips from the derm
“Tretinoin can be used in place of an eye cream if used carefully. Buffer your Tretinoin by applying a thin layer moisturiser immediately before application serves to effectively dilute the concentration and make it less potent and more tolerated for the eye area.”

How to apply Tretinoin cream

  1. Remove makeup or SPF with gentle cleanser
  2. Perform a second gentle cleanse to clean skin
  3. Pat dry with a towel to avoid irritation
  4. Ensure skin is completely dry
  5. Apply Tretinoin all over face
  6. Wait ten minutes
  7. Apply moisturiser
Tips from the derm
“If irritation or purging occurs after use, you should add a layer of moisturiser to your skin as a buffer before your topical Tretinoin cream.”

How long does a Tretinoin prescription take to work?

When you start to use your Tretinoin prescription, you should start to see a difference in your skin from three weeks onwards, it can take up to 12 weeks for some people to see visible results with significant improvement after 6 months. Ongoing use as maintenance is important to continue seeing the benefits.

Is long term use of Tretinoin safe?

Studies have been done where people have used Tretinoin regularly for between 1 and 4 years and these have shown that clinical improvements (as well as improvements seen under a microscope from biopsies) are seen over long periods and these benefits increase over time. These studies have shown that consistent use for at least 6 months is needed to see best results and they also tell us that long-term use of Tretinoin is safe, with no untoward effects.

See what others say

"Skin & Me has honestly changed my life in the way that only people with severe acne can understand."

Stef

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"I am in my third month in and nothing else has worked before like this. I have not had a SINGLE SPOT since I started and my skin is smooth and radiant."

Faaiza

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"It has helped so much with my acne scaring and reducing redness on my face and has also helped me build a better skin care routine!"

Beth

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"I can’t believe how much difference my personalised treatment makes. My skin has completely cleared up and I am more confident than I have ever been."

Sarah

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"Absolute magic!!!! After 3 months I am completely spot free, I mean not even one tiny spot! My skin surface is smoothing out and I’m am so happy."

Harriet

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"My acne has been horrendous this year... until I started my journey with Skin + Me. I am literally kicking myself for not trying it sooner!"

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Testimonials

"Skin & Me has honestly changed my life in the way that only people with severe acne can understand."

Stef

via Trustpilot

"I am in my third month in and nothing else has worked before like this. I have not had a SINGLE SPOT since I started and my skin is smooth and radiant."

Faaiza

via Trustpilot

"It has helped so much with my acne scaring and reducing redness on my face and has also helped me build a better skin care routine!"

Beth

via Trustpilot

"I can’t believe how much difference my personalised treatment makes. My skin has completely cleared up and I am more confident than I have ever been."

Sarah

via Trustpilot

"Absolute magic!!!! After 3 months I am completely spot free, I mean not even one tiny spot! My skin surface is smoothing out and I’m am so happy."

Harriet

via Trustpilot

"My acne has been horrendous this year... until I started my journey with Skin + Me. I am literally kicking myself for not trying it sooner!"

Samantha

via Trustpilot

Are there side effects from using a Tretinoin prescription?

Tretinoin side effects include dry skin, redness, irritation and mild peeling – which usually occur in the first few weeks of treatment, while your skin adjusts to the ingredient’s powerful properties.

There’s also a chance of purging too, which is where the increase in cell turnover can cause breakouts. This can appear as a few more blackheads, whiteheads or bigger, red spots that can take a few weeks to clear up again. While it can feel as though the treatment is making your skin worse, purging is actually a normal process in clearing your skin – a bit like a spring clean.

Tips from the derm
“ Tretinoin can make your skin more sensitive to sunlight, especially during the first 3 - 6 months of using it. It’s essential to wear a broad spectrum sunscreen every day (SPF 50) and try to avoid unnecessary or prolonged exposure while you’re using Tretinoin, especially during peak sunlight hours and cover up with protective clothing to shield your skin from UV-related damage.”

What should you know before using Tretinoin cream?

Certain underlying skin conditions, like rosacea and eczema, can cause sensitivity and you’ll need to be more careful introducing Tretinoin if you suffer from these. Rosacea is a common cause of skin sensitivity whereby the skin often feels dry and reacts easily. It can often lead to redness and breakouts and can be mistaken for acne. Using Tretinoin when you have rosacea is not always going to lead to problems (and in fact it can be helpful in certain situations), but the inflammation in rosacea needs to be controlled first before any Tretinoin is applied.

It’s important to remember that Tretinoin is a prescription-only active ingredient, and the first thing that needs to be considered is whether it’s appropriate for your skin.

It’s also worth noting that prescription retinoids and over the counter retinoids can’t be used in pregnancy and need to be avoided due to the risk of congenital abnormalities in infants with its use.

Skin irritation is a common expected side effect of retinoids particularly during the first month of use. When starting off your retinoid journey we advise to avoid any other active skincare ingredients in particular exfoliants such as AHA/BHAs and harsh cleansers or toners to minimise the risk of irritation. These products can later be introduced once retinoids are tolerated to maximise the benefit of both active ingredients.

Skin irritation is a common expected side effect of retinoids particularly during the first month of use. To minimise the side effects we advise you start with the lowest concentration of Tretinoin recommended for your skin which will be determined by your prescriber based on a number of factors including skin type, previous retinoid use, skin concern and any other skin conditions that may affect treatment. The potency of the retinoid will typically increase gradually and as tolerated. If you have a history of sensitive skin you may benefit from lower initial concentrations.

Our Prescribers will be able to assess your skin and advise if Tretinoin is safe for you to use.

Tretinoin vs Retinol, what’s the difference?

Retinoids are a large family of synthetic and naturally occurring compounds derived from vitamin A. Retinol and Tretinoin (as well as others such as retinaldehyde and retinyl palmitate) are types of retinoid. Weaker retinoids like Retinol need to be converted (by skin enzymes) to retinoic acid which activates retinoid receptors found on skin cells. The conversion of retinol to retinoic acid is slow and varies between individuals. Tretinoin is already retinoic acid and so works directly on the skin’s receptors. This is the reason over-the-counter retinoids are less effective than a Tretinoin prescription, and why it takes longer to see results using shop bought creams.

Retinol, the biologically active form of vitamin A, presents topically only a small retinoid-like action when compared to Tretinoin and is much less effective in anti-ageing. Retinol is commonly found in many over-the-counter anti-ageing preparations and we are therefore in a much stronger position to be able to offer prescription strength Tretinoin for anti-ageing to our customers. When we prescribe our retinoid experienced pathways we do not consider retinol as providing any retinoid experience as it is so much weaker than prescription retinoids. For this reason we only ask about whether or not customers apply prescription-strength retinoids.

References

  1. Thielitz A, Abdel‐Naser MB, Fluhr JW, Zouboulis CC, Gollnick H. Topical retinoids in acne–an evidence‐based overview. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2008;6(12):1023-31.
  2. Krautheim A, Gollnick HPM. Acne: topical treatment. Clinics in dermatology. 2004;22(5):398-407.
  3. Krishnan G. Comparison of two concentrations of Tretinoin solution in the topical treatment of acne vulgaris. The Practitioner. 1976;216(1291):106-9.
  4. Webster GF. Topical Tretinoin in acne therapy. Journal of the American Academy of Dermatology. 1998;39(2):S38-S44.
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