Table of Contents
What is Tretinoin?
Tretinoin (Altreno, Atralin, Avita, Retin-A) is a retinoid indicated for the topical treatment of acne vulgaris. It can also be used for fine lines, wrinkles, dark spots, melasma, post-inflammatory hyperpigmentation, post-inflammatory erythema, reverse signs of photoaging, preventing the formation of precancer or Actinic keratosis
The tretinoin cream contains tretinoin in either of three strengths, 0.1%, 0.05%, or 0.025%.
- Patients should discontinue treatment if hypersensitivity to any of the ingredients is noted.
- The safety and effectiveness of Tretinoin in pediatric patients below the age of 12 have not been established.
What should I tell my doctor before using Tretinoin?
You should tell your doctor if you have any medical conditions including:
- have eczema or any other skin problems.
- have a sunburn.
- are pregnant or planning to become pregnant.
- are breastfeeding or plan to breastfeed.
Who can use Tretinoin?
When starting Tretinoin you have to know what vehicle the Tretinoin is suspended in. The variety of vehicles includes Tretinoin gel, Tretinoin cream, Tretinoin liquid, and Tretinoin lotion. The reason why the vehicle is so important is that it can influence the amount of irritation you experience.
People with fair skin may experience more irritation than people with dark or olive skin
Tretinoin gel is more suitable for people who live in really hot and humid environments and have oily skin because it won’t leave the skin feeling greasy but they are more irritating because of its volatility meaning they have a higher penetration into the skin. It can also cause more irritation and dry the skin. It may be less effective when buffering for some
Tretinoin cream is more suitable for people who have dry skin and are living in drier climates.
The Tretinoin lotion should be suitable for people with sensitive skin and women in their 30s with hormonal acne, flares due to stress, menstrual cycles, etc. It is also less irritating.
The vehicle in either formulation can trigger breakouts, so if you’re still breaking out after 4-6 months, consider switching types (gel → cream, cream → gel).
How to use tretinoin?
- You can start by applying tretinoin 2x a week at first and slowly increase the frequency based on how your skin feels. A tentative schedule might be 2x/week for 2 weeks, 3x/week for 3 weeks, etc before using it daily. First, wash your face with a gentle cleanser and apply a moisturizer to a wet face, then allow your face to dry so the skin is hydrated, and then apply a pea-sized amount of Tretinoin.
- It is better not to use more than the amount suggested by your doctor or to apply more frequently than instructed. Using too much may irritate the skin and won’t give faster or better results.
- If your moisturizer or cleanser stings then, take days off to recuperate and mend your skin.
- Tretinoin should be kept away from the eyes, the mouth, angles of the nose, and mucous membranes.
- If you are using a Tretinoin Cream: Squeeze about less of the medication or a half inch onto the fingertip (you might need more or less to do the job). The medication should become invisible almost immediately. If it is still visible, you are using too much. Cover the affected area lightly with tretinoin cream by first dabbing it on your chin, forehead, and both cheeks, then spreading it over the entire affected area. Smooth gently into the skin.
- If you are using a Tretinoin Gel: Squeeze about less of the medication or a half inch onto the fingertip (you might need more or less to do the job). The medication should become invisible almost immediately. If it is still visible, or if dry flaking occurs from the gel within a minute or so, you are using too much. Cover the affected area lightly with tretinoin gel by first dabbing it on your chin, forehead, and both cheeks, then spreading it over the entire affected area. Smooth gently into the skin.
- If you are using a Tretinoin liquid: tretinoin liquid may be applied to the skin where acne lesions appear. You can spread the medication over the entire affected area, using a gauze pad, fingertip, or cotton swab. If gauze or cotton is employed, care should be taken to the extent that the liquid would run into areas where treatment is not intended (such as corners of the mouth, eyes, and nose).
What are some methods for applying tretinoin?
PM Step 1) – Cleanse
- Cleanse your face with a gentle cleanser and cool water to remove makeup, sunscreen, etc. If your face feels ‘tight’ after using your cleanser it is too harsh, get another one.
PM Step 2) – Apply tretinoin and a moisturizer
- Apply tretinoin to your dry, clean skin.
- After 5-10 minutes, rinse it off.
- Immediately apply moisturizer.
- Slowly increase the amount of time you leave the tretinoin on your face, going up by 5 minutes every week until your skin is used to it.
- Moisturizer on damp skin after cleansing. Research even shows that moisturizers even enhance the effects, especially a moisturizer containing niacinamide. Light serums are not that great because they increase absorption and therefore increase irritation.
- Wait for the skin to dry
- Apply tretinoin, and
- Followed by more moisturizer, then occlusive (optional) before heading to bed.
- Wait for the skin to dry after cleansing.
- Apply tretinoin to completely dry skin.
- Wait for tretinoin to dry (5 mins).
- Apply moisturizer, then occlusive (optional) > bed.
- NOTE: tretinoin products are designed with normal “trans-epidermal water loss” taken into account. Adding an occlusive on top disrupts the expected water loss, and could cause increased irritation. Always patch-test.
What precautions should I take while using Tretinoin?
- The effects of the sun on your skin: Tretinoin may make your skin more vulnerable to the sun and artificial sunlight, so you should avoid tanning beds, sunlamps, and ultraviolet light during treatment with Altreno.
- Laboratory findings: There is no evidence that tretinoin will cause the development of skin tumors.
- Use caution in the sun: make sure the areas treated with tretinoin are covered in sunscreen. For extended sun exposure, protective clothing, like a hat or cap, should be worn. If you do become sunburned, stop your therapy with Tretinoin and consult your doctor.
- Avoid excessive exposure to wind or cold: Extreme wind or cold may dry or burn normal skin. Skin treated with Tretinoin may be more vulnerable to these extreme wind or cold.
- Possible problems: individuals with really sensitive skin may become excessively red, blistered, swollen, or crusted. If you are experiencing persistent or severe irritation, discontinue the use of Tretinoin and consult your doctor. There have been reports that some patients treated with Tretinoin developed Temporary hyper- or hypopigmentation. The pigmentation in these areas returned to normal either when the skin was allowed to adjust to Tretinoin was discontinued.
- If you are pregnant, think you are pregnant, or are nursing an infant: consult your physician before using the medication.
Tips and tricks on using Tretinoin:
- Wash your hands after applying tretinoin and try to wash your face once a day (ideally in the evening).
- Buffering does not impede function, and in fact, using a moisturizer especially a moisturizer with niacinamide actually improves tret outcomes. This is partly because it minimizes the irritating side effects and makes people better able to tolerate more applications of tretinoin.
- Oil cleansing can work for many as a way to gently remove excess skin. Get an emulsifying oil cleanser that will wash off easily.
- Make sure your routine is hydrating enough.
- Consider skipping a night of tretinoin if you have lots of peeling. Yes, that may slow down your progress by a few days but a damaged moisture barrier can take months to recover. Go slow.
- Always apply retinoids to dry skin which means either
- 1) pat dry your skin after cleansing and wait a few minutes for it to dry completely, or
- 2) wait for your moisturizer to dry completely. It has long been known that hydration of the stratum corneum increases its permeability and also increases the absorption of topically-applied molecules. Additionally, manufacturers advise using topical drugs on clean and dry skin, so that’s what you should do. If your skin is wet at all when you apply tretinoin, you will likely see an increase in peeling, flaking, and irritation.
- Make sure to use non-soap cleansers or mild, non-medicated soaps. Avoid harsh scrubbing.
- You can apply a healing ointment like cerave or aquaphor around the eyes, the mouth, angles of the nose, neck, and mucous membranes to protect the skin before applying tretinoin.
- Make sure to use sunscreen.
- When using sunless tanning products with tretinoin, the colour won’t last much longer.
- Avoid the use of other retinoids, AHAs (glycolic acid, lactic acid, and mandelic acid), BHAs (salicylic acid), benzoyl peroxide, PHAs and LHAs, clindamycin, adapalene, chemical peels, balsam of Peru (myroxylon pereirae), cinnamic aldehyde, cinnamyl alcohol, hydroxycitronellal, isoeugenol, eugenol, oak moss absolute, oil of bergamot, alpha-amyl cinnamic aldehyde, geraniol, linalool, lavender, perfumes, toilet water, colognes, masking perfumes unscented perfumes, aroma chemicals, essential oils, cassia oil, cinnamon, cloves, citronella, ethylene bassylate, sweet orange, sweet basil, citrus lemon peel, limonene, spearmint, and menthol at the same time when applying Tretinoin.
- Avoid facial steamers, waxing, and other hair removal procedures. Be very careful when shaving as your skin will more sensitive.
What are the common side effects of using Tretinoin?
In the first few weeks you might experience:
- Dryness, redness, irritation, peeling, increased sensitivity, and
- Exacerbation or worsening of acne (it can last for maybe 4 to 6 weeks. At maximum, it’s typically 2 months but if it does not improve, then consult your doctor as it is probably not a purge and is irritation instead. You may be sensitive to an ingredient in your tretinoin formula, but far more likely you’re using it too much, too often).
What to expect from your tretinoin treatment?
Tretinoin works deep inside your skin and will takes time. You cannot make Tretinoin work any faster by applying it more than once daily, but an excess amount of Tretinoin may irritate your skin. Be patient. There may be some discomfort or peeling during the early days of treatment.
Some patients also notice that their skin begins to take on a blush. These reactions do not happen to everyone. If it does, it is just your skin adjusting to Tretinoin, and this usually goes away within two to four weeks.
These reactions can usually be minimized by following instructions carefully.
Should the effects become excessively troublesome, consult your doctor. By 3 to 6 weeks, some patients notice the appearance of new blemishes (papules and pustules). At this stage, it is vital to continue using Tretinoin.
If Tretinoin is going to have a beneficial effect on you, you should notice a continued improvement in your appearance after 6 to 12 weeks of therapy. Don’t be discouraged if you see no immediate improvement and do not stop treatment at the first signs of improvement. Once your acne is under control you should continue the regular application of Tretinoin until your doctor instructs otherwise.
Frequently Asked Questions:
What if I am still purging after many months (like 6 or 8 months)?
If you’re still purging after many months, then it is not actually purging but something else. Many people have been advised to put on occlusives like vaseline or aquaphor over tretinoin and it is the most popular method out there, but did you know that it can actually cause increased irritation?
Now, why is that?
Transepidermal water loss (TEWL) is the process of losing water through your skin. Occlusive products, like petroleum-based ones (but not necessarily thick creams like cicaplast and such) slow down TEWL almost completely.
Now, this can be a good thing when applying to dry skin, because the central process of dry skin is accelerated TEWL, and with occlusive products, you are helping dry skin with that.
And that’s how the idea of putting occlusive like vaseline or aquaphor over tretinoin, or any other retinoids, was born. People wanted a way to prevent the extreme dryness tretinoin brings by using an anti-dryness product. It makes sense when you say it like that.
When someone is making a new product, it is tested on skins with untempered TEWL. Why? Because TEWL is a part of that medication’s life expectancy on the skin. How long will it stay on the skin, and how big its effects will be, is in great correlation with present TEWL. So, when you temper with your TEWL right after you put an active, you are sealing it in your skin, where it stays much much longer than manufacturers intended, and that is why it causes increased irritation. You can of course still put occlusives when you’re not using tret, or even putting it a few hours later would be much better than putting it right after.
What if I am still experiencing lots of irritation after 5 months?
- If you’re using a higher formulation: consider scaling back. 0.05% is pretty high at first. 0.1% is very high. It can help to start with 0.025% or 0.04%. The micro formulation is generally less irritating.
- Switch formulations: Some people experience breakouts triggered by a particular formulation. If you’re still breaking out after 4-6 months, consider switching types (gel → cream, cream → gel).
- If your routine is too irritating: cut out all actives and focus on hydration.
- If you’re not using it enough: the skin has to go through the retinization process. That inherently involves some irritation. If you go too slow, your skin may actually never acclimate. If you’re only using tret a few times a week, try increasing your usage. At least 4x a week.
- Is there enough moisturization: All skin needs moisture and hydration.
How long does it take for Tretinoin to work?
It can take about 6 months to actually see some results for most people. To see a complete change on your face, you will need to use Tretinoin for 1 whole year.
What strength should I start Tretinoin with?
The strength does not really matter when starting Tretinoin because the results will always be the same. High percentages will give faster results than lower percentages but also more irritation. If you are able to tolerate the given percentage by your doctor then why increase it cause at the end of the year the results will always be the same.
What really matters is the vehicle (what the Tretinoin is suspended in). The variety of vehicles includes Tretinoin gel, Tretinoin cream, Tretinoin liquid, and Tretinoin lotion. The reason why the vehicle is so important is that it can influence the amount of irritation you experience.
Can Tretinoin treat PIE?
Yes, Tretinoin can help with PIE.
Can I use Tretinoin for perioral dermatitis?
Yes, you can use Tretinoin for perioral dermatitis and should be safe. There are people who have had positive experiences with it. You can use it once a week, then gradually increase it to 3 nights a week, and then use it every other night (consult a doctor if you want to use tretinoin for PD).
Can I use Tretinoin for sebaceous hyperplasia?
Yes, Tretinoin can be used for sebaceous hyperplasia and is completely safe. It will help to reverse sebaceous hyperplasia slowly over time and will also help keep the condition from worsening.
Can I use Tretinoin for sebaceous filaments?
Yes, tretinoin can be used for sebaceous filaments and is completely safe. It can help to reduce it and also keep the condition from worsening.
Can I use Tretinoin with salicylic acid?
Yes, it is safe to use tretinoin with salicylic acid as long as you use them both at separate times of the day. You can use salicylic acid as a face wash in the morning and tretinoin at night.
Can I use Tretinoin for seborrheic dermatitis?
Yes, tretinoin can be used for seborrheic dermatitis and might work for you. Many people have had positive experiences with it.
Can Tretinoin cause hair growth?
There are studies showing that topical tretinoin alone and in combination with 0.5% minoxidil can promote hair growth in patients with androgenetic alopecia.
Can I use Tretinoin for acne scars?
Yes, you can use tretinoin for acne scars and should be completely safe.
Can I use tretinoin for pitted acne scars?
Yes, you can use tretinoin for pitted acne scars but it won’t be that effective. You will need to use lasers for pitted acne scars.