How to Use Tretinoin for the Best, Least Irritating Results

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Just because every TikToker and their sister seems to be recommending a certain skin care treatment, that doesn’t necessarily mean it’s good advice. (Case in point: No, rubbing potatoes on your face is not a science-backed way to calm breakouts.) But one trend making the rounds that does deserve the hype? Tretinoin—or “tret,” as the cool kids call it. It’s a topical cream (or gel) used to treat acne and minimize signs of aging like wrinkles and dark spots, and BeautyTok is obsessed with it.

The sudden demand for tretinoin isn’t exactly surprising to dermatologists, who’ve been prescribing it for decades. “Besides sunscreen, tretinoin is the most evidence-based skincare product we have,” Leah Ansell, MD, a board-certified dermatologist at Treiber Dermatology Associates and assistant professor of dermatology at Columbia University, tells SELF. It was first FDA-approved in 1971 as an acne treatment, and has since become a mainstay ingredient for addressing a variety of skin concerns.

So what makes tretinoin such a big deal, and what kind of a difference might this buzzy cream make for your skin? Behold, everything you need to know.

How does tretinoin work? | Who should use tretinoin? | Who should avoid tretinoin? | What are the side effects of tretinoin? | Is tretinoin available over the counter? | How do you use tretinoin? | How long does it take for tretinoin to work? | Signs to stop using tretinoin

What is tretinoin and how does it work?

Tretinoin, or retinoic acid, belongs to a family of topical compounds called retinoids, which are vitamin A–based skin care ingredients, Dr. Ansell explains. Other members include retinaldehyde, retinol, and retinyl esters, with tretinoin being the most potent of the bunch. Once you apply it, it binds to retinoic acid receptors in your skin cells and improves how they operate.

“The skin regenerates through a process called epidermal turnover, where old and damaged cells are shed from the skin’s surface and continually replaced with new ones,” Asmi Sanghvi, DO, board-certified dermatologist and clinical instructor at the Mount Sinai Health School of Medicine in New York City, tells SELF. This process can be disrupted by certain skin conditions, including acne, and it also slows down as we age. Cue breakouts and hyperpigmentation, among other gems.

Not only can tretinoin speed up a sluggish turnover cycle, but it's also been shown to increase collagen production (more on that in a minute); a one-two punch that can be a game-changer for your skin.

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Who should use tretinoin?

Topical tretinoin is FDA-approved to treat acne and signs of sun damage (think: uneven skin texture, dark spots, and wrinkles).

Tretinoin for acne

When tretinoin hits the gas on the cell turnover cycle, this helps to prevent the buildup that can lead to acne, Dr. Sanghvi says. Basically, it gets into your pores and loosens up dead skin and sebum (oil), keeping them from sticking together and forming new breakouts. The topical treatment also has anti-inflammatory skills, she adds, which can reduce the potential severity of current blemishes and minimize future flare-ups.

Tretinoin for sun damage and signs of aging

Over time, the sun’s UV rays cause signs of aging, including hyperpigmentation. By promoting epidermal turnover, tretinoin pushes new skin cells to the surface that eventually replace the darker ones, ultimately fading “sun spots” and evening out skin tone, Marisa Garshick, MD, board-certified dermatologist at MDCS Dermatology and clinical assistant professor at Cornell University, tells SELF. (This is the same process that, in time, can help to fade acne scars.) Bonus: That constant exfoliation minimizes the buildup of dead cells, which means a smoother texture too, she adds.

Meanwhile, tretinoin can also reduce the appearance of wrinkles, which show up when you lose collagen, an important structural protein that gives your skin its strength and elasticity, Dr. Garshick says. This is a natural part of aging, but sun exposure can exacerbate the process. Tretinoin boosts collagen production, Dr. Garshick explains, while at the same time helping to slow further loss by blocking UV light from breaking it down more.

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Who should avoid tretinoin?

Tretinoin is suitable for most people, but there are a few caveats. If you have a condition where dry skin and irritation are already on the menu (à la eczema or rosacea) or you’re extremely sensitive to the sun, Dr. Sanghvi recommends either avoiding tretinoin or working closely with a dermatologist to minimize the risk of flare-ups. You should also check the label on any tretinoin cream or gel to make sure you’re not allergic to any of its supporting ingredients, such as the fish proteins found in some formulations, per the National Institutes of Health(NIH).

One group that should probably steer clear of tretinoin: People who are pregnant or breastfeeding. “We know that high oral doses of vitamin A can lead to fetal defects in the heart, face, and brain,” Dr. Sanghvi says. There’s no research showing the same is true for tret but, in theory, it could be risky for pregnant folks: “Since tretinoin is a topical form of vitamin A, it’s best to stay away from it,” she adds.

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Does tretinoin cause side effects?

During the first few weeks or so of using tretinoin, you’ll probably experience what’s called retinization; the period of time it takes for your skin to get acclimated. This introductory phase often comes with pesky symptoms like irritation, dryness, redness, peeling, and stinging, but “these usually improve as your skin adjusts to the medication,” Dr. Sanghvi says.

Around the three- to six-week mark, another potential side effect that can strike is the tretinoin purge, where the medication accelerates cell turnover and essentially pushes any looming breakouts to the surface, Dr. Sanghvi says. The result? A wave of acne clusters (blackheads, pimples, even cysts) all over your face, as SELF previously explained. When your skin gets angry like this, it can be tempting to peace out of your tretinoin regimen, but unless there’s extreme redness, swelling, or blistering going on, it’s worth it to power through—things should start to simmer down within a few weeks, Dr. Sanghvi says.

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Is tretinoin available over the counter?

Tretinoin is a prescription-only retinoid. Your primary healthcare provider can prescribe it if you’re a good candidate, but it’s better to consult with a skin specialist if you can. Dermatologists are uber-familiar with tretinoin and how it operates, and therefore often better equipped to prescribe a strength (0.025, 0.05, or 0.1%) and formulation (cream, lotion, or gel) that suits your skin type and specific concerns, Dr. Sanghvi says. Not to mention, they can give you a crash course on how to use it and minimize the side effects above.

The American Academy of Dermatology (AAD) has a search engine you can use to find a dermatologist in your area. (If you’d rather book an online consult, enter “teledermatology” as the practice focus.)

How to prepare for your appointment

The best way to gear up for your visit is to come in with a fresh, clean face, according to Dr. Sanghvi: Wash with a gentle cleanser, then leave your skin bare. The AAD recommends avoiding anything that might irritate your skin pre-appointment too, such as taking a hot shower or picking at a breakout. (And if your visit is a digital one, snap some well-lit photos that your dermatologist can use to examine your skin.)

Tell the doctor your primary concerns (stubborn acne? Dark spots? Uneven texture?) and what your ultimate goals are, along with a rundown of your current skin care routine, so they can see if tretinoin is compatible with the other ingredients on your roster. “It can help to take pictures of the products you use in advance, just in case you’re unable to recall them during the appointment,” Dr. Sanghvi says.

You should also name-drop any medications, vitamins, and supplements in your pill box. That way the doctor can make sure what you’re taking isn’t contributing to your skin woes—and won’t clash with tretinoin, per the AAD.

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How to use tretinoin for the best results

To minimize uncomfortable side effects, low and slow is where it’s at: Dr. Garshick recommends starting with the lowest concentration available and slowly making it a series regular in your routine—use it twice a week, say, then increase the frequency as tolerated (more specifics on that below). It’s best to apply it after cleansing and before moisturizing, she adds, and always before bed. (Exposure to light can cause it to degrade and decrease its effectiveness.)

As for the rest of your regiment, keep it super gentle and hydrating, especially during the adjustment period. Nix face scrubs and any products that contain alcohols, exfoliating acids, or other harsh “actives,” like benzoyl peroxide, unless your doctor tells you otherwise, Dr. Garshick recommends. For example, they might give you the green light to use another active ingredient (like vitamin C) during the day or an additional exfoliating acid once a week, so long as you never apply it during the same skin care sessions as your retinoid. And because tretinoin makes your skin more sensitive to the sun, make sure you wear a broad-spectrum sunscreen during the day, with a sun protection factor (SPF) of 30 or higher.

Before applying tretinoin, wash your face (gently; no scrubbing!) using a mild cleanser and warm water, then thoroughly pat your skin dry, Dr. Garshick recommends. Any residual dampness could cause more product to be absorbed and amp up the irritation factor.

Now, onto the good stuff: Apply no more than a pea-size amount of tretinoin to your entire face, Dr. Garshick says. Dab it onto your forehead, chin, and both cheeks. As you smooth it over your skin, spread it evenly, and away from the sensitive corners of your eyes and mouth. (The same goes for around your nostrils.) The tretinoin cream or gel should become invisible almost right away—if you can still see it, that means you’re using too much.

You should always follow up your tretinoin application with a layer of noncomedogenic (as in, it won’t clog your pores) moisturizer, Dr. Ansell says. If your skin skews dry or sensitive, she recommends using the sandwich method: “Apply a layer of moisturizer as the first step after cleansing, followed by your tretinoin, and finish off with another layer.”

Once you’re in your twice-a-week groove, it’s time to let your skin call the shots. Over the next two to four weeks, keep your eyes peeled for any, well, peeling or other signs of irritation. If your skin seems to be tolerating tretinoin well (no redness or dryness, for instance), you can step up your usage by another day per week and repeat the process for another month or so. “The ultimate goal is to use it anywhere between three to six days a week,” Dr. Sanghvi says. Tolerance levels are highly individual, she adds, so if upgrading to four days a week sends your skin over the edge and the side effects don’t go away (or get worse), it’s okay to hit rewind.

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How long does tretinoin take to work?

Adding tretinoin to your skin care portfolio requires playing the long game: The topical treatment helps to reduce breakouts and signs of aging, not cure them—if you stop using it, the improvements may gradually disappear, per the NIH. With consistent use, some changes may be visible in as early as four to six weeks, Dr. Garshick says, but it usually takes a minimum of two to three months for more significant results.

If you’re using it to treat acne, for instance, tretinoin may first tackle existing breakouts within the first few months, then after that, prevent new ones from forming. “Improvement in acne scarring can take up to six months, since it takes time for collagen to build,” Dr. Garshick adds.

Ditto for wrinkles. Unlike other antiaging ingredients that help to plump skin quickly (think: hyaluronic acid and ceramides), tretinoin works over several months to increase collagen and, eventually, smooth out facial lines, she says.

However, if you’ve been using tretinoin for a few months or so and are tolerating it well, yet it doesn’t seem to be doing much (you’re still breaking out or have dark spots that won’t take the hint), then it might be time to schedule a follow-up appointment to discuss increasing the concentration with your doctor, Dr. Garshick says.

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Signs you should stop using tretinoin

It’s normal to experience some dryness, peeling, and irritation—maybe even some purging—as you adjust to using tretinoin. But if the side effects become severe or don't go away, it might be time to hit pause and give your skin a breather.

“If your face is red, tender, or very parched and peeling, these are signs you’re overusing your retinoid,” Dr. Ansell says—either you’re applying too much, or too frequently. When this happens, she says, it’s important to take a break (from tretinoin and any other harsh actives) and heavily moisturize the area as it heals. Once your skin has calmed down, Dr. Garshick recommends reintroducing tretinoin one day a week, then slowly increasing at a pace your skin can legit tolerate.

Then again, you might try every derm-recommended strategy to build up your tolerance to tretinoin and they all backfire—believe it or not, this isn’t a fail. “There are so many retinoid formulations out there, including gentler, nonprescription options,” Dr. Ansell says. Tretinoin might not jibe with your skin, but now you’re one step closer to finding what will.

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Originally Appeared on SELF