Gentle cleanser for tretinoin: what labels say

A gentle cleanser for tretinoin is, in the words of the drug labels, a mild and non-medicated one. The sources give no more detail than that. No FDA label, American Academy of Dermatology (AAD) page or guideline read for this guide names a brand, a texture or a formula for people on tretinoin. This page shows the exact label wording, what the words mean, which washes the labels warn about, and when to wash. For what the drug is and what it treats, see the tretinoin guide.

Skinli gives general education and is not a doctor. Tretinoin is a prescription drug in the US, and your prescriber picks the strength and the schedule. If your prescriber gave you a cleanser to use with it, including a medicated one, follow that direction first. This guide names no cleanser brands.

What tretinoin labels say about the cleanser

Each label below is published on DailyMed, the National Library of Medicine's database of drug labels.

Source	Its words on washing
Generic tretinoin cream leaflet	"Use a mild, non-medicated soap. Avoid frequent washings and harsh scrubbing." Also: "Wash your skin gently with a mild, bland soap."
Retin-A Micro gel label	"thoroughly cleanse area(s) with a mild, non-medicated cleanser then pat the skin dry."
Atralin gel leaflet	"gently wash the affected skin area with a mild, non-medicated soap. Rinse and pat your skin dry."
Renova cream leaflet, for fine wrinkles	"Gently wash your face with a mild soap."
Ziana gel leaflet (tretinoin with the antibiotic clindamycin)	"Wash your face gently with a mild soap and warm water."
Tri-Luma cream leaflet (tretinoin with two other drugs, for dark patches called melasma)	"gently wash your face with a mild cleanser." In its trials, people washed with "a mild soapless cleanser"
MedlinePlus, tretinoin page	"mild, bland soap (not medicated or abrasive soap or soap that dries the skin) and water."

Three words repeat across the labels: mild, bland and non-medicated. The older labels say "soap" and the newer ones say "cleanser". None of them adds a formula or a type.

What "mild" and "non-medicated" mean

Non-medicated has a clear meaning in the labels. It is a cleanser with no acne drug in it. The Retin-A Micro label names the drugs it means: "benzoyl peroxide, sulfur, resorcinol, or salicylic acid". The AAD says benzoyl peroxide products "come in many forms from cleansing bars and washes to gels and creams", so read the active ingredient on the back of any face wash sold for acne.

Mild and bland are left undefined by the labels. Three other sources come closest to a description:

• The AAD's page on face washing says: "Use a gentle, non-abrasive cleanser that does not contain alcohol." Non-abrasive means it holds no rough grains.
• The AAD's page on acne habits says: "You want to use a mild, non-comedogenic cleanser." Non-comedogenic means made to avoid clogging pores.
• NICE, the guideline body in England, advises people with acne to wash twice daily with a cleansing product made from synthetic detergent. It uses the short name "syndet". NICE asks for one that is non-alkaline, which it explains as neutral or on the acid side of the pH scale, the scale that measures acid and alkali.

No source read for this guide compares foaming, gel, cream or oil cleansers for people on tretinoin, and none covers washing twice in a row with two products. Questions about those choices have no sourced answer here. The Skinli guides on a cleanser for acne-prone skin and a cleanser for a damaged skin barrier, meaning an irritated outer layer of skin, cover cleanser types in general, without the tretinoin labels.

Cleansers and products the labels warn about

The warning text on the generic tretinoin cream label reads: "medicated or abrasive soaps and cleansers, soaps and cosmetics that have a strong drying effect, and products with high concentrations of alcohol, astringents, spices or lime should be used with caution because of possible interaction with tretinoin." The Retin-A Micro label uses stronger words: the gel "is not recommended" with these products.

Product	What the sources say
Acne washes with benzoyl peroxide, sulfur, resorcinol or salicylic acid	The Retin-A Micro label says they "may increase the risk for local skin irritation". The Atralin label says: "Particular caution should be exercised"
Scrubs and other abrasive cleansers	Listed on the generic label, and the leaflet says to avoid "harsh scrubbing". The AAD says that exfoliating, which means removing dead skin cells, during treatment with a prescription retinoid such as tretinoin "may worsen dry skin or even cause acne breakouts"
Soaps with a strong drying effect	Listed on the generic label. MedlinePlus excludes "soap that dries the skin"
Products with alcohol, and astringents	Listed on the generic label. MedlinePlus gives examples: "shaving lotions, astringents, and perfumes". An astringent is a liquid sold to remove oil from the skin
Toners and exfoliants	The AAD's acne tips page says: "Avoid products that can irritate your skin, including astringents, toners, and exfoliants."
Medicated shampoos	The generic leaflet lists "certain medicated soaps, shampoos and hair permanent solutions" among products that may dry or irritate the skin. MedlinePlus names "dandruff shampoos containing sulfur or resorcinol"

Two more facts belong with this list. First, most of the label wording is "caution", and MedlinePlus adds the words "unless your doctor directs you to do so". A prescriber may choose to pair tretinoin with a medicated wash. Second, the Atralin leaflet asks patients to tell their healthcare provider about other acne medicines they use, "including medicated cleansers or soaps". For the two most common pairs, see salicylic acid with tretinoin and retinoid with benzoyl peroxide.

How to wash while using tretinoin

The generic leaflet explains why gentle washing is enough: "Acne isn't caused by dirt, so no matter how hard you scrub, you can't wash it away." It adds that washing too often or scrubbing too hard may at times make acne worse.

The AAD's face washing page gives the method:

1. Wet the face with lukewarm water.
2. Apply the cleanser with the fingertips. The AAD says "a washcloth, mesh sponge, or anything other than your fingertips can irritate your skin."
3. Do not scrub.
4. "Rinse with lukewarm water and pat dry with a soft towel." The tretinoin labels use the same words, "pat the skin dry".

The sources agree closely on how often to wash.

Source	How often
Generic tretinoin cream leaflet	"Two or three times a day should be sufficient"
Ziana gel leaflet	"Do not wash your face more than 2 to 3 times a day."
AAD, face washing page	"Limit washing to twice a day and after sweating."
AAD, acne habits page	"Washing your face several times a day can further irritate your skin, leading to more breakouts."
NHS (England), acne page	"wash your skin twice a day with a gentle cleanser"
NICE acne guideline	Twice daily

When to wash: before tretinoin, and after

Before. The labels in the first table put washing straight before the drug, at bedtime. Makeup comes off at this step. The generic label says patients "may use cosmetics, but the area to be treated should be cleansed thoroughly before the medication is applied". NICE also advises people with acne who wear makeup "to remove make-up at the end of the day."

The wait. Tretinoin goes on dry skin. The generic leaflet says: "Let the face dry 20 to 30 minutes before applying tretinoin." Newer labels say only to pat the skin dry. The table of waiting times for each label is in how to use tretinoin.

After. The Renova leaflet says: "Do not wash your face for at least 1 hour after applying". The acne labels give no figure, because tretinoin stays on overnight. The next wash is the morning one, and the generic leaflet follows it with a moisturizer or a moisturizer with sunscreen. The moisturizer with tretinoin guide covers that step.

Washing tretinoin off on purpose. NICE says a retinoid, the drug group tretinoin belongs to, may be started with "short-contact application (for example washing off after an hour)" to reduce irritation. One small study tested this with tretinoin: in a 2013 report in the Journal of Dermatological Treatment, 74 patients applied 0.05 percent cream for 30 minutes once daily. It had no comparison group, so it cannot show how a short contact compares with overnight use. A wash-off schedule is a decision for the prescriber.

If washing stings or the skin feels tight

Skin treated with tretinoin is often dry. MedlinePlus says products with a lot of alcohol, menthol, spices or lime "can sting your skin, especially when you first use tretinoin." The AAD's acne habits page says: "Dry skin is irritated skin. Anytime you irritate your skin, you risk getting more acne." Its face washing page says to apply moisturizer if the skin is dry or itchy.

Check the points above in order: the number of washes a day, the water temperature, fingertips only, and the active ingredients in the cleanser. Then tell your prescriber what you found, because the label gives the prescriber the next choice: to "use the medication less frequently, discontinue use temporarily, or discontinue use altogether."

Stop tretinoin and contact your prescriber if irritation is severe or does not settle. The leaflet says: "If you are experiencing severe or persistent irritation, discontinue the use of tretinoin and consult your physician." The same applies if the skin blisters, crusts or swells. The other reactions the labels list are in tretinoin side effects. See a doctor or a dermatologist in person if your acne is no better after 12 weeks of treatment, or at any time if you get deep, painful lumps or scars.