Is tretinoin a steroid? Its drug class explained

Tretinoin is a retinoid, a drug related to vitamin A. Steroids are a separate class of medicine. MedlinePlus, the patient site of the US National Library of Medicine, says: "Tretinoin is in a class of medications called retinoids." A plain tretinoin cream, gel or lotion has no steroid in it. This page explains the two classes, the one prescription cream that holds both, and what the sources say about skin thinning and steroid withdrawal. For the drug itself, see the tretinoin guide.

Skinli gives general education and is not a doctor. Your prescriber and your pharmacist can tell you exactly what is in your tube.

What class of drug tretinoin is

The FDA-reviewed drug labels on DailyMed, the National Library of Medicine's label database, say the same thing as MedlinePlus. The Retin-A Micro label says: "Tretinoin is a retinoid and a metabolite of naturally occurring Vitamin A." A metabolite is a substance the body makes from another one. The Altreno lotion label calls tretinoin "a member of the retinoid class of compounds".

Retinoids for acne act on skin cells. MedlinePlus says tretinoin "works by increasing production of new skin cells and unclogging pores." The guide on retinol vs retinoid explains the family.

What a steroid cream is

The word steroid covers more than one type of drug. The NHS in England says steroid medicines, also called corticosteroids, "are an artificial version of hormones your body usually makes by itself." It adds that they "are not the same as anabolic steroids, which some people use illegally to help build bigger muscles." MedlinePlus says corticosteroids "reduce inflammation and affect the immune system."

Hydrocortisone is one steroid that is used on the skin. Here it is next to tretinoin.

	Tretinoin	Hydrocortisone
Drug class (MedlinePlus)	Retinoids	Corticosteroids
Used for	Acne, and fine wrinkles	"redness, swelling, itching, and discomfort of various skin conditions"
How it works (MedlinePlus)	More new skin cells, and unclogged pores	Activates natural substances in the skin to reduce swelling, redness and itching
Listed skin side effects	Dryness, redness, peeling, burning, stinging	The MedlinePlus list includes acne and skin color changes. The NHS lists thinning of the skin

The NHS also says not to use hydrocortisone on the face without talking to a pharmacist or doctor first, because "it can damage the skin in these areas".

Does any tretinoin product contain a steroid?

A plain tretinoin product does not. The generic tretinoin cream label lists its inactive ingredients: stearic acid, isopropyl myristate, polyoxyl 40 stearate, stearyl alcohol, xanthan gum, sorbic acid, butylated hydroxytoluene and purified water. None of them is a steroid.

One combined product holds both drugs. Tri-Luma cream is, in its label's words, "a combination of fluocinolone acetonide (a corticosteroid), hydroquinone (a melanin synthesis inhibitor), and tretinoin (a retinoid)". Hydroquinone is a skin-lightening drug. The cream is a short-term prescription treatment for melasma, a condition of dark patches on the face. Because of the steroid, its label carries warnings about steroid passing into the body. Its patient leaflet says: "Too much TRI-LUMA Cream passing through your skin can cause your adrenal glands to stop working." The adrenal glands make the body's own steroid hormones. Each gram holds 0.1 mg of the steroid, 40 mg of hydroquinone and 0.5 mg of tretinoin. The label lists side effects known from steroid creams, among them skin atrophy, which means thinning, and striae, which are stretch marks. In a 12-month study of this three-drug cream, 2 cases of skin thinning were reported, and both were mild. The hydroquinone and tretinoin guide covers that cream.

Another combined product has no steroid. Ziana gel is "a lincosamide antibiotic and retinoid combination product", which means the antibiotic clindamycin with tretinoin.

To check your own tube, read the active ingredients on the box, and ask your pharmacist about any name you do not know.

Skin thinning and steroid withdrawal

These two worries belong to steroid creams.

Thinning. A 2006 review in the Journal of the American Academy of Dermatology names atrophy and striae first among the most frequent side effects of steroid creams, and acne is on its list too. The American Academy of Dermatology says: "Applying a corticosteroid to your skin for a long time can also cause stretch marks." A 2015 review in the journal Drug Safety concluded that thinning seems to be caused by long-term use of steroid creams.

Tretinoin trials found the opposite. In a 48-week trial of 99 people with sun-damaged skin, the outer skin layer thickened by 30 percent with 0.1 percent tretinoin cream and by 28 percent with 0.025 percent cream. It thinned by 11 percent with a cream that had no drug. A two-year trial of 204 people found no harmful change in the skin's outermost layer.

Withdrawal. A 2015 review in the Journal of the American Academy of Dermatology looked at topical steroid withdrawal. It found the reaction "primarily in the setting of long-term inappropriate use" of potent steroid creams, and it called the evidence low in quality. Its abstract does not mention tretinoin. The NHS says of hydrocortisone that has been prescribed for a long time: "Stopping suddenly can cause a withdrawal reaction."

Stopping tretinoin has a different result. MedlinePlus says "the improvement may gradually disappear." The guide to what happens if you stop tretinoin reports the trials.

Using a steroid cream with tretinoin

The tretinoin leaflet says: "Do not use other medications with tretinoin which are not recommended by your doctor." That covers a store-bought hydrocortisone cream.

A prescriber sometimes adds a mild steroid for a short time. In the trials of Renova cream, a tretinoin cream for fine wrinkles, some patients "had sufficiently severe local irritation to warrant short-term use of mild topical corticosteroids". That happened under medical care. The tretinoin side effects guide covers irritation and when to call.

Steroids also have a use in acne that is done only in a clinic. For a deep, painful acne cyst or nodule, the American Academy of Dermatology says a dermatologist can inject it with a corticosteroid, and adds: "Only a doctor should inject a corticosteroid."

See your prescriber if tretinoin irritates your skin so much that you want to add another cream. Ask before you put any steroid cream on your face, and see a doctor for skin that is blistered, swollen or painful.