Retinoids for acne: retinol, adapalene, tretinoin

Topical retinoids are among the acne treatments that the 2024 guideline recommends most strongly, and they raise many questions: which one, how to start, why the skin dries, whether retinol counts, and what happens in pregnancy. This guide summarises what the American Academy of Dermatology (AAD), NICE, the NHS, MedlinePlus, the American Academy of Pediatrics (AAP) and the FDA drug labels say, and it points to Skinli's detailed guide on each question. It is education and not a substitute for a doctor.

The short answer

The 2024 AAD acne guideline recommends topical retinoids for acne with a strong rating, based on moderate certainty evidence from 20 studies. It names four that are FDA-approved for acne: tretinoin, adapalene, tazarotene and trifarotene. Only adapalene 0.1 percent gel is sold over the counter, and the others need a prescription. Retinol, a related ingredient sold in cosmetics, is not among the four, and the evidence for it in acne is limited. Every retinoid dries and irritates skin, so the sources agree on a slow start, night use, sun protection and a moisturizer. The pregnancy rules are strict enough that anyone pregnant or planning a pregnancy should ask a doctor first.

Skinli read the guideline text from a copy archived in March 2025. A correction notice for the guideline was published in July 2026, and Skinli has not seen what it changes.

What retinoids are and how they work

The AAD calls "retinoid" a catch-all term for an array of vitamin A-based products used on skin. For acne, the 2024 guideline describes topical retinoids as vitamin A derivatives that clear blocked pores, reduce inflammation, improve skin discoloration, and help acne stay clear once it has cleared. The AAD explains it for patients this way: "When spread on acne-prone skin, a retinoid can unclog pores. This can give you clearer skin and allow other acne gels and creams to work better."

MedlinePlus describes the individual drugs. Tretinoin "works by increasing production of new skin cells and unclogging pores," and adapalene "works by stopping pimples from forming under the surface of the skin." The guideline adds that each retinoid binds to a different set of retinoic acid receptors, which is why efficacy and tolerability can differ between products.

The trial evidence is the reason for the strong rating. In four randomized trials, a greater proportion of people treated with a topical retinoid than with vehicle, which is the same product without the medicine, reached success on the Investigator Global Assessment at 12 weeks. That assessment is a clinician's overall rating of acne severity. In three trials, 1.4 percent of people stopped treatment at 12 weeks because of side effects.

The four retinoids approved for acne

Retinoid	Sold as	What the labels and guidelines say
Adapalene	Over the counter as 0.1 percent gel (Differin). By prescription as 0.3 percent gel and 0.1 percent cream	Labeled for 12 and older. The AAD says it is the one retinoid you can buy without a prescription
Tretinoin	By prescription: Retin-A, Retin-A Micro, Atralin, Altreno	Ages differ by product, from 9 to 12. Evening or bedtime use
Tazarotene	By prescription: Tazorac, Fabior, Arazlo	Must not be used in pregnancy. Pregnancy test within 2 weeks before starting
Trifarotene	By prescription: Aklief	Labeled for 9 and older. Face and upper trunk

Retinoids also come combined with benzoyl peroxide or an antibiotic in one tube. In May 2026 the FDA approved Differin Epiduo, adapalene 0.1 percent with benzoyl peroxide 2.5 percent, for over-the-counter sale. Skinli's guides to Differin gel and adapalene strengths, adapalene vs tretinoin and prescription retinoids for acne cover the products one by one.

Where retinol fits

The AAD calls retinol "a type of retinoid that's routinely used to improve uneven skin tone, pigmentation, and texture," and says it is sold over the counter in many products. It names other retinoids for acne. The full text of the 2024 guideline, NICE guideline NG198, the NHS acne page and the AAD's main acne treatment page do not use the word retinol. One AAD patient page lists retinol among products for mild acne without citing a study, and a 2026 review says smaller, lower-quality studies have explored retinol in acne. The AAD also points out that retinol product labels need not state the percentage of retinol.

Retinol is a cosmetic ingredient, and the FDA says whether a product is a cosmetic or a drug is determined by its intended use. Skinli's guides on whether retinol works for acne and on retinol vs adapalene for acne set out the evidence.

Which one to pick

The guideline does not rank the four. It says existing comparative effectiveness data do not suggest superiority of one topical retinoid against another, and that efficacy and tolerability differ by specific concentrations and formulations. NICE offers two fixed combinations as first-line options for acne of any severity: adapalene with benzoyl peroxide, and tretinoin with clindamycin. The NHS says prescription treatments from a GP or skin specialist are stronger than products sold in pharmacies and shops.

So the choice rests on practical points. The first is a prescription: adapalene 0.1 percent gel can be bought, and the others cannot. The second is age, because labels set minimum ages from 9 to 12. The third is pregnancy, because the rules differ by product. The fourth is how your skin tolerates the product. A dermatologist can weigh those points.

How to start a retinoid

The starting advice is consistent across the AAD, the AAP and NICE.

• Test first. The AAD recommends testing a new skin care product on a small spot twice daily for seven to 10 days before regular use.
• Go slowly. The AAD says to use the least-intense retinoid formula you can find and to use it every other night to start. The AAP says every other day or a couple of times a week, then increase little by little. NICE says to start with alternate-day or short-contact application, and to progress if tolerated.
• Use it at night. The AAD's source dermatologist advises using a retinoid only at night, with sun protection during the day. After washing, the AAD advises waiting 20 to 30 minutes before applying it.
• Use a small amount on the whole area. The AAP describes a pea-sized amount applied in five dots and rubbed over the entire face, including skin without visible pimples. The Differin label says the gel is not a spot treatment.
• Moisturize. The AAD says using a moisturizer every day can help your skin tolerate adapalene, tazarotene or tretinoin.
• Add one thing at a time. The AAP says to start acne products one by one and little by little.

Skinli's guides to starting retinol for acne and starting adapalene without irritation give the steps in full.

What to expect in the first weeks

NICE says positive effects of acne treatments can take 6 to 8 weeks to become noticeable and offers a 12-week course before review. The AAP says acne takes at least two months to get better, and the over-the-counter Differin Gel label says it may take up to 3 months of once daily use to see results.

On early worsening, the sources disagree. The Differin label says acne may appear to worsen before it improves, which it calls normal, and MedlinePlus says acne probably will get worse in the first 7 to 10 days of tretinoin. A 2009 review and a 2012 analysis of adapalene trials found no evidence of a flare. None of the sources uses the word purge, and none studies retinol for this question. See Skinli's guide to whether retinol makes acne worse at first.

Acne can return when treatment stops. The AAD says dermatologists may recommend a topical retinoid as a maintenance treatment that can keep your skin clear once acne is under control.

Side effects, sun and weather

Dryness is the side effect the sources name most. The AAP calls it the most significant side effect of topical retinoids, and the labels list redness, scaling, peeling, itching and stinging or burning, most likely in the first four weeks. The AAD says irritation does not usually mean an allergy and lists ways to ease it: use a smaller amount, use the retinoid less often, or apply moisturizer first, with your dermatologist's help. For darker skin, the AAD warns that irritation can trigger dark marks known as hyperpigmentation, and that starting slowly and using moisturizer helps reduce the risk.

Retinoids increase sun sensitivity. The AAD advises sun protection during the day, and its acne page recommends broad-spectrum sunscreen of SPF 30 or higher with water resistance. Several labels also say wind or cold may irritate treated skin, and that retinoids should not go on sunburned, broken or eczematous skin. Skinli's guide to retinoid dryness and peeling has the details.

Combining retinoids with other products

The main risk of mixing products is more irritation. The prescription Differin label says to approach other potentially irritating products with caution, including medicated or abrasive soaps and cleansers, strongly drying products, and products with high concentrations of alcohol, astringents, spices or lime. The AAD says exfoliating while using products with retinoids, retinol or benzoyl peroxide may worsen dry skin or cause breakouts, and it says to avoid retinoid creams before waxing.

Doctors combine a retinoid with benzoyl peroxide on purpose. The guideline recommends a fixed combination of a topical retinoid with benzoyl peroxide, with a strong rating. Tretinoin is the exception to check: some tretinoin formulations should not be applied with benzoyl peroxide. Skinli's guides to using a retinoid with benzoyl peroxide and what to mix with a retinoid cover the combinations. On vitamin C, niacinamide, hyaluronic acid and peptides, the guidelines give no rule, and the 2024 guideline says the evidence on niacinamide is insufficient for a recommendation.

Pregnancy, breastfeeding and teens

The AAD says retinoids should not be used during pregnancy, NICE says topical retinoids should not be used during pregnancy and when planning a pregnancy, and ACOG says it is generally recommended that they be avoided. The labels word it differently: the tazarotene labels say the medicine must not be used in pregnancy and call for a pregnancy test within 2 weeks before starting, while other labels list none. For breastfeeding, LactMed calls topical adapalene probably a low risk and tretinoin a low risk to the nursing infant, and advises keeping the medicine off the nipple area. Skinli's guide to retinoids during pregnancy and breastfeeding gives each source in full.

For teens, an AAD release quotes a dermatologist advising tweens and teens to avoid retinol, and adds that a dermatologist may recommend a retinoid for acne after a consultation. Labels set minimum ages between 9 and 12, and adapalene 0.1 percent gel covers 12 and older. See Skinli's guide to retinoids for teens.

Blackheads, whiteheads and body acne

For blackheads and whiteheads, the AAD says to unclog pores dermatologists recommend using a retinoid, that you can buy one retinoid, adapalene, without a prescription, and that you will also want to use a benzoyl peroxide wash. Skinli's guide to adapalene for blackheads and whiteheads has the details.

For the back and chest, labels differ. Aklief names the face and upper trunk, Epiduo Forte names the face and/or trunk, Tazorac gel is for facial acne, and the AAD says adapalene 0.1 percent gel with benzoyl peroxide can help back acne, applied where it is needed.

When to see a doctor

See a doctor if acne is painful, cystic, getting worse, or has not improved after a few months of steady care. The AAD says that if you have large, painful pimples that sit deep in your skin, or acne that leaves a scar when it clears, you will need to see a dermatologist, and the NHS says to see a GP if spots are deep, painful or causing scars. NICE says that if mild to moderate acne fails to respond to two different 12-week courses of treatment, referral to a dermatologist-led team should be considered.