Salicylic acid with tretinoin: can you use both?

Salicylic acid can be used with tretinoin only with care. Tretinoin labels ask for "particular caution" with it, because the two together can dry and irritate the skin, and they tell patients to check with their doctor before adding other skin medicines. This guide shows what each label says about salicylic acid, what is known about glycolic acid, and what the sources say about exfoliating during treatment. 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, the schedule and what else goes on your skin with it. This page covers tretinoin only. For retinol sold in stores, see salicylic acid with retinol.

What tretinoin labels say about salicylic acid

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

Source	Its words
Generic tretinoin cream label	"Particular caution should be exercised in using preparations containing sulfur, resorcinol, or salicylic acid with tretinoin."
Generic tretinoin cream leaflet	"Do not use other medications with tretinoin which are not recommended by your doctor."
Retin-A Micro gel label	Store-bought acne products "containing benzoyl peroxide, sulfur, resorcinol, or salicylic acid" used with the gel "may increase the risk for local skin irritation"
Retin-A Micro gel label	"Consider withholding the use of topical OTC acne products if signs of skin irritation develop." OTC means sold without a prescription
Atralin gel label	"Particular caution should be exercised with acne preparations containing benzoyl peroxide, sulfur, resorcinol, or salicylic acid."
MedlinePlus, tretinoin page	Lists salicylic acid among products that "may interact with tretinoin", and says: "Do not start any of these medications while using tretinoin without discussing with your healthcare provider."
MedlinePlus, salicylic acid page	Lists tretinoin among products to keep off skin treated with salicylic acid "unless your doctor tells you that you should"

The wording is caution, with the doctor deciding. None of these sources forbids the pair outright, and none describes a way to combine them.

The labels also cover the case of switching from one to the other. The generic label says it is advisable to rest the skin "until the effects of such preparations subside before use of tretinoin is begun." The Retin-A Micro label says to "allow the skin irritation effects of the topical OTC acne products to subside" before the first dose. Neither gives a number of days. MedlinePlus says: "If you have used any of these topical medications recently, ask your doctor if you should wait before using tretinoin."

What each drug does

	Tretinoin	Salicylic acid
Drug class (MedlinePlus)	"retinoids", drugs related to vitamin A	"keratolytic agents", drugs that loosen the outer layer of skin
How it works on acne (MedlinePlus)	"increasing production of new skin cells and unclogging pores"	"reducing swelling and redness and unplugging blocked skin pores to allow pimples to shrink"
How it is sold	Prescription only	In several strengths. MedlinePlus says some are prescription only, and the Retin-A Micro label refers to salicylic acid products sold without a prescription
Forms	Lotion, cream and gel	Pads, wipes, cream, lotion, liquid, gel, ointment, shampoo and patch
2024 acne guideline from the American Academy of Dermatology (AAD)	Strong recommendation for topical retinoids	Conditional recommendation, which is the weaker grade

Both drugs act on clogged pores, and both can dry the skin. MedlinePlus says of salicylic acid: "your skin may become dry or irritated at the beginning of your treatment." The Retin-A Micro label says tretinoin can cause "excessive dryness, redness, swelling, peeling, itching, blistering, burning, or stinging". Two drying products on the same skin is the risk the labels describe.

MedlinePlus states the result in plain words on its salicylic acid page: skin may become badly irritated if tretinoin and the other listed products are applied to skin that is being treated with salicylic acid.

What the one comparison trial found

One trial in the sources compares the two drugs. In 2011 the Journal of the European Academy of Dermatology and Venereology published a 12-week study of 46 patients aged 18 to 35 with mild to moderate acne on the face. One group used tretinoin 0.05 percent cream and the other a 3 percent salicylic acid liquid with an alcohol base. Both groups also used the antibiotic clindamycin.

• At 12 weeks, the abstract reports "no significant difference between the two groups in terms of all lesion counts." Lesions are acne spots of every type.
• The total count of acne spots fell faster in the tretinoin group, with a difference seen as early as 2 weeks.
• Side effects were mild to moderate, peaked at week 2, and declined after that.

Only the abstract, the short published summary, was read for this guide. The trial was small. It compared the two drugs with each other, and neither group used both, so it cannot show whether the pair clears more acne than one drug alone.

The AAD's 2024 guideline recommends, as good practice, combining skin treatments that work in different ways. Its abstract gives no detail on this pair.

Salicylic acid face wash, pads and leave-on products

Face wash. A wash with salicylic acid is a medicated cleanser. The Retin-A Micro label asks for "a mild, non-medicated cleanser" before the gel, and says the gel "is not recommended" with "medicated or abrasive soaps and cleansers". The cleanser for tretinoin guide gives the wording of each label.

Pads, gels and lotions. These stay on the skin, and the same label caution applies. MedlinePlus adds a rule for salicylic acid itself: "Do not apply topical salicylic acid to skin that is broken, red, swollen, irritated, or infected." Skin in the first weeks of tretinoin is often red or peeling.

Order and timing. No source read for this guide says which of the two goes on first, whether to use them on alternate nights, or how many hours to leave between them. Those questions go to the prescriber.

If your prescriber wants you to use both. The sources give three checks.

1. Start one product at a time. MedlinePlus suggests testing a salicylic acid product on one or two small areas for 3 days before wider use.
2. Follow each label. The FDA's page on beta hydroxy acids, the group that includes salicylic acid, says: "Follow the use instructions on the label. Do not exceed the recommended applications."
3. Stop the store-bought product first if skin becomes irritated. That is the Retin-A Micro label's direction, and the FDA says to stop a product that causes "skin irritation or prolonged stinging" and to consult your physician.

Glycolic acid and tretinoin

No tretinoin label read for this guide names glycolic acid. The label text that applies is general: the generic label asks for caution with "soaps and cosmetics that have a strong drying effect", and the Tri-Luma cream label, for a product that holds tretinoin with two other drugs, tells patients to avoid "other irritants or keratolytic drugs".

Glycolic acid is an alpha hydroxy acid, or AHA. The FDA says: "AHA-containing products cause exfoliation, or shedding of the surface skin." The AAD's page on exfoliating at home groups these acids under chemical exfoliation, which "uses chemicals, such as alpha and beta hydroxy acids, to dissolve dead skin cells." The same page warns about using an exfoliant during prescription retinoid treatment: "Exfoliating while using these products may worsen dry skin or even cause acne breakouts."

Sun is a second concern. The FDA reports studies in which, after four weeks of AHA use, "volunteers' sensitivity to skin reddening produced by UV increased by 18 percent." UV is ultraviolet light. One week after the AHA was stopped, the researchers found no significant difference. Tretinoin labels carry their own sun warning, so a person using both has two reasons for daily sun protection. The FDA says: "If you are using AHAs, it is advisable to use sun protection." See sunscreen with tretinoin.

The FDA also counted complaints. It received 114 reports of skin problems from AHA products between 1992 and February 2004, including burning, rash and swelling.

No source read here tested glycolic acid and tretinoin on the same skin, compared their strength, or gave a schedule for using both. For the two acids themselves, see salicylic acid vs glycolic acid.

Exfoliating and peeling during tretinoin treatment

To exfoliate is to remove dead cells from the skin's surface, with a scrub or brush or with an acid. The sources give four points for people on tretinoin.

• Scrubs. The generic tretinoin leaflet says: "Avoid frequent washings and harsh scrubbing." The NHS in England says of acne in general: "do not scrub your skin as this can irritate it and make acne worse".
• Darker skin. The AAD says that for some people, especially those with darker skin tones, stronger forms of exfoliation can lead to dark spots.
• Open or burned skin. The AAD says: "Never exfoliate if you have open cuts or wounds or if your skin is sunburned."
• Peeling from tretinoin. For peeling, the labels advise moisturizer and, when needed, a change made by the prescriber. The guide to retinoid dryness and peeling covers daily care, and moisturizer with tretinoin covers the label wording.

Some people ask whether tretinoin makes a separate exfoliant unnecessary. No source read for this guide answers that directly. MedlinePlus says tretinoin works "by increasing production of new skin cells and unclogging pores", and the AAD's acne tips page says to avoid products that can irritate acne-prone skin, "including astringents, toners, and exfoliants."

Other pairs, and when to call your prescriber

Three other pairs have their own Skinli guides: retinoid with benzoyl peroxide, niacinamide with tretinoin and azelaic acid with tretinoin.

Contact your prescriber if skin becomes irritated after you add any product to tretinoin. The label gives the prescriber three options: "use the medication less frequently, discontinue use temporarily, or discontinue use altogether." Stop tretinoin and call if irritation is severe or does not settle, or if the skin blisters, crusts or swells. The tretinoin side effects guide lists the reactions on the labels.

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. The AAD says that using a different product every few days can irritate the skin and cause new breakouts, so ask before you add another one.