Tretinoin cream: what it is, what it does, its uses

Tretinoin is a prescription medicine that goes on the skin as a cream, a gel or a lotion. In the US its labels approve it for acne, and one tretinoin cream is approved to lessen fine facial wrinkles. It belongs to the retinoids, a family of drugs related to vitamin A. This guide covers what it does in the skin, how well it worked in trials, how it is used, its side effects and how it compares with other treatments. Every statement comes from the drug labels on DailyMed (the National Library of Medicine's database of drug labels), MedlinePlus, the American Academy of Dermatology (AAD), the NHS, the NICE guideline for England or a named study.

Skinli gives general education and is not a doctor. Tretinoin needs a prescription, and your prescriber picks the product, the strength and the schedule. The leaflet for generic tretinoin cream says in capital letters that the product is "TO BE USED ONLY ACCORDING TO YOUR DOCTOR'S INSTRUCTIONS".

What tretinoin is

Tretinoin is a retinoid. MedlinePlus, the patient site of the US National Library of Medicine, says: "Tretinoin is in a class of medications called retinoids." The Retin-A Micro label adds where the drug comes from: "Tretinoin is a retinoid and a metabolite of naturally occurring Vitamin A." A metabolite is a substance the body makes when it processes another one, so tretinoin is one of the forms that vitamin A takes inside the body. MedlinePlus lists two other names for it, retinoic acid and vitamin A acid.

The AAD says the FDA approved a retinoid as an acne treatment for the skin in 1971, and that this retinoid was tretinoin.

In the US, tretinoin is sold by prescription. The carton of generic tretinoin cream on DailyMed carries the words Rx only, which means prescription only, and the AAD lists tretinoin among the retinoids "available by prescription for acne".

MedlinePlus says: "Tretinoin comes as a lotion, cream, and gel." The labels on DailyMed show these products:

Product	Form and strengths	Use on the label
Generic tretinoin cream	Cream, 0.025, 0.05 and 0.1 percent	Acne
Generic tretinoin gel	Gel, 0.01 and 0.025 percent, in a base that is 90 percent alcohol	Acne
Retin-A	Cream in the same three strengths, gel in the same two	Acne
Retin-A Micro	Gel, 0.04, 0.06, 0.08 and 0.1 percent	Acne
Atralin	Gel, 0.05 percent	Acne
Altreno	Lotion, 0.05 percent	Acne
Renova	Cream, 0.02 percent	Fine facial wrinkles

MedlinePlus lists the brand names Altreno, Atralin, Avita, Renova, Retin-A and Retin-A Micro. The prescriber picks the form along with the strength, and tretinoin cream vs gel explains what each form is made of.

Tretinoin also exists as a capsule taken by mouth. MedlinePlus lists that capsule as a treatment for a type of blood cancer. This guide covers tretinoin for the skin.

What tretinoin does in the skin

MedlinePlus describes the action in one sentence: "It works by increasing production of new skin cells and unclogging pores."

The labels give more detail and more caution. The Retin-A Micro label says the exact way tretinoin treats acne is unknown. The generic cream label reports what current evidence suggests, in two parts:

• Fewer new plugs. Tretinoin makes the cells that line the pore less sticky, so fewer tiny plugs form. Doctors call a clogged pore a comedone, and blackheads and whiteheads are its two forms.
• Old plugs pushed out. Tretinoin speeds up the turnover of those cells, which pushes out the plugs that are already there.

Other sources describe the same action in plainer words. The AAD says a retinoid "works to clear your pores, and can treat blackheads, whiteheads, and some pimples." The NHS in England says skin retinoids such as tretinoin "reduce inflammation and oiliness, and prevent spots".

What tretinoin is approved to treat

Acne. The generic label states its use in one line: "Tretinoin Cream is indicated for topical application in the treatment of acne vulgaris." Topical means put on the skin, and acne vulgaris is the medical name for acne. Ages differ by label. Altreno lotion is approved from age 9 and Retin-A Micro gel from age 12, and the generic cream label says safety and effectiveness below age 12 have not been established.

Fine facial wrinkles. Renova cream 0.02 percent is the one tretinoin product read for this hub with wrinkles on its label. The label approves it to lessen fine facial wrinkles in people who also follow a skin care and sun avoidance program. MedlinePlus gives both uses: "Tretinoin is used to treat acne. Tretinoin is also used to reduce fine wrinkles."

Other conditions. The generic label says the safety and efficacy of long-term use "in the treatment of other disorders have not been established." Efficacy means how well a drug works. A prescriber can still choose tretinoin for a use that its label leaves out.

Guidelines place retinoids among the first treatments for acne. The AAD's 2024 acne guideline says: "Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline." Oral means taken by mouth. In England, the guideline body NICE lists a product that combines tretinoin with the antibiotic clindamycin among its first options for acne of any severity, each offered as a 12-week course.

How well tretinoin works for acne

The labels print the results of the trials behind each product. Each trial gave some people tretinoin and gave the others the same gel or lotion with no drug in it, then compared the two groups at week 12.

Label and trials	People on tretinoin	Inflamed pimples, average drop: tretinoin against no drug	Top result: tretinoin against no drug
Retin-A Micro gel 0.1 percent, Studies 1 and 2	72 and 72	37 and 29 percent, against 18 and 24	Rated "excellent": 35 and 28 percent, against 11 and 9
Retin-A Micro gel 0.04 percent, Studies 3 and 4	108 and 110	44 and 41 percent, against 13 and 30	Rated "excellent": 14 and 19 percent, against 5 and 9
Altreno lotion 0.05 percent, Trials 1 and 2	406 and 413	50.9 and 53.4 percent, against 40.4 and 41.5	Clear or almost clear, and 2 grades better: 16.5 and 19.8 percent, against 6.9 and 12.5
Ziana gel trials, the group on tretinoin 0.025 percent alone	846	39 percent, against 26	Clear or almost clear: 14 percent, against 8

Blackheads and whiteheads fell as well, by 29 to 49 percent on tretinoin across these trials. Three points follow from the table.

Tretinoin did better than no drug in each trial. This is true of the spot counts and of the top result.

The top result went to a minority. It was reached by 14 to 35 percent of people on tretinoin. People on the product with no drug improved too, by as much as 41.5 percent in one Altreno trial, so part of any change happens without the drug.

The rows cannot rank the products. Each trial had its own people and its own grading. The Altreno label says that rates seen in the trials of one drug "cannot be directly compared to rates in the clinical trials of another drug". That sentence is about side effects, and the same care applies to results.

The Altreno trials enrolled people with "two or fewer facial nodules". Nodules are the deep, painful lumps of severe acne, so these figures say little about that type.

A 2019 review of 54 trials in the American Journal of Clinical Dermatology concluded that the differences between retinoids for the skin in how well they work appear minor, and that retinoids "should be used in combination with benzoyl peroxide to optimize results in patients." The tretinoin before and after guide gives every count from every trial.

How tretinoin is used

The table gives the main points of the label directions, and how to use tretinoin lists each step.

Point	What the sources say
How often	The generic cream label says "once a day, before retiring", and MedlinePlus says: "Use tretinoin daily at bedtime."
Where	On "the skin where acne lesions appear", in a thin layer over the whole area where acne appears. Lesions are acne spots
How much	The generic leaflet says half an inch or less on a fingertip, and gives a check: "If it is still visible, you are using too much."
Areas to avoid	"Keep the medication away from the corners of the nose, mouth, eyes and open wounds."
A slower start	The generic leaflet says a physician may start a patient every other night, and NICE describes the same approach. The Retin-A Micro label says efficacy at fewer applications "has not been established"

More medicine does not bring a faster result. The leaflet says: "You cannot make tretinoin work any faster by applying more than one dose each day". Skinli gives no schedule of its own.

Three other products appear in the label directions.

Cleanser. The generic leaflet asks for "a mild, non-medicated soap". The older labels say to wait 20 to 30 minutes after washing, and the newer ones say only to pat the skin dry. See cleanser for tretinoin.

Moisturizer. The AAD says tretinoin tends to dry and irritate the skin, and several labels ask for moisturizer. The generic leaflet places it every morning after washing, the Retin-A Micro leaflet allows it after the medicine, and the AAD says a dermatologist may recommend moisturizer first. See moisturizer with tretinoin.

Sunscreen. The Retin-A Micro label says the gel "can cause photosensitivity", which means the skin reacts more strongly to sunlight. The Retin-A Micro, Renova, Altreno and Atralin labels ask for SPF 15 or more, and the AAD recommends SPF 30 or higher for everyone. See sunscreen with tretinoin.

How long tretinoin takes and what results look like

MedlinePlus says it in one short sentence: "Tretinoin works slowly to control acne." The sources give these times:

Source	Time for acne
Generic tretinoin cream label	Results after 2 to 3 weeks, and more than 6 weeks for a definite effect
Its patient leaflet	"many users see improvement by 12 weeks."
AAD, for acne treatment in general	At least 6 to 8 weeks before fewer breakouts, and 3 to 4 months for complete clearing
NICE, England	A 12-week course, then a review

These times fit what Skinli says about its own plan, which uses two gels sold without a prescription: skin needs 8 to 12 weeks to change. The guide on how long tretinoin takes to work lists the weeks in order.

Acne can look worse in the first weeks. MedlinePlus says acne will probably get worse during the first 7 to 10 days, with red, scaling skin and more acne sores, and adds: "Continue to use it." The generic leaflet says that by 3 to 6 weeks some patients see new blemishes. Many people call this purging, and the tretinoin purging guide covers it.

Marks left by acne have their own guides: tretinoin for acne scars and retinol and tretinoin for dark spots.

Side effects and who should take extra care

The side effects on tretinoin labels are reactions of the treated skin. The Retin-A Micro label says the gel "can cause local skin irritation, including excessive dryness, redness, swelling, peeling, itching, blistering, burning, or stinging".

The trials show how often. In the Atralin gel trials, with 674 people on the gel and 487 on a gel with no drug, dry skin was reported by 16 percent against 2 percent, peeling by 12 against 1, a burning feeling by 8 against 2, and redness by 7 against under 1. On the Retin-A Micro label, irritation "peaked during the initial two weeks of therapy and decreased thereafter", and 6 percent of people on the 0.1 percent gel (14 of 224) stopped treatment because of it.

The generic label says that, to date, every side effect of tretinoin has gone away after treatment stopped. The tretinoin side effects guide reports the full lists and rates, and retinoid dryness and peeling covers daily care for dry, flaking skin.

People sometimes ask whether tretinoin is a steroid cream. Tretinoin and steroids are two separate classes of medicine, and is tretinoin a steroid explains what that means for side effects.

The labels ask for extra care in these cases:

• Eczema. The generic label says tretinoin "has been reported to cause severe irritation on eczematous skin". Eczematous means affected by eczema. Newer labels say to avoid those areas.
• Sunburn. The Retin-A Micro leaflet says: "Do not use RETIN-A MICRO on sunburn skin until your skin has healed."
• Open skin. The leaflets say to keep tretinoin away from open wounds, and a pimple that was just popped is open skin. See tretinoin on a popped pimple.
• The eye area. The generic label says tretinoin "should be kept away from the eyes, the mouth, angles of the nose, and mucous membranes." Mucous membranes are the moist linings inside the nose and mouth. See tretinoin under the eyes.
• A fish allergy. The Altreno label says the lotion "contains soluble fish proteins."
• Changes in skin color. The generic label says temporary darker or lighter patches have been reported with repeated use. The AAD says that in darker skin, irritation can trigger dark marks.
• Pregnancy and breastfeeding. Tell your prescriber before you use tretinoin if you are pregnant, planning a pregnancy or breastfeeding. The sources word their advice in different ways, and retinoids during pregnancy and breastfeeding shows what each one says.

Tretinoin with other treatments

The AAD's 2024 guideline recommends, as good practice, combining skin treatments that work through more than one mechanism. A mechanism is the way a drug acts. The generic leaflet adds a caution: "Do not use other medications with tretinoin which are not recommended by your doctor."

Used with tretinoin	What the sources say	Guide
Benzoyl peroxide	The 2019 review of 54 trials advises using retinoids with benzoyl peroxide. The Retin-A Micro label says store-bought acne products with benzoyl peroxide may raise the risk of skin irritation	Retinoid with benzoyl peroxide
Clindamycin, an antibiotic	One prescription gel, Ziana, contains both drugs. In its label trials, 21 percent of people on the combined gel were clear or almost clear, against 14 percent on tretinoin alone and 8 percent on a gel with no drug	Clindamycin and tretinoin
Hydroquinone	One prescription cream, Tri-Luma, contains tretinoin, a steroid and hydroquinone, a skin-lightening drug. Its label approves it for the short-term treatment of moderate to severe melasma of the face, a condition of dark patches	Hydroquinone and tretinoin
Salicylic acid	The generic label asks for "particular caution" with products that contain salicylic acid	Salicylic acid with tretinoin

Two more pairs have their own guides: niacinamide with tretinoin and azelaic acid and tretinoin.

Other uses people ask about: wrinkles and stretch marks

Wrinkles. The Renova label approves that cream for fine facial wrinkles and states its limits in capital letters. The cream "DOES NOT ELIMINATE WRINKLES, REPAIR SUN-DAMAGED SKIN, REVERSE PHOTOAGING, or RESTORE MORE YOUTHFUL or YOUNGER SKIN." Photoaging is skin aging caused by the sun.

In the label's four 24-week trials in people with lighter skin, 279 people used Renova and 280 used a cream with no drug, and both groups used sun protection and moisturizer. Fine wrinkles improved in 60 percent of the Renova group and in 39 percent of the other group, and the improvement was graded moderate in 10 percent against 3 percent. In the one trial in people with darker skin, the group without the drug improved more often (43 percent against 29 percent), and the label says this may reflect the small size of that trial. The label says up to 6 months of use may be needed. MedlinePlus states the limit in one line: "Tretinoin may reduce fine wrinkles but does not remove them or repair sun-damaged skin." See tretinoin for wrinkles.

Stretch marks. None of the six tretinoin labels checked for this hub mentions stretch marks, and the generic leaflet says the product "SHOULD NOT BE APPLIED TO OTHER AREAS OF THE BODY". The evidence comes from small studies. In a 1996 trial in Archives of Dermatology, 22 people with early stretch marks used 0.1 percent tretinoin cream or a cream with no drug for 6 months. Eight of the 10 people on tretinoin had definite or marked improvement, against 1 of the 12 on the other cream. An 11-person trial of 0.025 percent cream found no improvement.

The AAD says: "Tretinoin is a retinoid, which may also make early stretch marks less noticeable." It also says: "Like any scar, stretch marks are permanent, but treatment may make them less noticeable." See tretinoin for stretch marks.

How tretinoin compares with other retinoids

Compared with	What the sources say	Guide
Retin-A	MedlinePlus lists Retin-A as a brand name of tretinoin	Retin-A vs tretinoin
Adapalene	The AAD says: "adapalene comes in both prescription and over-the-counter formulations"	Adapalene vs tretinoin
Tazarotene	A prescription retinoid. The 2019 review found "no significant difference in efficacy between tretinoin and tazarotene." The Tazorac cream label says the cream is contraindicated in pregnancy, which means it must not be used then	Tazarotene vs tretinoin
Isotretinoin (Accutane)	A capsule taken by mouth. The AAD calls it "an oral medication available by prescription only for severe acne." It is sold only through a safety program named iPLEDGE	Tretinoin vs isotretinoin
Retinol	The AAD calls retinol "a type of retinoid" and says: "It is available over the counter"	Retinol vs retinoid

The guide to prescription retinoids for acne lists each prescription option with its form, its age limit and its pregnancy rule.

Getting, storing and stopping tretinoin

Getting it. A licensed prescriber writes the prescription, in person or online, and a pharmacy fills it. The guide on how to get tretinoin explains the steps and the FDA's checks for an online pharmacy.

The retinoid sold without a prescription. Adapalene 0.1 percent gel is the acne retinoid that US stores sell without a prescription. The FDA's approval letter of July 8, 2016 "provides for the over-the-counter use of" that gel for acne, and its Drug Facts label on DailyMed gives the age as 12 and older. It is one of the two gels in Skinli's own plan at /analyze, next to benzoyl peroxide 2.5 percent. That plan is made for everyday acne that store products can treat.

Storing it. Labels give these temperatures: below 80°F for the cream, below 86°F for the standard gel, and 68° to 77°F for Retin-A Micro, Altreno and Atralin. MedlinePlus says: "Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not allow the medication to freeze." The FDA says: "If your medicine has expired, do not use it." See does tretinoin expire.

Stopping it. The generic leaflet says: "Once your acne is under control you should continue regular application of tretinoin until your physician instructs otherwise." MedlinePlus says: "If you stop using tretinoin, the improvement may gradually disappear." Talk to your prescriber before you stop, unless you have a strong reaction. The guide on what happens if you stop tretinoin reports the trials on stopping and on long-term use.

When to see a doctor

A prescriber starts tretinoin, and these are the times to go back or to call sooner:

• Severe irritation. The leaflet says: "If you are experiencing severe or persistent irritation, discontinue the use of tretinoin and consult your physician." The label describes skin that becomes "excessively red, edematous, blistered, or crusted." Edematous means swollen.
• Itching, a rash or hives. MedlinePlus lists these among the symptoms that mean a call to your doctor immediately.
• Tretinoin taken by mouth. The Retin-A Micro leaflet says: "Call the Poison Help line at 1-800-222-1222 if RETIN-A MICRO is taken by mouth."
• No change after 12 weeks. NICE reviews acne treatment at 12 weeks and gives prescribers further options for acne that has not responded well enough.
• Deep, painful lumps or scars. These need a doctor in person. The guide on severe acne and when to see a dermatologist explains why.