Tazarotene vs tretinoin for acne: how they differ

Tazarotene and tretinoin are both prescription retinoids that go on the skin for acne, and the evidence does not show that one clears acne better than the other. A 2019 review of 54 trials found "no significant difference in efficacy between tretinoin and tazarotene." Efficacy means how well a drug works. The clear difference is on the labels: tazarotene must not be used in pregnancy. For tretinoin itself, see the tretinoin guide.

Skinli gives general education and is not a doctor. Both drugs need a prescription, and the prescriber picks the drug, the strength and the schedule. The guide to prescription retinoids for acne lists every option with its age limit, so this page stays with how these two compare.

Two drugs from the same family

A retinoid is a drug related to vitamin A. The American Academy of Dermatology (AAD) names the ones used for acne: "tretinoin, tazarotene, and trifarotene are topical formulations available by prescription for acne". Topical means applied to the skin.

The two drugs are separate chemicals. The Retin-A Micro label on DailyMed, the National Library of Medicine's database of drug labels, 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 Tazorac label says: "Tazarotene is a retinoid prodrug which is converted to its active form". A prodrug becomes active after it is applied.

The summary of the 2024 AAD acne guideline recommends topical retinoids as a group: "Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline." The AAD's news release on the guideline names adapalene, tretinoin, tazarotene and trifarotene as that group of retinoids.

The products compared

	Tretinoin	Tazarotene
Brand names on DailyMed and MedlinePlus	Retin-A, Retin-A Micro, Altreno, Atralin, Renova	Tazorac, Arazlo, Fabior
Forms	Cream, gel, lotion	Cream, gel, foam, lotion
Strengths on the acne labels read	Cream 0.025, 0.05 and 0.1 percent. Gel 0.01 and 0.025 percent. Microsphere gel 0.04 to 0.1 percent. Lotion 0.05 percent	Tazorac cream 0.1 percent. Tazorac gel 0.1 percent. Arazlo lotion 0.045 percent
How often on the label	Once a day, in the evening or at bedtime	Once a day. The Tazorac cream label says in the evening
Youngest age on a label	9 years (Altreno lotion)	9 years (Arazlo lotion)
Pregnancy	Wording differs by label	Must not be used
Another labelled use	Fine facial wrinkles (Renova cream)	Psoriasis, a skin disease with scaly patches (Tazorac cream)

Tazorac cream also comes in 0.05 percent. The label gives that strength for psoriasis, and says: "TAZORAC Cream 0.1% is indicated for the topical treatment of acne vulgaris." Acne vulgaris is the medical name for common acne. The Tazorac gel label covers "mild to moderate facial acne vulgaris." The guide to Retin-A vs tretinoin explains the tretinoin brand names.

Trials that compared the two directly

Trial	People and length	What was compared	Result
Cutis, 2001	143 people with mild to moderate facial acne, 12 weeks	Tazarotene 0.1 percent gel and tretinoin 0.025 percent gel	"tazarotene 0.1% gel is more effective than tretinoin 0.025% gel in reducing noninflammatory lesions and similarly effective in reducing inflammatory lesions."
Cutis, 2002	169 people, 12 weeks	Tazarotene 0.1 percent gel and tretinoin 0.1 percent microsphere gel	Overall severity fell 36 percent with tazarotene and 26 percent with tretinoin. Noninflammatory lesions fell 60 percent and 38 percent
Journal of the American Academy of Dermatology, 2000	An early report of a trial	Tazarotene 0.1 percent gel and tretinoin 0.025 percent gel	"Both drugs appear to be equally efficacious against closed comedones."
American Journal of Clinical Dermatology, 2019	A review of 54 trials published from 2008 to 2018	Adapalene, tretinoin and tazarotene	"There was no significant difference in efficacy between tretinoin and tazarotene."

Noninflammatory lesions are blackheads and whiteheads. Closed comedones are whiteheads. Inflammatory lesions are red, swollen pimples.

Three points help in reading this table. The two Cutis trials are older than the trials in the 2019 review, so the review did not count them. Their abstracts show no funding line, so who paid for them is unknown here. And the 2019 review reached a wider conclusion about the whole drug family: "The differences in efficacy of topical retinoids appears minor". Its authors wrote that the type of retinoid matters less than its strength and what it is combined with.

Which one irritates more

The studies read for this guide found similar irritation.

• Sensitive skin study. In a study in Cutis in 2001, volunteers with sensitive skin used tazarotene gel on one side of the face and a tretinoin or adapalene gel on the other for up to 29 days. "Increases in facial dryness and erythema were comparable among all retinoids." Erythema means redness. The authors wrote that the need to pause treatment "depends more on the individual than on any major inherent differences in the irritant potential of these retinoids."
• The 2001 trial. "At some time points, tazarotene was associated with increased irritation, but peeling, erythema, dryness, burning, and itching never exceeded trace levels."
• The 2002 trial. "There were no clinically significant between-group differences in these measures of tolerability." Tolerability means how well the skin handled the drug.
• The Tazorac cream label. In its acne trials the most frequent reactions, "occurring in 10-30% of subjects, in descending order included desquamation, dry skin, erythema, and burning sensation." Desquamation means peeling.

The labels give the same steps for irritation. The Arazlo label tells prescribers to "instruct patients to use a moisturizer, reduce the frequency of the application of ARAZLO, or discontinue use." The Altreno label has the same sentence with its own name in it. Both drugs carry a warning about eczema. The Tazorac gel label says: "TAZORAC Gel should not be used on eczematous skin, as it may cause severe irritation."

For what the tretinoin labels report, see tretinoin side effects.

Pregnancy: the clear difference on the labels

The Tazorac cream and Arazlo labels forbid use in pregnancy. "TAZORAC Cream is contraindicated in pregnancy." "ARAZLO is contraindicated in pregnancy." Contraindicated means the drug must not be used.

The Tazorac cream label adds a test and birth control. A patient who can become pregnant "should have a negative pregnancy test within 2 weeks prior to initiating treatment and use an effective method of contraception during treatment." MedlinePlus says: "You should not become pregnant while using tazarotene."

The tretinoin labels word pregnancy in several different ways, depending on the product and the year. Tell your prescriber if you are pregnant or planning a pregnancy before you use either drug. The guide to retinoids during pregnancy and breastfeeding reports each label.

Arazlo and Aklief

Arazlo is tazarotene in a lotion. Its label says: "Each gram of ARAZLO contains 0.45 mg (0.045%) tazarotene in a white to off-white topical lotion." It covers acne from age 9. Its label has a warning on a common acne ingredient: "Avoid concomitant use with oxidizing agents, such as benzoyl peroxide." Concomitant use means using both in the same period. The label says benzoyl peroxide may break tazarotene down, and that a patient who needs both should apply them at different times of day. The guide to a retinoid with benzoyl peroxide covers that pair.

Aklief is a cream with a third retinoid, trifarotene. Its label says: "AKLIEF Cream is a retinoid indicated for the topical treatment of acne vulgaris in patients 9 years of age and older." Its trials treated acne on the chest, shoulders and back as well as the face. On pregnancy, the label says the data from its trials "have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes."

No source read for this guide reports a trial that tested Arazlo or Aklief against tretinoin. The labels do report each product against the same product with no drug, and the table below puts the lotion and cream results next to those of Altreno, a tretinoin lotion. All three labels counted success the same way: skin rated clear or almost clear at week 12, with an improvement of at least 2 grades.

Label trial, week 12	Success with the drug	Success with no drug
Altreno, tretinoin 0.05 percent lotion, trial 1 (406 and 414 people)	16.5 percent	6.9 percent
Altreno, trial 2 (413 and 407 people)	19.8 percent	12.5 percent
Arazlo, tazarotene 0.045 percent lotion, trial 1 (402 and 411 people)	25.5 percent	13 percent
Arazlo, trial 2 (397 and 404 people)	29.6 percent	17.3 percent
Aklief, trifarotene cream, face, two trials (2,420 people in all)	29.4 and 42.3 percent	19.5 and 25.7 percent

This table cannot rank the three drugs. The Altreno label says of side effect rates that those "observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug". The same caution fits success rates, and the table shows why. Success with no drug ranged from 6.9 percent in one Altreno trial to 25.7 percent in one Aklief trial, so the trials differed from each other in more than the drug.

How the choice is made

The choice between these drugs belongs to the prescriber. Tell them about pregnancy plans, eczema and the other acne products you use, because the labels carry a warning on each. The AAD says "newer retinoids tend to be less irritating than the original ones", and it advises changing how you use a retinoid only with your dermatologist's help.

One retinoid needs no prescription. Adapalene 0.1 percent gel is sold in stores, and it is one of the two treatment gels in Skinli's own plan. The guide to adapalene vs tretinoin compares those two.

See your prescriber if acne is no better after 12 weeks, which is when the NICE guideline in England says to review a first treatment. Call sooner for severe or lasting irritation, for blistering or swelling, or if you become pregnant while using either drug.