What happens if you stop using tretinoin?

If you stop using tretinoin, the improvement may slowly fade. MedlinePlus, the patient site of the US National Library of Medicine, puts it in one line: "If you stop using tretinoin, the improvement may gradually disappear." This guide reports what the labels and trials say about stopping, about using tretinoin for years, and about the other options a prescriber has. For the drug itself, see the tretinoin guide.

Skinli gives general education and is not a doctor. Tretinoin is a prescription drug, and your prescriber picks the strength and the schedule and decides when treatment ends. Talk to that person before you stop, unless you have a strong reaction. In that case the label says to stop first and then call.

What the labels say about stopping

The labels are published on DailyMed, the National Library of Medicine's database of drug labels.

Source	What it says
Generic tretinoin leaflet (acne)	"Once your acne is under control you should continue regular application of tretinoin until your physician instructs otherwise."
Generic tretinoin leaflet (acne)	"Don't stop treatment at the first signs of improvement."
Generic tretinoin label (acne)	"it may be possible to maintain the improvement with less frequent applications, or other dosage forms."
Renova cream label (fine wrinkles)	"Patients may lose some of the mitigating effects of RENOVA (tretinoin cream) 0.02% after 12 weeks of discontinuation"
Renova leaflet	If treatment is stopped, "the improvement may gradually disappear."
Tri-Luma cream label (melasma)	"Melasma usually recurs upon discontinuation of TRI-LUMA Cream."

Mitigating effects means the lessening of fine wrinkles. Tri-Luma is a cream that holds tretinoin with two other drugs, and melasma is a condition of dark patches on the face. Its label says the cream is for short-term use and should be stopped "when control is achieved". The hydroquinone and tretinoin guide covers that cream.

The labels also say what happens to side effects. The cream label says: "To date, all adverse effects of tretinoin have been reversible upon discontinuance of therapy". On skin color changes, the leaflet says the color "returned to normal either when the skin was allowed to adjust to tretinoin or therapy was discontinued."

What trials found after people stopped

The clearest test comes from sun-damaged skin. In a 1997 trial in the Journal of the American Academy of Dermatology, 126 people who had used tretinoin 0.05 percent cream once a day for 48 weeks were split into three groups for 24 more weeks.

Group	Result over the next 24 weeks
Three applications a week	The improvement was sustained
One application a week	Sustained "to a lesser extent"
No treatment	Effects "tended to regress", which means they went back toward the start

The authors concluded: "Discontinuation of therapy results in some reversal of beneficial effects."

For acne, the sources read for this guide hold one small study. In 2012, 20 men aged 18 to 45 who had finished a course of isotretinoin, a retinoid taken by mouth for severe acne, used tretinoin 0.04 percent gel or a gel with no drug. The spot count was 38.7 percent lower with tretinoin. The authors list the small number of patients, and the share who did not return for follow-up, among the study's limits. No source read for this guide measured how quickly acne returns after tretinoin is stopped.

Do you have to use tretinoin forever?

No source read for this guide sets an end date for tretinoin in acne, and none says it is for life. The prescriber decides, and guideline bodies describe the choice this way:

• NICE in England. After a course of acne treatment, "maintenance treatment is not always necessary." Maintenance treatment is treatment that continues after the skin clears, to keep acne from coming back. NICE says to consider it "in people with a history of frequent relapse after treatment", meaning acne that often comes back, and to review it after 12 weeks to decide if it should continue.
• The American Academy of Dermatology (AAD). "Dermatologists also may recommend a topical retinoid as a maintenance treatment." A topical retinoid is a drug of tretinoin's family that is put on the skin. The same page says such treatment can keep skin clear once acne is under control.
• The AAD on stopping early. On its page for acne that will not clear, the AAD says: "Even when you see clearing, you'll want to keep using the acne treatment. This helps to prevent new breakouts."

The maintenance treatment that NICE names first uses a different retinoid. It says to consider "a fixed combination of topical adapalene and topical benzoyl peroxide as maintenance treatment for acne." A fixed combination is two drugs in one product. Those are the two drugs in Skinli's own plan, which uses adapalene 0.1 percent and benzoyl peroxide 2.5 percent, both sold without a prescription.

One more limit applies to tretinoin that comes combined with an antibiotic. NICE says to continue a treatment that includes an antibiotic for more than 6 months only "in exceptional circumstances." See clindamycin and tretinoin.

Using tretinoin less often

The sources disagree on whether less frequent use keeps the result.

Source	What it says
Generic tretinoin cream label	Improvement may be maintained "with less frequent applications"
Retin-A Micro gel label	"Efficacy of RETIN-A MICRO at reduced frequencies of application has not been established."
Retin-A Micro leaflet	"It is not known if RETIN-A MICRO is effective when used less than 1 time a day."
Atralin gel label	"Efficacy at reduced frequencies of application has not been established."
1997 trial, sun-damaged skin	Three applications a week kept the improvement after 48 weeks of daily use

Efficacy means how well the drug works. Skinli gives no schedule of its own. If you want to use tretinoin less often, ask your prescriber, who knows your skin and your product.

Is long-term use safe?

The sources give four facts here, and they do not all agree.

The wrinkle cream label sets a limit on what is known. The Renova label says: "Neither the safety nor the efficacy of using RENOVA (tretinoin cream) 0.02% daily for greater than 52 weeks has been established". It also reports "atypical changes in melanocytes and keratinocytes and of increased dermal elastosis in some patients" who used an older 0.05 percent cream for longer than 48 weeks. Melanocytes and keratinocytes are two kinds of skin cell, and dermal elastosis is a change in the deeper layer of the skin. The label adds: "The significance of these findings and their relevance for RENOVA (tretinoin cream) 0.02% are unknown."

A two-year trial did not find those changes. In a 2005 trial in the American Journal of Clinical Dermatology, 204 people used tretinoin 0.05 percent cream or a cream with no drug on the whole face once a day for as long as 2 years. Skin samples showed "no increase in keratinocytic or melanocytic atypia, dermal elastosis" with tretinoin compared with the other cream.

Side effects became less common with time in one trial. In a 48-week trial of tretinoin cream for sun-damaged skin, skin side effects "were less common during the extension study than during the first 24 weeks of therapy." The Atralin label reports the other case: in some people, skin reactions lasted through the whole treatment period.

One trial in older men was stopped early. In a 2009 report in the Archives of Dermatology, 1,131 veterans with a mean age of 71 used tretinoin 0.1 percent cream or a cream with no drug twice a day on the face and ears. The trial ended 6 months early "because of an excessive number of deaths in the tretinoin-treated group." The authors wrote: "We observed an association of topical tretinoin therapy with death, but we do not infer a causal association that current evidence suggests is unlikely." In plain words, they saw the difference and did not conclude that the cream caused it.

The generic cream label, which covers acne, adds one line on long use: its safety and efficacy "in the treatment of other disorders have not been established." A prescriber considers these facts for each patient. The tretinoin side effects guide covers the skin reactions.

When to stop or pause

The labels name these cases:

• Severe or lasting irritation. "If you are experiencing severe or persistent irritation, discontinue the use of tretinoin and consult your physician." The label lets the prescriber choose less frequent use, a temporary stop, or a full stop.
• Sunburn. "If you do become sunburned, stop your therapy with tretinoin until your skin has recovered."
• Pregnancy. Tell your prescriber if you are pregnant or planning a pregnancy. See retinoids during pregnancy and breastfeeding.
• Waxing. The Renova label says waxes and hair removal creams "should be used with caution". The labels for two other retinoids go further. The trifarotene cream label says waxing "should be avoided" on treated skin, and the nonprescription adapalene label says "do not wax to remove hair in areas where the product has been applied". None of these labels gives a number of days.

Early worsening of acne is a different case. The Retin-A Micro label says that if the gel is tolerated, the first worsening of inflamed pimples "should not be considered a reason to discontinue therapy." The tretinoin purging guide covers those weeks.

Tretinoin alternatives

If tretinoin does not suit your skin, a prescriber has other choices. Each one is the prescriber's decision.

Option	What the sources say
Adapalene	A retinoid. The AAD says it "comes in both prescription and over-the-counter formulations". The store label says results may take as long as 3 months of once daily use
Tazarotene and trifarotene	Retinoids available by prescription for acne, the AAD says
Benzoyl peroxide	Strongly recommended in the AAD's 2024 acne guideline
Antibiotics put on the skin, and the antibiotic doxycycline taken by mouth	Strongly recommended in the same guideline
Salicylic acid and azelaic acid	The same guideline gives these a conditional, which means weaker, recommendation

A 2019 review of 54 trials concluded that the differences in how well the retinoids work appear minor. Skinli has guides on adapalene vs tretinoin, tretinoin vs tazarotene and the full list of prescription retinoids for acne.

Before you stop

Ask your prescriber whether to stop at once or to use it less often first, what to use afterward, and when to come back. NICE reviews acne treatment at 12 weeks, and that visit is a good time to raise the question.

See a doctor or a dermatologist in person if acne returns after you stop, if you get deep and painful lumps, or if scars are forming.