Your Complete Guide to Using Tretinoin for Acne

Including how to prevent the dreaded retinoid uglies.

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Acne treatments aren't one size fits all.

While your friend's zits might not stand a chance against a drugstore benzoyl peroxide spot treatment, the same one might do absolutely nothing for your breakout.

And when you've tried every over-the-counter cream, gel, lotion, serum, face mask, and even retinol — which is supposed to be the next best thing to magic for a number of skincare concerns including acne — it might be time to schedule an appointment with your dermatologist. Not only to get to the root of what's causing you to break out, but to also prescribe you a treatment plan.

One option your dermatologist might prescribe is tretinoin, a topical retinoid cream used to treat chronic acne. You might also have heard of tretinoin by one of its brand names, Retin-A.

While consulting with your own dermatologist is the ultimate way to find out which acne treatment is best for you, we turned to two top MDs in the field to find out what you need to consider before using tretinoin cream, including side effects and more.

What Is Tretinoin?

The short answer? Tretinoin is a derivative of vitamin A.

"Tretinoin is one of the most potent and widely-researched vitamin A derivatives (retinoids)," says Dr. David Lortscher, board-certified dermatologist and founder and CEO of Curology. "It is considered the gold standard among dermatologists for treating wrinkles, fine lines, uneven skin tone, and acne."

The ingredient works by promoting skin cell turnover.

"It is comedolytic, meaning it breaks down dead skin cells and oil-clogged pores," explains Dr. Adeline Kikam, dermatologist and founder of @brownskinderm. "It decreases inflammation in the skin, promotes skin cell turnover, and keeps pores from becoming clogged while reducing over-production of sebum to prevent and treat acne breakouts."

While tretinoin cream is a potent acne treatment, don't expect to see results overnight. It can take an average of eight to twelve weeks to see an improvement in your acne, while some people will have to wait a year to experience the full result.

How Is Tretinoin Cream Prescribed by Dermatologists?

While tretinoin could be the sole prescription in your acne treatment plan, dermatologists may combine it with other topical or oral medications.

"Dermatologists typically use it as monotherapy or combination therapy with oral or other topical anti-acne agents to boost the effectiveness of treatment," says Dr. Kikam. Some of these topical ingredients include those with antimicrobial properties such as clindamycin, benzoyl peroxide, and dapsone. Azelaic acid, a dicarboxylic acid, and salicylic acid, a beta-hydroxy acid can also be used.

Dr. Lortscher says that tretinoin can be used to treat all kinds of acne, but the right treatments to pair with tretinoin will depend on your individual skin type and concerns.

What Are the Side Effects of Tretinoin Cream?

Like using an OTC retinol, tretinoin can cause irritation.

"The most common side effects from tretinoin are dryness and mild irritation," Dr. Lortscher says. "Some may experience a slight burning sensation when starting to use topical tretinoin, and itching, dryness, and redness may occur."

Dr. Kikam notes that for the first month of taking tretinoin, your acne may get worse before it gets better, but that's no reason to be alarmed. "Moisturizers with humectants, such as hyaluronic acid, are helpful in improving irritation such as dryness, she suggests. "Also, sunscreen helps with reducing hypersensitivity to the sun which some people might experience on the medication."

Another way to minimize the risk of irritation is to ensure you aren't using any skincare ingredients that may negatively react to tretinoin. Dr. Lorscher recommends temporarily pausing using vitamin C, AHAs, and BHA acids until your skin has adjusted to tretinoin. It's also not necessary to use any other products containing retinol or retinoids while using the medication.

Eventually, your skin will calm down — especially if you follow the advice of your medical provider.

VIDEO: When You Apply Sunscreen in Your Skincare Routine Actually Matters A Lot

Who Isn't the Ideal Candidate for a Tretinoin Prescription?

While tretinoin can be an effective option for many skin types, experts say to avoid it while pregnant or nursing.

"Oral retinoids are teratogenic, meaning they can harm the fetus so we tend to avoid the topical version in this group as well," says Dr. Kikam.

Sensitive, reactive skin types may have trouble using tretinoin, too.

"As tretinoin can be drying and irritating, someone with very dry or sensitive skin may want to consider starting with a gentler topical medication and working their way up to tretinoin use," Dr. Lortscher explains.

Finally, Dr. Kikam says tretinoin shouldn't be used on open wounds, cuts, scrapes, or sunburned and eczema-affected skin.

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