Journal / Anti-Aging

10 Tips on How to Integrate Your Skincare Routine with Tretinoin

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

10 Tips on How to Integrate Your Skincare Routine with Tretinoin

Tretinoin skincare creams are used to treat fine wrinkles, acne, dark spots, or rough skin on the face. It works by lightening the skin, replacing old cells with newer skin, and slowing down the way the body removes skin cells that may have been harmed by the sun.1 Tretinoin can come in treatment options including tretinoin acne cream and tretinoin for anti-aging. This article shares how to start a skincare routine with tretinoin and prevent some of the potential side effects. 

What Does Tretinoin Fix?

Retinoids can increase the production of several types of collagen in the skin, increase epidermal thickness, and make the outermost layer of your skin (stratum corneum) more compact, giving you younger-looking, plump, smooth skin. 

Retinoids are anti-inflammatory, which means that the redness and swelling you might notice from acne or other skin conditions can be calmed down. It’s important to note that initially, retinoids can trigger redness from irritation, so proper use is critical. 

Tretinoin affects skin cell growth, development, and how quickly skin cells are shed. This means that with troubled skin you can start to see quick results, faster turnover of damaged skin, and reduce the common signs of aging. Retinoids help fade pigmentation that can cause unevenness in your skin by making pigmented cells shed faster, and slow down melanin production. 

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What Is Tretinoin, Exactly?

Tretinoin, also known as retinoic acid (all-trans-retinoic acid), is an active form of vitamin A. It should be noted that it has a different chemical structure than isotretinoin (13-cis-retinoic acid), which is the acne medication Accutane and is heavily regulated. While Accutane has many warning labels, Tretinoin is a different chemical, and the Vitamin A derivatives (retinoids) are one of the most studied categories of skin treatments and work incredibly well to fix a range of things including acne, pigmentation, and aging. 

Tretinoin, all-trans-retinoic acid (ATRA), is a prescription form of vitamin A patented in 1957, FDA approved for medicinal use in 1962, and topical use in 1971. It has been used internally for treating acne and its anti-aging benefits. Originally marketed under the brand name Retin-A, it is available in different strengths and forms such as cream and gel.

How Does Tretinoin Work? 

Tretinoin works in a wide variety of ways. Let’s list them:

  1. Binding with 2 types of vitamin A receptors found in skin cells. By binding to these skin cell receptors, you will see less “stickiness” and less development of whiteheads (keratinocytes implicated in forming comedones), 

  2. Decreasing inflammation can reduce acne breakouts and rosacea. 

  3. Improve the effectiveness of other acne and anti-aging medications, likely due to a thinning of the top layer of your skin (stratum corneum). 

  4. This also results in the improvement of dry, rough aging skin. 

  5. Other benefits include collagen production, thickening of the epidermis, and reversal of sun-damaged skin (keratinocyte), and pigment (melanocyte) cells.

How Long Does It Take to See Skin Improvements?

For acne treatment, improvement is usually seen within 2-3 months of regular use. Anti-aging benefits of tretinoin will require 6 months or more. Any improvement seen requires continual use for maintenance. Assuming the treatment is well tolerated, the only reason to discontinue would be pregnancy.

What Are the Potential Side Effects?

Potential side-effects of tretinoin include dryness, redness, irritation, and increased sun sensitivity. It should not be used on eyelids, lips, or nostrils due to irritation. Strict sun protection is recommended, including broad-spectrum SPF 30+ sunscreen, hats, and protective clothing if used on the neck, chest, or hands.

Strategies for decreasing irritation include starting with a lower strength topical tretinoin such as 0.025% and a vehicle that includes hyaluronic acid. Hyaluronic acid (HA) is a natural component of the skin matrix. It is a sugar molecule that attracts water and plumps the skin, while also decreasing evaporative loss of water from the epidermis. Since it is naturally found in our skin, the risk of allergy is extremely low. Irritation from topical tretinoin + HA is due to the retinoid.

How to Integrate Skincare Routine with Tretinoin? 

The key to success with topical retinoids includes patience and modification of a current skincare regimen. Tretinoin comes in a range of concentrations from 0.01% to 0.1%, and lots of different formulations (time-released, gel, creams, etc.). 

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Here are a couple of doctor-recommended tips: 

  1. A pea-sized amount of tretinoin is sufficient for the entire face. 

  2. Cream formulas have better penetration and absorption. 

  3. It should be used at bedtime, after cleansing with a gentle non-soap cleanser such as Cetaphil or CeraVe. 

  4. It is more readily absorbed by wet skin, so either dry using a blow dryer on a cool setting or wait 20 minutes post-cleansing. 

  5. After applying, follow by moisturizing cream. 

  6. Avoid products that contain retinol or alpha-hydroxy acids due to additive irritation. 

  7. Begin no more than 2-3 nights/week, ideally non-consecutive (i.e. Mon/Wed/Fri). 

  8. Very gradually increase to nightly as tolerated. 

  9. Expect mild dryness or peeling in the beginning, but discontinue if facial itching or swelling occurs.

  10. In the morning, choose a gentle cleansing method – no scrubs or loofahs! Broad-spectrum SPF 30+ sunscreen and a moisturizer. 

How to Deal with Tretinoin Irritation?

The main drawback to using tretinoin is that it can be irritating and lead to dry, flaky skin that’s more prone to stinging and redness. If you do experience these side effects, you will likely notice them in the first few weeks until your skin gets used to them. It’s best to add the tretinoin into your skincare routine slowly so your skin can adjust. 

If you are experiencing irritation, there are a few strategies that are commonly recommended for helping you build-up to the full leave-on treatment for retinoids.

  1. Using a lower concentration and build-up to a higher concentration. Of course, discuss concentrations with your physician.  

  2. Alternate day application. As mentioned above, Begin no more than 2-3 nights/week, ideally non-consecutive (i.e. Mon/Wed/Fri).

  3. Ensure other mild skincare products. Use gentle cleansers and moisturizers, and avoid active treatments like acid exfoliants while your skin’s getting used to the retinoid. 

  4. If the irritation is bad, contact your dermatologists who can prescribe a corticosteroid cream to help your skin recover.

  5. While applying to wet skin is suggested for best absorption, initially, you may want to NOT apply tretinoin to the skin while wet – at least until you have gotten used to the tretinoin. 

  6. Dot the tretinoin around your skin and then rub it gently (maybe with a roller applicator), so you can make sure it’s applied as evenly as possible.

  7. Sunscreens are a must while on retinoids, so slathered up every day.

Conclusion

It is certainly worth trying tretinoin for anti-aging and for acne. Be sure to take your tretinoin skincare routine seriously to prevent dryness or flakiness. Tretinoin can be a real game-changer in the effort to improve your skin’s health and appearance.

Tretinoin creams are used to treat fine wrinkles, acne, dark spots, or rough skin on the face. It works by lightening the skin, replacing older skin with newer skin, and slowing down the way the body removes skin cells that may have been harmed by the sun.1 Tretinoin can come in treatment options including tretinoin acne cream and tretinoin for anti-aging. Let’s talk about how to start a skincare routine with tretinoin and prevent some of the potential side effects. 

Newer formulations included an emollient base (Renova) designed for mature skin types and microencapsulated spheres to reduce irritation (Retin-A Micro).  Tretinoin is also found in the brands Avita, Atralin, Tretin-X, and ReFissa. Combination acne topicals also include tretinoin, such as Ziana and Veltin  (tretinoin + clindamycin) and Tretinoin + benzoyl peroxide (Twyneo, not yet released). Lastly, some skin lightening products contain tretinoin in combination with hydroquinone and topical steroid including Tri-Luma.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”

References: 

  1. https://www.mayoclinic.org/drugs-supplements/tretinoin-topical-route/description/drg-20066521