Reviewed by Kristin Hall, FNP
Written by Our Editorial Team
A topical retinoid derived from vitamin A, tretinoin is a versatile medication that’s used to treat skin conditions from acne to aging.
Tretinoin works by increasing epidermal turnover, your body’s internal process for creating new skin cells. By promoting faster skin cell growth, tretinoin can help to clear problematic acne and treat many common signs of skin aging, including wrinkles and discoloration.
As a prescription medication, tretinoin is significantly more powerful than most over-the-counter retinoids, such as retinol.
You’ll need to speak to your healthcare provider before you can begin using it, and you’ll usually begin with a relatively low-concentration version of the cream or gel.
Like with most skincare treatments, the results from tretinoin aren’t always immediate. However, over the long term, tretinoin really does work, with studies showing major improvements in acne, wrinkling and skin discoloration over the course of three to six months.
Below, we’ve explained what tretinoin is, as well as how it works as a prescription medication for acne and aging. We’ve also discussed how you can use tretinoin as part of your daily routine for smoother, healthier and better looking skin.
Tretinoin belongs to a class of medications called retinoids, which are derived from vitamin A. It works by increasing the speed at which your body creates new skin cells to replace old, worn or damaged ones.
To understand how tretinoin works as an acne and anti-aging treatment, it’s important to quickly go over how your skin repairs and maintains itself.
Your skin is constantly subject to damage, whether it’s from the physical contact, wind or bright, direct sunlight. In order to maintain itself, your body constantly creates new skin cells through a process called epidermal turnover.
As part of this process, new cells are created in the basal layers of your epidermis. These cells travel upwards towards the surface, where they replace old, dead skin cells. As these old cells are replaced, they form a protective layer of dead skin cells called the stratum corneum.
The stratum corneum plays an important role in protecting your skin from sun damage, retaining water and ensuring your skin is able to function as a barrier.
On average, it takes 40 to 56 days for your skin to complete the epidermal turnover process and fully replace itself.
Enter tretinoin. Tretinoin works by increasing epidermal turnover, meaning your skin can create new cells at a faster rate. This promotes shedding of the dead, leftover skin cells that make up the outermost layer of your epidermis.
It also stimulates the production of collagen, an important structural protein that gives your skin its strength and elasticity.
By promoting the shedding of dead skin cells, tretinoin reduces your risk of developing clogged pores, which can turn into acne.
It also helps to improve your skin’s texture. In fact, topical tretinoin is approved by the FDA as a medication for treating facial wrinkles, smoothing rough, worn skin and reducing the visibility of age spots and other forms of hyperpigmentation.
Tretinoin cream is easy to use. If you’re using a multi-ingredient product that contains tretinoin, such as our Customized Acne Cream for Men or Anti-Aging Cream for Men, you can follow the instructions provided with the product.
If you have a prescription tretinoin cream, you can apply it using the following steps:
Start by cleaning your face. Before applying tretinoin, wash your face so that it’s totally clean. Use warm water and a mild soap or non-irritating cleanser to remove dirt, oils and other unwanted substances from your skin.
Gently dry your skin. Blot your skin dry using a small, clean towel. Try to avoid rubbing your skin too much, as this may cause irritation.
Apply a small amount of tretinoin onto your finger. Squeeze a pea-sized amount of tretinoin out of the tube. There’s no need to use more than this.
Carefully apply the cream or gel to your skin. Apply the tretinoin cream to your entire face, with a focus on areas affected by acne or anti-aging. Avoid applying tretinoin close to your eyes, lips or nostrils.
Massage the tretinoin cream into your skin. Spend one to two minutes massaging the tretinoin cream into your skin. If there’s any leftover tretinoin cream, use a cotton swab or soft towel to carefully remove it.
Wait before applying moisturizer. If you use moisturizer, wait for at least 20 minutes to apply it. This will give the tretinoin cream or gel enough time to be fully absorbed by your skin.
Tretinoin is a safe, effective medication for most people. However, like other medications used in skin care, it can occasionally cause adverse effects.
Common side effects of tretinoin include:
Stinging of the skin
Warm feeling skin
Dry skin, peeling or flaky skin
A temporary increase in acne
Red sores and scaling
Swollen, crusty or blistered skin
Although uncommon, tretinoin can cause allergic reactions and other issues. Seek medical help if you develop severe skin irritation, itching, hives or pain or discomfort that affects areas of skin treated using tretinoin.
Tretinoin is one of the most powerful medications available for treating and preventing acne. It’s also significantly safer than other acne treatments, with a far shorter list of potential side effects than widely used oral medications like isotretinoin.
Study data shows that tretinoin is very widely used as an acne treatment. In the United States, it accounts for about 12.5% of all acne treatments for preadolescents, with a similar number of users to over-the-counter products like adapalene and benzoyl peroxide.
Unlike many over-the-counter acne products, tretinoin really works as an acne treatment -- a fact that’s highlighted by several scientific studies.
In a 2009 study, people with acne were instructed to use either tretinoin gel or a non-therapeutic placebo gel over the course of 12 weeks. The people given tretinoin experienced a decrease in acne that significantly outperformed the placebo group.
In a more recent study from 2015, participants were given a combination treatment made up of tretinoin cream and clindamycin 1% gel. These participants recorded an average reduction in facial acne from 13.70 ± 4.80 to 1.30 ± 2.95 over 12 weeks of treatment.
In short, tretinoin works very well for reducing both the amount and severity of acne without many of the potential side effects of harsher, more powerful oral acne medications such as accutane.
As well as clearing up acne in the short term, tretinoin also works well as a long-term acne prevention treatment. Many dermatologists recommend long term, daily use of tretinoin for patients with persistent, recurring acne that doesn’t respond to other treatments.
Used over the long term, tretinoin can significantly reduce the visibility of forehead wrinkles, frown lines, crow’s feet and other facial wrinkles, making it a powerful tool for combating the aesthetic signs of aging.
Tretinoin also treats skin roughness and other forms of damage from UV radiation, making it one of the best medications to use in your anti-aging skincare routine.
In a 2001 study, researchers found that tretinoin cream 0.02% (a fairly low concentration of tretinoin, compared to many widely used creams) produced improvements in fine wrinkling, coarse wrinkling, and skin yellowing over the course of 24 weeks of treatment.
The study also found that tretinoin cream is well tolerated, with a favorable safety profile and relatively low rate of side effects.
Anti-aging studies also show that it doesn’t take a huge amount of tretinoin to produce major improvements in skin quality.
In a 1995 study, researchers concluded that .025% and .01% tretinoin creams lead to similar results, with “no clinically or statistically significant differences” in skin thickening or increased vascularity.
In short, even a relatively small amount of tretinoin is scientifically documented to reduce the appearance of wrinkles and other signs of aging, helping you maintain fresh, younger-looking skin as you get older.
Tretinoin is also used to treat unwanted pigmentation and uneven skin tone caused by aging and sun damage.
Known as “hyperpigmentation,” skin discoloration can occur over time as your body produces excessive amounts of melanin in certain areas of the skin.
As you get older, melanin deposits tend to become more obvious, resulting in the appearance of dark areas such as liver spots.
In a 1989 study, researchers found that regular use of tretinoin can prevent the appearance of certain forms of skin photodamage.
Participants in the study used a .05% tretinoin cream once daily -- a standard concentration of tretinoin that’s widely used for anti-aging purposes.
Over the course of six months, the tretinoin users experienced a significant improvement in skin hyperpigmentation.
The tretinoin users also experienced improvements in fine and coarse wrinkling, looseness and sallowness (the development of a yellowish or lightish brown color on the skin).
After six months, participants who used tretinoin could also clearly perceive the improvement in their appearance.
A 1990 Italian study of tretinoin for treating skin discoloration and wrinkling resulted in similar findings.
After six months of treatment with tretinoin cream, participants showed a significant improvement in mottled hyperpigmentation, xerosis and coarse and fine skin wrinkling.
Finally, a 1991 study of .05% and .01% tretinoin cream produced similar results, with 79% of participants showing reductions in mottled hyperpigmentation, skin roughness and laxity after using tretinoin cream for 24 weeks.
Used regularly, tretinoin can be a powerful tool -- perhaps the most powerful tool -- in your skin care and anti-aging arsenal.