Tretinoin: a dermatologist’s guide for patients

Table of Content:
What is tretinoin? | What is it used for? | Benefits | Side effects | Formulations | Concentrations | Getting used to it | Shelf life | Request a consultation | Tretinoin and Altreno | Tretinoin and isotretinoin | Tretinoin and adapalene | Tretinoin and tazarotene | Tretinoin and trifarotene | Tretinoin and retinol | Tretinoin with Winlevi | Tretinoin with azelaic acid | Is tretinoin over the counter?

What is tretinoin (Retin-A) cream?

Tretinoin, (also known as all-trans retinoic acid ATRA), is a topical prescription medication belonging to the retinoid class. Tretinoin is used to treat various skin conditions by regulating the process of skin cell growth and differentiation. In simpler terms, tretinoin help regulate how skin cells develop and mature which is beneficial to manage different skin problems¹.  For example, tretinoin accelerates the turnover of aging skin cells while stimulating the generation of fresh ones. Consequently, it also helps unclogging pores, reducing inflammation, and improving the overall skin texture appearance.

What is tretinoin used for? 

Treatment of acne

Tretinoin is commonly prescribed for treating mild to moderate acne, including both non-inflammatory (whiteheads and blackheads) and inflammatory (papules, pustules, and cysts) forms. It helps to prevent the formation of new acne lesions and promote the healing of existing ones².

Hyperpigmentation

Tretinoin can be effective in treating hyperpigmentation issues such as melasma and post-inflammatory hyperpigmentation. It helps to fade dark spots and even out skin tone³.

Rough skin texture

Tretinoin can improve the texture of the skin by encouraging the shedding of dead skin cells and promoting the growth of newer, smoother skin cells⁴.

Stretch marks

Clinical studies show that tretinoin can be used in some cases, to improve the appearance of stretch marks, although its effectiveness tends to vary from person to person⁵.

Wrinkles and anti-aging

Tretinoin can also be used for wrinkles and anti-aging. Its regular use can lead to the reduction of fine lines, wrinkles, and other signs of skin aging by stimulating collagen production and improving skin elasticity⁶.

Benefits of tretinoin on the skin 

Tretinoin, a potent topical treatment, has several effects on the skin that help reduce the number of acne lesions and improve overall skin health. 

Tretinoin has proven comedolytic properties, which helps prevent the formation of comedones – the building blocks of acne. It regulates exfoliation, promoting healthy turnover of skin cells within hair follicles and preventing pore congestion⁷.

Tretinoin also helps prevent follicular plugging by inhibiting the activity of transglutaminase, an enzyme that contributes to the adhesion of skin cells.^8.

Tretinoin also plays a role in the drainage and expulsion of excess sebum and acne-contributing bacteria. It cultivates an aerobic follicular environment, unsuitable for the growth of acne-causing bacteria⁹.

Anti-inflammatory effects

Tretinoin has mild anti-inflammatory properties. It can help decrease the inflammation associated with acne lesions, reducing redness and discomfort¹⁰.

Stimulation of collagen production

Tretinoin also stimulates the production of collagen and helps preserve existing collagen, by inhibiting collagenase, an enzyme that breaks down collagen fibers. This leads to smoother and more youthful-looking skin. As collagen levels increase, the skin becomes more supple, wrinkles and fine lines are reduced, and overall skin texture improves¹¹.

Cell renewal 

Tretinoin accelerates the turnover of skin cells, a process known as desquamation and exfoliation. This involves shedding the outermost layer of dead skin cells and replacing them with new ones. By promoting this turnover, tretinoin helps to reveal fresher, younger skin cells, resulting in a smoother complexion and improved skin tone¹².

Enhanced blood flow

Tretinoin’s action on the skin can lead to increased blood flow to the treated areas. This enhanced circulation brings more oxygen and nutrients to the skin cells, aiding in their renewal and overall skin health¹³.

Normalization of keratinization

Tretinoin helps regulate the process of keratinization¹⁴. This is a natural process that occurs in the body as a defense mechanism in which the outer layer of  the keratinized cells acts as a shield, protecting the body and helping it to retain moisture within the skin¹⁵. 

However, in conditions like acne, abnormal keratinization can lead to the formation of plugs within hair follicles, contributing to the development of acne breakouts. Tretinoin helps to normalize this process and prevent pore blockages¹⁶.

Reduction of pigmentation

Multiple clinical studies show that tretinoin contributes to the fading of hyperpigmentation, sunspots, and uneven skin tone^{17 18} .

Pore size reduction

Studies show that tretinoin can reduce the appearance of large pores due to the increased cell turnover. As dead skin cells are shed more efficiently, pores may appear smaller and less noticeable¹⁹.

Potential side effects and precautions

Tretinoin, while effective in addressing various skin concerns, can also have some side effects, particularly when starting the treatment or if used improperly. It is important to be aware of these potential side effects and to use tretinoin under the guidance of a dermatologist. Here are some common side effects of tretinoin:

• Skin irritation
• Peeling and flaking
• Increased sensitivity to sun
• Dryness
• Skin redness
• Tingling or burning sensation
• May cause hyperpigmentation in skin of color due to irritation²⁰
• Increased breakouts in the beginning of the treatment (commonly referred to as tretinoin purging)

It is recommended that women stop using tretinoin one month before planning a pregnancy, during pregnancy, and until they are nursing. This is due to the teratogenic effects it may cause to the developing fetus²¹.

Since tretinoin is photosensitive and causes sun sensitivity²², so it is important that it is applied during the night and that you use a sunscreen with SPF 50 during the course of the treatment to prevent sun damage. 

Tretinoin formulations

Tretinoin comes in three different formulations: creams, gels and a lotion. They have different benefits and uses, and the right formulation greatly depends on your type of skin and your concern.

Tretinoin concentrations

Tretinoin cream comes in different concentrations such as 0.01%, 0.02%, 0.025%, 0.05%, 0.08%, and 0.1%. The mildest concentration is 0.01% and the most potent concentration is 0.1%.

Different pharmaceutical companies produce different strengths, and not all brands offer all variations.

Getting used to tretinoin cream

Although tretinoin has benefits for the skin, it tends to be quite irritating, especially if you have never used it before. That is why it is essential that you only use it under medical supervision and that you follow your dermatologist’s guidance on when and how to use it, how to layer it, and the best strength for your needs.

Tretinoin shelf life and expiration date

Like all medications, tretinoin cream has an expiration date which is very different from the medicine’s shelf life after opening. The expiration date and the shelf life after opening in many cases is not the same, but which one should you follow?

Get tretinoin with an online dermatologist consultation 

To get tretinoin, you must have a doctor’s prescription. To get this, you can have a virtual photo consultation with an online dermatologist which only costs $59. It will take 1-2 days to get your answer and the prescription. Once you have the prescription, you can buy tretinoin at your local pharmacy or order it online.

Comparing tretinoin to other retinoids

Retinoids play a significant role in addressing various skin concerns. Among them, tretinoin cream stands out as a well-known and widely-used option. However, there are several retinoids and they all have unique benefits. As a general rule, you should not use two different retinoids at the same time because the benefits are quite similar and they could cause too much irritation on the skin. 

Tretinoin and Altreno

Tretinoin (also known by its brand name Retin-A) has been the gold standard for addressing acne, minimizing fine lines, and enhancing skin texture. However, Altreno^TM, a new and revolutionary tretinoin formulation has emerged with clear advantages due to its unique formulation which includes tretinoin, hyaluronic acid, collagen and glycerin. 

Tretinoin and Isotretinoin

Tretinoin is a first generation retinoid approved for the treatment of mild to moderate acne, fine wrinkles, hyperpigmentation and rough skin²³. Isotretinoin is a second generation retinoid that is taken by mouth. It is indicated in the treatment of severe acne that has not responded to other treatments²⁴. Due to its teratogenic effect and serious side effects, it is a medication that is only prescribed as a last resource. 

Tretinoin and adapalene

Adapalene is a third generation retinoid that is considered as effective as tretinoin for acne but less irritating²⁵. The advantage of adapalene is that it can be used by people with sensitive skin and is priced similarly to tretinoin while some of the newer retinoids tend to be very expensive.

Tretinoin and tazarotene

Tazarotene is a third generation retinoid and is considered the most potent retinoid available in the market.  It is approved for the treatment of moderate to severe acne, photodamaged skin and psoriasis. Clinical studies have shown that tazarotene shows results faster than tretinoin in the treatment of acne, fine lines and wrinkles, and photodamaged skin^{26 27}. 

Tretinoin and trifarotene 

Trifarotene is a fourth generation retinoid approved by the FDA for the treatment of acne.  An important difference from tretinoin is that it is less irritating on the skin and has less side effects which is why it is one of the few retinoids that can be used by patients as young as 9 years of age²⁸. In contrast, most retinoids should only be used by patients who are at least 12 years of age.   

Tretinoin and retinol 

Retinol, is a very popular, over the counter retinoid available in the market. Since it is much less potent than tretinoin and it has milder side-effects it is widely used in many skin care products. 

Combining tretinoin with other medications

Acne is often treated with a combination of two or more medications at the same time, which is commonly referred to as “combination treatment.” 

Combination therapy aims to address multiple factors that contribute to acne development, such as excess oil production, bacterial growth, inflammation, and abnormal skin cell shedding.

By using different medications that target these various factors, dermatologists can often achieve better and more comprehensive results than by using a single treatment alone. 

For example, a common approach might involve using a topical retinoid (like tretinoin cream) alongside a topical antibiotic or benzoyl peroxide to target both acne-causing bacteria and skin cell turnover. Combination therapy can lead to improved efficacy, faster results, and reduced potential for antibiotic resistance, which can occur when antibiotics are used as a monotherapy. 

Tretinoin with Winlevi^®

Using Winlevi together with tretinoin is an effective way to combat acne since they complement each other. Winlevi is an androgen receptor inhibitor which regulates sebum production and inflammation²⁹ while tretinoin unclogs pores and reduces the number of new and existing acne breakouts.

Tretinoin with spironolactone

Using spironolactone together with tretinoin is an effective and affordable way to combat hormonal acne long-term. Oral spironolactone is a is potassium-sparing diuretic used off-label in the treatment of hormonal acne and female pattern baldness.

Tretinoin with azelaic acid

The combination of azelaic acid with tretinoin is a powerful acne treatment since they complement each other quite well.  These two medications address some of the same causes of acne such as decreasing sebum production, act as anti-keratinizing agents, reduce hyperpigmentation, inflammation and unclog pores. On the other hand, azelaic acid also has antimicrobial properties and targets some hormonal causes similar to Winlevi. 

Is tretinoin sold without a prescription?

Tretinoin cannot be purchased without a prescription. To get tretinoin, you must get a prescription from a healthcare professional.

Conclusion

This comprehensive guide on tretinoin cream can serve you as a valuable resource if you want to improve your skin health with the guidance of your online dermatologist. 

By covering various aspects of tretinoin, from its definition and diverse applications to its benefits, proper usage guidelines and concentration variations, you will be better equipped with the knowledge needed to make informed decisions about your dermatology treatment.

Article References:
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https://www.winlevi-hcp.com/androgen-sebum-pathway