Tretinoin (Topical)

Tretinoin (topical) is a drug available in the form of a gel, liquid or cream that is used to treat acne, fine lines and wrinkles on the skin, dark spots or rough skin patches as well as other skin conditions depending on the patient's symptoms.


What is Tretinoin topical?

Tretinoin topical is a medication prescribed by doctors to treat acne, fine wrinkles and rough or dark skin patches. Tretinoin is available in gel (jelly), solution, liquid or cream form and is applied to the face to clear pores, lighten skin and encourage cell replacement. Patients using Tretinoin are encouraged to protect their skin from the sun during the course of treatment. While Tretinoin controls acne and other skin conditions, it is not a known cure for these conditions.

Patients following a course of treatment of Tretinoin topical prescribed by their health care provider should follow all instructions given to them, including the prescription label. Be aware that patients could experience a worsening of their condition including red, scaling skin and an increase in acne sores during the first seven to 10 days of treatment. Continuous treatment should be maintained, as an improvement in skin will typically be seen anywhere from three weeks to six weeks after the first treatment.

Tretinoin is also known under the brand names of Renova, Refissa, Atralin, Avita, Retin-A, Retin-A Micro, Stieva-A, Rejuva and Tretin-X, among others.

How does Tretinoin topical work?

Tretinoin topical belongs to a category of medications called retinoids that work by affecting the growth rate of skin cells. A derivative of vitamin A, Tretinoin is applied to the skin to treat mild to moderate acne or skin that shows damage from being exposed to the sun for too long or too often.

Tretinoin irritates the skin, causing the skin cells to grow and die more rapidly than normal, increasing the turnover of new, healthy skin cells. This rapid turnover of skin cells treats acne by eliminating existing sores and preventing new ones from forming.

By the same method, Tretinoin is also effective on mild lines and wrinkles by improving their appearance with new skin cells. Patients who have skin darkening symptoms such as hyperpigmentation or rough areas of the skin that appear after sun damage will also see an improvement in appearance with the use of Tretinoin.

Tretinoin actually reduces the number of layers of cells in the skin and improvements to skin symptoms will be seen within three to four weeks of use. Apart from the obvious benefits in treating acne sores, Tretinoin also gives patients clear, glowing skin that is less oily and less wrinkled. Tretinoin is not effective on deep wrinkles or in lessening the appearance of scar tissue.

What is acne?

Acne is a skin disease that is caused by hair follicles being blocked with dead skin cells and oil. Acne symptoms include blackheads or whiteheads, pimples, oily skin and possible scarring from cysts. Acne occurs on the face, upper chest and back, where the skin has a relatively high number of oil-secreting glands. Acne sufferers often have symptoms of anxiety, self-esteem issues and depression or suicidal thoughts due to their appearance.

In 80% of cases, acne is thought to be genetic and is worsened by an increase of hormones during puberty. Many people out-grow their acne condition; others do not. In 2015, acne was estimated to affect 633 million people worldwide. The skin-rejuvenating action of Tretinoin, by removing layers of skin cells, improves the appearance of acne by eliminating the accumulation of dead cells and reducing the production of oil.

What is sun damaged skin?

Wrinkles, brown spots and leather-like appearance are all symptoms of sun damaged skin. Sun damage to the skin can occur over a long period of time and often become irreversible. Part of the sun's effect on skin is the heat drying out skin that is unprotected, depleting it of natural oils. This causes dryness, scaly patches and redness on the skin and, at its worse, can lead to skin cancer.

Use of Tretinoin on sun-damaged skin has been successful in restoring the appearance of skin including reduction of wrinkles, smoothing of rough, dry, leather-like areas and lightening of hyperpigmentation areas or brown spots. Tretinoin's properties of renewing the cell layer directly affect symptoms of sun damage.

Conditions treated

  • Acne
  • skin wrinkles
  • hyperpigmentation
  • skin texture
  • other skin conditions as prescribed

Type of medicine

  • Antineoplastic agent

Side Effects

The most common side effects associated with treatment under Tretinoin include the following:

  • Burning skin (during application and a short time after)
  • Stinging skin (during application and a short time after)
  • Lightening or darkening of treated area
  • Skin peeling
  • Skin redness
  • Unusual increased skin dryness
  • Unusually warm skin

All of these side effects will most likely disappear when the use of Tretinoin is discontinued. Changes in the color of skin that occur as a side effect to treatment with Tretinoin, however, may last several months after use of the medication has stopped.

If, however, these side effects worsen or are experienced over a prolonged period of time, notify your health care provider promptly as it may be necessary to decrease the use or strength of Tretinoin or make a change to other treatments you are receiving.

Be aware that acne sores may increase or worsen in appearance within the first two to four weeks of using Tretinoin topical medication. While this is a worrisome condition for many patients anxious for improvement in their appearance with use of Tretinoin, it is encouraged to stay with the treatment as this increase in acne appearance will improve with time.

Any peeling or dryness experienced during treatment with Tretinoin can be eased with the use of a moisturizer. Be aware, however, that moisturizers with formulations that include active ingredients such as menthol or alcohol should not be used. Medicated cleansers, toners and moisturizers containing abrasive ingredients or ingredients such as sulfur, resorcinol or salicylic acid should be avoided. Side effects can also be worsened by using skin products that contain alpha hydroxyl acid, glycolic acid or strong skin drying agents.

Your healthcare provider should be notified immediately if you experience any of the following severe side effects of Tretinoin:

  • Blistering
  • Crusting
  • Severe swelling, itching or burning of the skin
  • Eye redness and watering
  • Swelling of eyelids
  • Severe skin discoloration

Those experiencing a severe allergic reaction to this drug may exhibit symptoms such as a rash, itching or swelling of the face, tongue or throat, severe dizziness or trouble breathing. These symptoms should be immediately reported to your health care provider as they may indicate severe health issues.

This is not a complete list of possible side effects and every patient is different, so any changes to your overall health while using Tretinoin should be discussed with your doctor immediately. To improve the success of the effectiveness of treatment with Tretinoin and to ensure your safety, you should disclose your full medical history to your doctor prior to treatment. This includes any prescription, non-prescription, vitamin, herbal or holistic medications or treatments you are currently taking or have taken in the past.


Different patients will require different strengths or dosage of Tretinoin depending on their unique condition and circumstances. For treatment of acne and wrinkles, dark spots or rough skin, Tretinoin topical will most likely be prescribed for application once per day at bedtime, keeping in mind the directions provided with the medication.

Before using Tretinoin, review the patient information leaflet available from your pharmacist and discuss any questions with the pharmacist or with your health care provider. Patients are advised to use a gentle cleanser that is considered mild and does not contain any medications or soaps and to pat skin dry following cleansing.

After 20 to 30 minutes, apply a pea-sized amount of Tretinoin topical, using just enough to lightly cover the treatment area. Rub the Tretinoin topical in gently but well in order to increase absorption by the skin.

To use the liquid or solution form of Tretinoin topical, a clean gauze pad or cotton applicator should be used to apply the adequate amount to cover the affected areas. Avoid getting the gauze or cotton too wet, which will stop it from dripping and running into areas that are not intended to be treated with Tretinoin topical.

This application of Tretinoin should be performed once per day, as advised by your healthcare provider. Typically, doctors will advise patients to use Tretinoin topical at bedtime, but your instructions may be different depending on your particular circumstances. Always follow doctor's instructions. After application of Tretinoin, wash your hands to avoid unwanted contact with other parts of your body, with others or with objects.

Avoid eyes, nostrils and mouth when applying Tretinoin and wait at least 1 hour before applying other skin products or washing your face. Do not increase the use or amount of Tretinoin in order to get faster or better results, as this could instead increase your risk of developing side effects such as redness, peeling and painful skin.

Do not use Tretinoin on broken skin that has been cut or scraped, sunburned or is affected by eczema. Avoid getting Tretinoin in your eyes; if it does get in your eyes, flush them with large amounts of clean water immediately.

Improved appearance will increase gradually over time, with skin appearance most improved after six months of continued use. Again, the appearance of acne may worsen before it starts to improve.

If you miss an application of Tretinoin topical, it is advised that you skip the dose and go back to the regular schedule as soon as possible. It is not advised to double the dose in order to catch up on the missed application.


Use of other drugs when on a treatment regimen with Tretinoin topical can decrease the effectiveness of one or both drugs and/or cause unwanted health risks and side effects. Inform your health care provider of any prescription, non-prescription, vitamin, herbal or holistic medications or remedies you are taking now or have taken in the past to determine if they will cause unwanted interactions with Tretinoin during treatment.

This is not a full list of all interactions, but the following medicines are known to affect patients in a negative way during treatment with Tretinoin and their use at the same time is not recommended:

  • Aminocaproic Acid
  • Aprotinin
  • Chlortetracycline
  • Demeclocycline
  • Doxycycline
  • Lymecycline
  • Meclocycline
  • Methacycline
  • Minocycline
  • Oxytetracycline
  • Rolitetracycline
  • Tetracycline
  • Tranexamic Acid

An increased risk of certain side effects of Tretinoin can be worsened if the following medicines are used at the same time:

  • Fluconazole
  • Ketoconazole
  • Voriconazole

Additionally, certain health conditions can also cause the safety and/or effectiveness of treatment with a regimen of Tretinoin to be affected adversely. Inform your doctor if you have any of the following health conditions:

As with all drug treatment regimens, patients are advised to fully inform their health care provider of any and all health conditions or treatments they are currently experiencing. This includes any prescription or non-prescription medications or vitamin, herbal or holistic supplements or treatments. Inform your doctor of any pre-existing health conditions that you are suffering from now or have been treated for in the past. Your family history is also important information to pass on to your health care provider so that any possible risks can be determined prior to treatment.


Prior to treatment with Tretinoin, patients are advised to inform their healthcare provider if they have used this drug before and if they have experienced any allergic reactions or side effects. If you have a history of eczema, this should also be made known to your doctor prior to treatment.

Use of Tretinoin may make your skin more sensitive to sun exposure or exposure to ultraviolet light from sunlamps, tanning booths and other light sources. Weather extremes such as cold or wind may irritate skin that is being treated by Tretinoin topical. It is advised that patients on this treatment regimen use a sunscreen on a daily basis and wear protective clothing when outside. If you have been sunburned, it is advised that you wait until it is fully healed before beginning treatment with Tretinoin.

Avoid electrolysis, waxing and chemical depilatories for removing hair on the areas of skin being treated with Tretinoin as these areas will become more sensitive during treatment. If you have recently used skin products that are formulated with the following active ingredients, proceed with caution when beginning treatment with Tretinoin:

  • Sulfur
  • Resorcinol
  • Salicylic Acid

It is advised that you wait until the effects of these products have decreased - or approximately two to three weeks - before beginning treatment with Tretinoin topical.

Women who are pregnant or who may become pregnant or who are breastfeeding should discuss the risks and benefits of using this medication with their doctor. It is not advised or recommended that this medication be used during pregnancy.


Tretinoin topical, whether in gel, cream or liquid solution form, should be kept in the original packaging and out of sight and reach of children. Store the Tretinoin topical at room temperature away from heat, moisture and direct light exposure. Do not allow the Tretinoin topical medication to freeze. The gel form of Tretinoin is flammable and should be stored and applied away from fire or excessive heat.

If you find yourself with unused amounts of Tretinoin topical or if your prescription expires before it is completely gone, consult with your healthcare provider on the best practices for disposal of this medication.


Tretinoin topical is a medication prescribed by a doctor to be applied to the skin to treat the symptoms of acne. This medication is also prescribed for the treatment of sun exposure and is effective on symptoms such as mild wrinkles, hyperpigmentation and skin texture symptoms such as leathery, dry patches. Tretinoin is not a known cure for these conditions but does improve skin appearance with use over time, sometimes for as long as six months.

Tretinoin topical is available in gel, cream or liquid solution form and is to be applied once daily to the affected area, typically before bedtime and after cleansing with a mild, soapless cleanser and patting dry. Avoiding the eye, nose and mouth areas is advised as is strongly recommending washing hands after application. Liquid forms for Tretinoin topical are to be applied with a gauze or cotton applicator or pad, which should not be overly soaked in the solution to avoid dripping.

Patients who suffer from other skin conditions such as eczema are advised to inform their health care providers of this condition, whether they currently exhibit symptoms or not. Side effects of this medication include increased skin sensitivity to sun and ultraviolet light, dryness, itching or redness in the treatment area and possible worsening of acne sore appearance and number of sores. These side effects should improve over time but if they are severe or become prolonged, it is advised that the patient inform their health care provider immediately.

Tretinoin topical, in gel form, is considered flammable and should be stored and applied away from heat sources. All forms of Tretinoin topical should be kept in their original packaging and stored away from direct light, moisture and heat sources. Storing this and all medications away from sight and reach of children is advised.

Tretinoin topical medication has a gradual improvement effect on symptoms of acne, wrinkles and sun damage over time; sometimes as long as six months of continuous use. Patients are encouraged to continue their treatment regimen without skipping applications or increasing applications expecting faster results. This will only increase the chances of unwanted side effects such as itching, burning, redness and dryness.

Last Reviewed:
December 24, 2017
Last Updated:
April 03, 2018
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