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Everything You Need To Know About Tretinoin, According To Experts

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These days, it's nearly impossible to step into a New York City subway car without seeing 15 different advertisements for products promising to change your skin. And while the branding might be different in every case, they've all got one thing in common: they're selling retinoids.

Retinoids are the umbrella term for vitamin A derivatives that promise to speed up cell turnover, increase collagen production, and when used diligently bring an all-over glow to skin by squelching acne, obliterating dark spots, and making fine lines yesterday's problem. You can get them over the counter in the form of retinols, which vary in strength and potency depending on the one that you slather. However, stronger, more potent formulas, like Tretinoin are also available with a prescription from a doctor.

"Tretinoin was originally created to help treat acne, but it was later discovered that it helps stimulate collagen production in the skin," says Dr. Michael I. Jacobs, a board-certified dermatologist and associate professor of dermatology at Weill Cornell Medical College. Because of this, tretinoin is now a coveted ingredient for anti-aging benefits, which include the ability to diminish dark spots and soften fine lines and wrinkles. And, since it's so potent, it works a lot faster than retinol.

"Tretinoin helps cells on the skin's surface and deep in the pores mature in a more normal fashion, meaning they can be shed normally as the skin goes through its life cycle. This process prevents the blocking of pores while also reducing hyperpigmentation," explains David Lortscher, MD, a board-certified dermatologist and CEO of Curology. "Tretinoin also stimulates collagen growth, which boosts your skin's firmness and helps minimize the appearance of fine lines and wrinkles. It reverses UV-induced collagen breakdown and the degeneration of elastic fibers, which are essential to youthful, firm skin."

Though it's impossible to directly compare the strength of retinol to tretinoin across the board, Dr. Lortscher notes that some observations have found it to be roughly 20 times more potent than retinol. And why is that? "Over the counter products are made with retinol, retinaldehyde, and retinyl esters," explains board-certified dermatologist Joshua Zeichner, MD. "When applied to the skin these ingredients need to go through one or more steps to be converted to its more active form." And that active form is retinoic acid (which, FWIW is tretinoin), which means that its ready to sink into your skin and get to work.

But, what is Tretinoin, exactly? Let's deep dive, ahead.

What exactly does Tretinoin do?

Tretinoin is a retinoic acid that, as Dr. Jacobs notes, was originally prescribed for treating acne. But, thanks to its ability to stimulate collagen production, experts recommend the ingredient for minimizing fine lines, wrinkles, and even sun damage. "By accelerating the turnover rate of skin cells, it works to shed dead skin cells, uncovering a fresh layer of healthy skin cells," says Dr. Dendy Engelman, MD, FACMS, FAAD, a board-certified cosmetic dermatologist and Mohs surgeon at Shafer Clinic in New York City. "This process not only promotes a balanced texture and tone, but it also aids in unclogging pores and preventing acne formation," she adds.

Is Tretinoin the same as retinol?

Since Tretinoin is a retinoic acid, many wonder: Is Tretinoin the same as retinol? While there are some similar benefits of Tretinoin and retinol, both have some differences. "Tretinoin and retinol are both derived from vitamin A and can produce similar results such as exfoliation, stimulating collagen and elastin production, as well as increasing cell turnover rate," says Dr. Engelman. However, retinol is actually a natural form of vitamin A and can be less irritating. It can also be purchased over the counter (which is why there are so many amazing and effective skincare products with retinol). "Tretinoin is a synthetic form of vitamin A that is only available with a prescription due to its potency," Dr. Engelman adds.

So, as much as the two are similar, Tretinoin is actually much stronger than retinol and, therefore, considered a medical treatment for its potent formulation. Retinol is an excellent Tretinoin alternative, though, since it's a little less potent (and, therefore, less irritating) and can be purchased over the counter in creams, serums, and more.

What are the risks and downsides of Tretinoin?

Since Tretinoin is so potent and a prescription-strength vitamin A, Dr. Jacobs says it acts quicker and has more drastic results than typical retinol on the skin. "For Tretinoin use, a tolerance should be built up slowly over time before working up to daily use," he explains, noting that, for some, daily use might never be tolerable. Because of this, Dr. Jacobs recommends starting by using it once per week for a couple of weeks, then once every couple of days. "If tolerance isn't built up first, Tretinoin can be very drying for the skin and may cause skin irritation and flakiness."

Some people might also experience purging when they first start using Tretinoin. Both Dr. Jacobs and Dr. Engelman say this is to be expected because, when applying the Tretinoin, it can cause congestion to come to the skin's surface and result in a breakout. However, this side effect of Tretinoin subsides after a couple of weeks and it's okay to continue using it for its anti-aging and anti-aging benefits.

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In addition to irritation, flakiness, and purging, Dr. Engelman says sun sensitivity is a concern with Tretinoin use. Much like retinol, limiting sun exposure and wearing sunscreen while using Tretinoin in your skincare routine is crucial to preserving skin health.

Who is a good candidate for Tretinoin?

When it comes to who is a good candidate for Tretinoin, Dr. Engelman says those who suffer from severe or recurring acne can reap the benefits of this impressive treatment. "Anyone who is looking to reduce the appearance of sun damage, fine lines, and wrinkles could also be considered," she adds.

With that said, she doesn't recommend using Tretinoin if you're pregnant, breastfeeding, or on certain medications, so it's important to disclose your medical history to your doctor while seeking a Tretinoin prescription.

What should I avoid using on my skin while using Tretinoin?

If you're adding Tretinoin to your skincare routine, Dr. Jacobs says not to layer this potent prescription with other retinol products. "Also, if you have sensitive skin, be cautious with using Tretinoin in conjunction with other exfoliants like AHAs or BHAs as this may be too drying on the skin," Dr. Jacobs adds, noting that some skin types can still tolerate this combination.

In addition to AHAs and BHAs, Dr. Engelman says to also hold off on using salicylic acid, benzoyl peroxide, glycolic acid, and lactic acid since these can also cause severe dryness and irritation when combined with potent Tretinoin. She also says not to wax while using Tretinoin since this prescription makes the skin extremely sensitive.

What you should know before using retinoids

Retinoids, in general, are known to cause skin irritation, and tretinoin is no exception. If you're using a product too frequently or with too high of a concentration, you may wind up with redness and oversensitivity. "Not all prescription written words are created equally—I often write brand-name drugs for my patients, as they offer better vehicles," says Dr. Zeichner. The delivery system of the topical will impact whether the skin develops irritation, maintains stability of the active ingredient, and ultimately impacts patient outcomes."

Though tretinoin usually requires a prescription from a derm, an actual visit isn't always necessary thank to advances in teledermatology. "The direct to consumer teledermatology market is a great option for people who cannot get into see a live dermatologist," says board-certified dermatologist Dr. Zeichner. "Nothing replaces an actual visit, but that may not be possible for many people. These services allow a greater number of people to have access to prescription options they would not normally be able to get." When in doubt, though, schedule a visit to the derm.

Brands that will give you a tretinoin prescription online

Thanks to very successful subway advertising, you may already be familiar with some of the new direct to consumer tretinoin brands on the block. But just in case, here are a few worth keeping on your radar, which will allow you to buy tretinoin with the click of a button.

Dear Brightly: Dear Brightly offers $29 dermatological consults to help personalize and tailor your prescription. Their $59 tretinoin lotion (which is formulated with hyaluronic acid) has between 0.015 and 0.1 percent tretinoin depending on what your skin needs. I've personally used this product for four months, and it's given me the glass skin of my dreams.

Curology: Curology's skin-care formulas are all customized, but many of them utilize tretinoin for its powerful acne-fighting abilities. You'll start your visit to the company's website with a consult with a tele-derm, and they'll prescribe you with the best product combos to help you deal with whatever is ailing your skin.

Altrenno: You'll need to get a prescription from a derm before you place an order with Alrerno, but this product is great for anyone who is nervous about having a reaction to tretinoin. "Altreno is the only tretinoin lotion available on the market," says Dr. Zeichner, who works closely with the brand. "Its specialized formulation significantly reduces skin irritation so patients can use tretinoin without developing as much redness, burning, and peeling." It has a 0.05 percent potency, and is mixed with sodium hyaluronate (a form of hyaluronic acid) to help with hydration.

Hers: Hers offers different tretinoin formulations depending on whether you're looking to target acne, signs of aging, or melasma. Prices range from $37 to $75, and you'll go through a dermatological consult via the brand after you check out to be sure the product you picked is the right one for you.

Retinoid Vs Retinol: How Do They Compare For Skincare?

Retinoids include all derivatives of vitamin A or retinol. They are typically used to treat skin conditions and for cosmetic purposes. Retinoids can be naturally occurring or synthetically made.

Vitamin A (retinol) is converted to retinaldehyde (retinal) in the body. Retinaldehyde is then converted to retinoic acid (tretinoin). Retinoic acid binds to retinoic acid receptors in the body, producing positive skin results.

Weaker-strength retinoids are available over-the-counter and can treat acne and signs of aging. OTC retinoids are usually retinol or retinaldehyde.

Stronger retinoids are available by prescription only and can be used for acne, aging, psoriasis, and cancer. Adapalene is available both OTC, in a lower strength, and by prescription.

How long retinoids take to work depends on what they are being used for. Retinoids may start helping acne quickly, but results may not be seen until six to eight weeks or more.

To see an effect on fine lines, wrinkles, and pigmentation, you may need three to six months of consistent use. If you stop using retinoids, the results may gradually disappear.

Retinoids are available as topical and oral medications and have varying uses. These medications may be prescribed for other conditions under the supervision of a healthcare provider.

The table below highlights different retinoids, how they are supplied, and US Food and Drug Administration (FDA)-approved uses.

Types of Retinoids Retinoid Topical Oral Acne Aging Psoriasis Cancer Acitretin X X Adapalene X X Alitretinoin X X Bexarotene X X X Isotretinoin X X Tazarotene X X X Tretinoin X X X X X Trifarotene X X Side Effects of Retinoids Topical Retinoids Prescription-strength topical retinoids typically cause more side effects than OTC options and are typically worse in the first two weeks of treatment. Common side effects of topical retinoids include: Burning Changes in skin pigmentation (coloring) Itching Skin dryness Skin irritation Skin peeling Skin redness Sun sensitivity If you experience side effects, it is best to alter your application regimen. Applying it less frequently will help your skin get accustomed to it. It is recommended that you start applying topical retinoids every other evening or every three days, gradually increasing to every night. Applying a moisturizer afterward can help prevent irritation. Oral Retinoids Oral retinoids are absorbed systemically, meaning they travel through your bloodstream. This is beneficial for treating certain conditions but can cause more side effects, some of which can be severe. Common side effects from oral retinoids include: Changes in cholesterol Dry skin and mucous membranes (mouth, lips, nose) Dry eyes Increased liver enzymes Joint pain Muscle pain Serious side effects associated with oral retinoids include: Other Precautions Retinoids can make your skin more sensitive to the sun. This can cause sunburn, irritation, and damage to your skin. While using retinoids, you should protect your skin by: Avoiding the sun during the peak times of 10 a.M. To 4 p.M. Wearing protective clothing, sunglasses, and a wide-brimmed hat Wearing sunscreen with at least an SPF of 30 Exposure to ultraviolet light can decrease the effectiveness of retinoids. They should be applied at bedtime, except for adapalene (Differin), which can be used during the day. Since retinoids make your skin more sensitive, it is best to avoid certain skin procedures while using these products, such as: Oral retinoids like isotretinoin can cause severe birth defects and should not be taken by anyone pregnant. Because the risk is so high, people taking these medications will be required to enroll in the iPledge program. This program helps to ensure that pregnancies do not occur while taking oral retinoids. If you are using topical retinoids and are pregnant, planning on becoming pregnant, or breastfeeding, you should discontinue retinoids and find a safer alternative. Speak with your pharmacist or healthcare provider for more information. Understanding Retinol Retinol, also known as vitamin A, is a type of retinoid commonly found in OTC skincare products for acne or aging. It is naturally occurring and can be found in plant and animal sources; however, most available retinol products are chemically made. OTC products may contain retinyl esters, retinol, or retinal. Each of these must be converted to retinoic acid, with retinyl esters being the weakest and retinal being the strongest. Keep in mind that OTC products containing retinol are considered cosmetic products and are not regulated the same way prescription and OTC medications are. Benefits Retinol has been shown to improve the appearance of the skin. It can improve: Acne Fine lines Skin tone Texture Wrinkles Retinol is a weaker retinoid, so results will be less pronounced and take longer. Prescription retinoids can take up to six months to work, so don't expect quick results. However, it should result in fewer side effects. Retinol may be a better option for someone with sensitive skin or new to trying a retinoid. Uses Retinol is used to treat the following issues: Acne Fine lines and wrinkles Dark spots Side Effects of Retinol Retinol side effects are usually temporary and less intense than prescription-strength retinoids. You may experience the following side effects: Burning or stinging skin Dry skin Itching Peeling Skin irritation Skin redness Summary Retinol is a type of retinoid. It is a weaker retinoid and is available OTC. It will take longer to see changes with retinol, but it generally causes fewer side effects. Retinol may be a better choice for someone with sensitive skin. Retinoid products are stronger and will show results quicker than OTC options. However, retinoids cause more side effects. Proper sunscreen, moisturizers, and application techniques can help minimize side effects. Retinoids may be a better choice for someone with more severe skin concerns. Both retinol and retinoids can improve the appearance of the skin, however, retinoids can also be used for other treatments, such as psoriasis and certain types of cancer.

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