How does tretinoin work? | Medical News Bulletin

Tretinoin is a prescription retinoid used to treat acne and other skin problems. How does tretinoin work, what is it used for, and what are the potential benefits and side effects?

What is tretinoin?

Tretinoin is prescribed by a doctor and can be applied topically or orally as isotretinoin capsules (Accutane ®). For simplicity, this article will focus on topical treatment with tretinoin and how it works. Topical tretinoin, sold under brand names such as Retin A, Altreno, and others, is available as a cream, lotion, gel, or liquid solution, and concentrations range from 0.01% to 0.1%.1 Tretinoin can also be prescribed simultaneously with antibiotics to treat specific types of acne, and it can be part of certain combination therapies, such as clindamycin / tretinoin gel.2

Tretinoin is a form of retinoic acid, which is a derivative of vitamin A, and it’s been used to treat a variety of conditions since the 1960s.3 Topical tretinoin is approved by the FDA to treat acne vulgaris as well as to treat signs of photoaging, such as fine wrinkles, roughness, and certain types of hyperpigmentation.1.4 It is also sometimes prescribed off-label to treat other skin problems.

How does tretinoin work?

Although the exact mechanism of how topical tretinoin works is unknown, current research suggests that tretinoin, when applied to the skin, binds to nearby retinoic acid receptors.5 This can be responsible for activating a variety of different functions, such as reducing the buildup of keratin in the sebaceous ducts and encouraging collagen production.5 More research is needed to determine exactly how tretinoin works and how it can be optimized to be as beneficial as possible.

The excessive buildup of keratin in the sebaceous ducts can play a role in the development of certain types of acne, so targeting this pathway may help treat and prevent acne in some people.6, 8. Additionally, by improving collagen production and skin cell renewal, tretinoin could potentially help reduce signs of photoaging in some people, such as wrinkles and sun spots.7 Talking to a health care provider could help you determine if tretinoin would work for your skin type and unique concerns.

What are the side effects of tretinoin?

Some common side effects of using topical tretinoin include excessive dryness of the skin, redness, peeling, and a scaly appearance of the skin.4 This is usually most important during the first few weeks of topical tretinoin use, and it often goes away after a few weeks of use.4 The use of tretinoin can also be associated with increased sensitivity to the sun, so it is especially important to limit sun exposure and use broad spectrum sunscreens that protect against UVA and UVB rays.4

It is important to tell your doctor or pharmacist of any side effects that concern you; they may want to change the concentration of tretinoin or stop it altogether. Seek immediate medical attention if you experience any signs of an allergic reaction after using the medicine, such as hives, chest tightness, and swelling of your face, mouth, or throat.

Although oral isotretinoin cannot be used during pregnancy due to a risk of birth defects to the developing fetus, the evidence for this occurrence with topically applied tretinoin is inconclusive because a minimum amount of Tretinoin is actually absorbed into the bloodstream.9 Since the consensus on this is relatively unknown, it is generally not recommended to use tretinoin during pregnancy, so it is important to discuss this with your doctor.ten

Some other topical medications and skin care ingredients may not mix well with tretinoin; for example, the application of benzoyl peroxide at the same time as certain forms of topical tretinoin may reduce the effectiveness of tretinoin.11 Because tretinoin can cause irritation and dryness to the skin where it is applied, your doctor may not recommend the use of other drying care ingredients when you start using topical tretinoin.12

Tretinoin can also interact with some oral medications, so it’s important to tell your doctor about all the products, supplements, and medications you use. This article does not constitute medical advice and is not intended to prescribe, diagnose or promote specific treatments for any condition. Consult your doctor or other qualified healthcare professional for your specific skin needs.

The references

  1. Yoham, AL, Casadesus, D. (December 5, 2020). Tretinoin. StatPearls [Internet]. Accessed online May 5, 2021 at
  2. Oschendorf, F. (June 7, 2015). 1.2% Clindamycin Phosphate / 0.025% Tretinoin: A New Fixed Dose Combination Treatment for Acne Vulgaris. Journal of the European Academy of Dermatology and Venereology 29 (5): 8-13. Doi: 10.1111 / jdv.13185
  3. Stuttgen, G. (1986, October). Historical perspectives of tretinoin. Journal of the American Academy of Dermatology 15 (4): 735-740. Doi: 10.1016 / S0190-9622 (86) 70228-4.
  4. Mukherjee, S., et al (2006, December). Retinoids in the treatment of aging skin: an overview of clinical efficacy and safety. Clin Interv Aging 1 (4): 327-348. Doi: 10.2147 / ciia.2006.1.4.327
  5. Baldwin, HE, Nighland, M., Kendall, C., et al (2013, June 1). 40-year review of topical use of tretinoin. Journal of Drugs in Dermatology: JDD 12 (6): 638-642. Retrieved May 13, 2021, from
  6. Botros, PA, Tsai, G., Pujalte, GGA (2015). Acne Assessment and Management. Prim Care Clin office practice 42: 465-471. Doi: 10.1016 / j.pop.2015.07.007
  7. Kang, S., Fisher, GJ, Voorhees, JJ (1997). Photoaging and topical tretinoin: therapy, pathogenesis and prevention. Arc Dermatol 133 (10): 1280-1284. Doi: 10.1001 / archderm.1997.03890460104012
  8. Schmidt, N., Gans, EH (2011, November). Tretinoin: a review of its anti-inflammatory properties in the treatment of acne. J CLin Aesthet Dermatol 4 (11): 22-29. Retrieved May 13, 2021 from
  9. Van Hoogdalem, EJ (2006). Transdermal absorption of topical anti-acne agents in humans; review of clinical pharmacokinetic data. Journal of the European Academy of Dermatology and Venereology 11 (1): S13-S19. Doi: 10.1111 / j.1468-3083.1998.tb00902.x
  10. Bozzo, P., Chua-Gocheco, A., Einarson, A. (2011). Safety of skin care products during pregnancy. Fam Can Doctor 57 (6): 665-667. Accessed online May 15, 2021 at
  11. Del Rosso, JQ, Pillai, R., Moore, R. (2010). No degradation of tretinoin when benzoyl peroxide is combined with an optimized formulation of tretinoin gel (0.05%). J Clin Aesthet Dermatol 3 (10): 26-28. Retrieved May 15, 2021 from
  12. Laquieze, S., Czernielewski, J., Rueda, MJ (2006). Beneficial effect of a moisturizer as an adjunct to oral isotretinoin or topical tretinoin in the management of acne. Journal of Drugs in Dermatology: JDD 5 (10): 985-990. Retrieved May 15, 2021, from
  13. Image by andreas160578 from Pixabay

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