Tretinoin: What is it and How Does it Work?

Tretinoin is a prescription topical medication that is used to treat acne and other skin conditions. It can also be prescribed for certain types of wrinkles, sun damage, or age spots. This tretinoin guide outlines how to use tretinoin for different purposes but we will focus mainly on its treatment of acne, as well as the side effects and risks involved with tretinoin use. We hope to provide you with enough information to have an informed discussion regarding topical tretinoin with your dermatologist.

What is tretinoin?

Tretinoin is a topical cream or lotion that is used to treat acne, also called acne vulgaris. It is also used to treat acute promyelocytic leukemia too in its oral form (in a pill, capsule, or liquid taken orally) but we will focus on the acne-fighting aspects of the drug which come in the form of topical solutions. 

Tretinoin, also called by its scientific name all-trans retinoic acid or ATRA for short, is a retinoid. It is a man-made form of vitamin A and works by altering the way that skin cells grow, develop, and die.

What is tretinoin used for?

It's an FDA-approved medicine that can be prescribed by your dermatologist if you have mild, moderate, or severe acne, and it works by reducing the amount of oil produced by glands in the skin and slowing down the growth of skin cells which causes inflammation and premature aging. 

Tretinoin is a retinoid, which means it is a man-made form of vitamin A. Treatments using tretinoin have been around for decades as one of the most effective acne medications available on the market today. Tretinoin helps to reduce inflammation of pimples or pustules which can help decrease their size and frequency over time. It does this, as all retinoids do, by binding to two nuclear receptor sites in keratinocytes, keratinocytes being the most common cell type found in your skin. This allows blood to flow more to the follicles which prevents blocking of pores by sebum (the natural oil your body produces in the sebaceous glands next to hair follicles) and dead skin cells, which is the beginning stage of all acne. 

What is the active ingredient in tretinoin?

Tretinoin is one topical treatment that is FDA-approved for use on adults with mild to moderately severe acne. Not shockingly, tretinoin's active ingredient is tretinoin. The tretinoin solutions contain tretinoin in three strengths: 0.1%, 0.05%, and 0.025%.  

The milder prescription may be less irritating when used daily compared to other topical anti-acne products like benzoyl peroxide or salicylic acid solutions which are very common over-the-counter acne medications that you can find at your local drugstore.

Tretinoin works because it's a topical treatment that reduces inflammation.  When bacteria infect one pore they produce an inflammatory response which leads other pores around it to do the same. By tamping down inflammation, tretinoin can prevent other pore-inflamed acne.

What are the side effects of tretinoin?

Although tretinoin has a number of serious side effects when taken orally, its side effects from using the topical solutions are usually very mild and mostly involve skin irritation.

Tretinoin cream can cause skin problems and possible side effects during treatment for acne such as: 

  • Peeling
  • Dryness
  • Irritation
  • Redness
  • Swelling
  • Blistering 

Tretinoin should not be used near the eyes or any other part of the body with sensitive skin. If it irritates your eyes, wash your eyes thoroughly with water or a saline solution before applying it to your face so it doesn't get in your eyes.

If you experience any of these symptoms, using the product less frequently should help. Any peeling skin can be gently exfoliated using a washcloth and a moisturizer may be used to help prevent further peeling. Some have also experienced increased sun sensitivity while taking tretinoin. [link: https://www.scmsjournal.com/article/buy_now/?id=274] If you experience any moderate or severe symptoms please seek medical attention right away to determine the best course of action for you.

Who can take tretinoin?

Because side effects are mild in treating acne, if you have mild, moderate, or severe acne and are over the age of 12 years old, you can take tretinoin. It’s not advisable if you are pregnant or trying to become pregnant. You will need to take extra care when outside in the sun to cover your skin and wear a hat because tretinoin may make skin more sensitive with sun exposure.  

Tretinoins to treat acne are typically for topical use as a cream or gel, although it is sometimes prescribed orally for severe cases (under strong physician supervision). When taking tretinoin orally in a pill, capsule, or liquid form, it’s reserved for treating patients with cancer and comes with intense side effects such as vomiting. We must reiterate that these side effects and treatment options are vastly different than using tretinoin only for the topical treatment of acne, as the side effects from taking a pill for leukemia can be far harsher.  

Where can I get tretinoin?

Retin-A is the most common brand of tretinoin and is only available by prescription from your doctor and is not available over-the-counter in the United States. Your dermatologist is the best person to ask about tretinoins and how to use it, how much dosage to use, and any additional precautions required when using this drug. Please consult your doctor about your best treatment options. 

Summary

Tretinoin is a topical treatment for reducing inflammation caused by acne. Tretinoin is often prescribed topically for acne relief due to its severe side effects when taken orally. Tretinoin should not be near sensitive areas of your face such as your eyes. Tretinoin can also be used for people who have sensitive skin because it is less aggressive than tetracycline, benzoyl peroxide, erythromycin, and clindamycin–all common acne treatments. 

Topical use has a shortlist of mild side effects that include peeling skin, dryness, irritation, redness, swelling, blistering, and sun sensitivity. Despite the risk of these side effects, the benefits of treating acne should far outweigh the negatives, although that can only be determined by your doctor. You can take tretinoin for mild, moderate, or severe acne if you are over 12 years old and avoid sun exposure and sunburns during tretinoin treatment. Tretinoin is only available by prescription from your doctor and is not available over-the-counter in the United States. If you have any questions, always consult your physician or pharmacist to determine if tretinoin is the right treatment to help clear your acne and to achieve the best results. 

NIH – Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments

NIH – Tretinoin: A Review of It’s Anti-Inflammatory Properties in the Treatment of Acne

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