Patient Handouts : Topical Retinoids

Topical Retinoids
(Tretinoin, Retin-A Micro, Differin, Tazorac)

  • Topical retinoids are most commonly used for the treatment of acne, but they are also used for other purposes, such as treatment of photodamaged skin (fine lines, wrinkling, dyspigmentation).
  • Retinoids are derivatives of vitamin A and are effective in both comedonal acne (blackheads and whiteheads) as well as inflammatory acne (red bumps).
  • Retinoids should be applied to all acne prone areas every night after the skin is washed with a mild cleanser (Cetaphil, Dove). They can be applied in the morning if you prefer.
  • Treat the entire area (forehead, etc) -- retinoids are preventative and do not work well for "spot" treatment.
  • If you never get acne in a certain area, then you donŐt have to use the retinoid there.
  • Use topical retinoids sparingly -- a pea sized amount should cover most of your face.
  • It is preferable that when the retinoid is applied no other topical product is used at the same time, i.e. moisturizer, other acne medications, make-up.
  • Retinoids commonly cause some irritation such as mild redness, peeling and dryness.
  • Irritation is especially common around the eyes and mouth -- avoid treating this area unless you develop acne there regularly.
  • Many patients use an oil-free moisturizer during the day.
  • If excessive irritation develops, stop the retinoid until the irritation resolves, then restart it at a reduced frequency, such as every other day or every third day. The key is to find a regular schedule that your skin will tolerate.
  • Retinoids may cause your acne to flare some in the first few weeks of treatment -- this is normal and will resolve.
  • Retinoids work very slowly. Don't stop it just because you donŐt see any improvement in a few weeks; they generally take at least 6-8 weeks to work.
  • If you are using a retinoid for treatment of photodamage, keep in mind that it takes many months to see improvement.
  • Retinoids are generally used in combination with other medications to treat acne, such as topical/oral antibiotics and benzoyl peroxide.
  • Retinoids should not be used if you are pregnant or trying to get pregnant. They also should not be used if you are breast feeding.
  • Many patients are concerned about retinoids causing sun sensitivity, but this effect is usually overstated. If you are going to spend a fair amount of time in the sun, you should be using a sunscreen regardless of retinoid use!
  • Tazorac is often considered the "strongest" retinoid and Differin the "weakest"; one retinoid may be work better for you than another. The key is to find one that is strong enough to be effective, but gentle enough to avoid excessive irritation.
  • Waxing. Retinoids make the skin more sensitive; some people will have an irritant reaction if they wax an area of skin where retinoids have been applied. Although this is infrequent, to avoid it you should discontinue applying a retinoid to the area you want to wax 1-2 weeks before waxing.