Tretinoin

Tretinoin is a vitamin A derivative, used for the treatment of acne and to treat and prevent signs of ageing.

Benefits of Tretinoin

Tretinoin is a prescription-strength retinoid that works with your skin to speed up cell turnover which regulates and promotes healthier, younger looking skin. It delivers visible results that help restore deterioration caused by age and sun damage.
  • Tretinoin is proven to improve fine and coarse wrinkles by restoring dermal collagen.
  • Diminishes skin roughness.
  • Tightens loose and sagging skin.
  • Reduces comedones, papules and pustules, and is suitable for long term maintenance therapy.

Smooths fine lines and wrinkles

Tretinoin has been investigated the most out of all the topical retinoids for clinical effectiveness and safety, with over 20 randomised trials comparing it either to placebo or to other treatments.[1] Evidence of its effectiveness was first demonstrated in the 1980s. [2]

Certain genes, formed from sequences in our DNA, are sensitive to topical retinoids, which lead to changes in the function of the cell. They improve signs of ageing by: increasing cell division leading to increased thickness in the top layer of the skin (the epidermis); compaction of the outermost cells in the skin (stratum corneum); and production of glycosaminoglycans (complex chains of sugar molecules which attract water). [1][2]

Clinical trials looking at the effectiveness of tretinoin look at the various signs of ageing including fine wrinkles, coarse wrinkles, hyperpigmentation (brown marks), skin texture, laxity, and signs of ageing seen on skin samples under the microscope.

Three trials were published between 1988-1993 involving 55 patients between them; all showed statistically significant improvements with short-term (1-4 months) tretinoin use. [2]

As the short term studies showed continued improvements over time, five six-month trials were performed between 1989 and 1992 including 1,199 patients in total. All of these trials showed significant improvement in signs of ageing, even after six months. [2]

Since the six-month trials, longer-term trials have been performed, and consequently long term maintenance regimes have been recommended. [1]

Reduces pigmentation in the skin

There have been two American trials including over 80 patients comparing treatment with tretinoin to placebo. One of the trials showed a significant improvement of pigmentation with tretinoin, although the other trial did not report a significant difference with placebo. [3]

However tretinoin can be mixed with other ingredients to make it more effective in the treatment of melasma, including bleaching agents such as hydroquinone and fluocinolone acetate, which is a topical steroid. A recent systematic review of clinical trials, which looked at 20 studies of 2125 participants, has concluded that triple therapy with tretinoin, hydroquinone and fluocinolone acetate is more effective than hydroquinone alone, or dual combinations of tretinoin or hydroquinone with fluocinolone acetate. [3]

Treats acne and minimizes inflammation

Topical retinoids are recommended as a first line treatment option either on their own or in combination with other treatments for mild acne. They are also recommended as a first line treatment option for moderate and severe acne in combination with other treatments. [4]

Tretinoin as a single therapy has been found to be effective in clinical trials for comedonal acne (blackheads and whiteheads) and inflammatory acne (papules (small bumps), nodules (large bumps) and pustules). [5][6]

Tretinoin is especially good in treating comedonal acne, and is also recommended to treat all acne variants when combined with other ingredients. [4] For example the combination of tretinoin with clindamycin (an antibiotic) has been shown to be more effective than either tretinoin or clindamycin alone. [7][8]

Topical antibiotics alone have been shown to be effective in treating acne but are no longer recommended as single therapy due to concerns of resistance. They can however be safely given in combination with other ingredients such as tretinoin.

Older studies have shown adapalene (a different topical retinoid) may be better tolerated than tretinoin; however, this is based on old formulations. Limitations of the existing studies makes direct comparison of the effectiveness of different topical retinoids difficult. [4]

References

1 Darlenski R, Surber C, Fluhr J. Topical retinoids in the management of photodamaged skin: from theory to evidence‐based practical approach. British Journal of Dermatology. 2010;163(6):1157-65.

2 Mukherjee S, Date A, Patravale V, Korting HC, Roeder A, Weindl G. Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Clinical interventions in aging. 2006;1(4):327.

3 Rajaratnam R, Halpern J, Salim A, Emmett C. Interventions for melasma. The Cochrane Library. 2010.

4 Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. 2016;74(5):945-73. e33.

5 Krishnan G. Comparison of two concentrations of tretinoin solution in the topical treatment of acne vulgaris. The Practitioner. 1976;216(1291):106-9.

6 Christiansen J, Holm P, Reymann F. The retinoic acid derivative Ro 11-1430 in acne vulgaris. Dermatology. 1977;154(4):219-27.

7 Zouboulis C, Derumeaux L, Decroix J, Maciejewska‐Udziela B, Cambazard F, Stuhlert A. A multicentre, single‐blind, randomized comparison of a fixed clindamycin phosphate/tretinoin gel formulation (Velac®) applied once daily and a clindamycin lotion formulation (Dalacin T®) applied twice daily in the topical treatment of acne vulgaris. British Journal of Dermatology. 2000;143(3):498-505.

8 Richter J, Förström L, Kiistala U, Jung E. Efficacy of the fixed 1.2% clindamycin phosphate, 0.025% tretinoin gel formulation (Velac®) and a proprietary 0.025% tretinoin gel formulation (Aberela®) in the topical control of facial acne. Journal of the European Academy of Dermatology and Venereology. 1998;11(3):227-33.
WHAT TRETINOIN TREATS

Acne, Inflammation, Dark Spots, Wrinkles, Firmer Skin, Smoother Skin, Clogged Pores

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Tretinoin FAQs

How and when do I apply my treatment?
Tretinoin is best applied at night time, before bed.
  • Cleanse your face of all makeup thoroughly before bedtime but don’t scrub with a washcloth or use exfoliating face washes as these can irritate your skin and worsen your acne. We recommend a gentle facial cleanser, or to remove makeup gently, we recommend an oil cleanser.
  • Pat skin dry (don’t rub) and allow skin to dry completely (20-30 minutes)
  • Apply your clindamycin/tretinoin in a thin layer to your entire face (avoiding eyes, lips and nostrils) and allow to absorb completely, which usually takes 15-20 minutes.
  • Once your clindamycin/tretinoin is completely absorbed by your skin, apply a thin layer of moisturiser to your entire face. We suggest a lightweight, non-pore clogging moisturiser like Cetaphil Moisturising lotion.
  • In the morning, gently wash your face, pat dry and apply a lightweight moisturiser with SPF, such as Cetaphil Dermacontrol SPF 30 moisturiser.
What are the side effects of Tretinoin?
The most common side effects of tretinoin include reddening, peeling or scaling of the skin, which may be swollen.
Dry skin, itching, warmth or a burning sensation, rashes, pain or a stinging sensation may occur.
Temporary changes (increase or decrease) in skin pigmentation may occur. Not everyone gets these side effects.
  • You can minimise side effects by using the product every other day at night until your skin starts to get used to it, which could take a few weeks. Remember – only use a thin layer of the treatment at night (more is not better!)
  • If the dryness, peeling and redness are so bad you just can’t take it, try applying your moisturiser first, waiting 20 minutes for it to absorb, and then applying your topical treatment over the top.
  • If your skin is extremely irritated after the first few days of treatment, take a few days off and don’t use any medicated treatments on your skin until it settles down. Then, when you are start using it again, apply the treatment as above but wash it off after 60 minutes. Slowly build up the amount of time you have the treatment on your skin until you can keep it on overnight.
  • It is important to remember that these side effects are worst during the beginning few weeks of treatment and that they are entirely normal.
How quickly will my treatment work?
Results vary from person to person. You may begin to notice an improvement in your skin after two to four weeks but it can take up to four months of regular use of the treatment before you begin to notice the effects. Be patient!
Can I use other creams with my treatment?
The use of keratolytic agents such as sulphur, salicylic acid, benzoyl peroxide or resorcinol and chemical abrasives should not be used whilst you are using tretinoin. If you have been treated with such preparations, the effect of the peeling agents must subside before starting tretinoin. Some medicated cleansers and scrubbing solutions have a strong drying effect. They should not be used whilst you are using tretinoin. Abrasive soaps, soaps and cosmetics as well as spices or lime should be used with caution whilst you are using tretinoin.
Will my treatment make my oily/dry skin worse?
It is very unlikely that tretinoin will make oily skin worse. Dryness of skin is a common side effect of this treatment.
Why is my acne worsening since starting treatment?
When you first start using prescription treatment for acne, you may notice your skin becoming red, flaky, and you could even see your acne get worse. The treatments can also make your skin feel dry and tight as well as giving you a burning, itching or stinging sensation. This is a normal response to the treatment, and should be expected, but there is no need to worry and these effects will lessen as your skin gets used to the treatment.
I am taking other medication, can I still use the treatment?
Most medications are safe to take whilst using tretinoin but it is always best to check with a member of the Dermatica team before starting treatment to ensure there are no interactions.
How long will I have to use my treatment for?
Treatment duration varies from person to person. After 12 weeks of treatment, the Dermatica team will review your progress and you will be prescribed a further course of tretinoin or your treatment may be changed depending on the results that you are achieving and how your skin is tolerating the medicine.
Why do I need to wear sun protection whilst using my treatment?
Tretinoin increases your skin’s sensitivity to sunlight. Our dermatology team recommends using sunscreen with an SPF of 30 or higher every day to avoid normal sun damage, but this is especially important during treatment.
I am planning on becoming pregnant, can I still use my treatment?
Tretinoin should not be used in pregnancy or if you are planning on becoming pregnant, or are breastfeeding. We recommend that you use effective contraception while using clindamycin/tretinoin and for at least one month after stopping treatment.
What if I forget to use my treatment?
It is essential you try to integrate the treatment into your daily routine or as advised by the Dermatica team. However if you miss a few days, just start the following day with the same amount you always use on each of the affected areas and you will be back on track.
How does my treatment work for acne?
Tretinoin is a retinoid. It reduces the formation of blackheads and whiteheads, and increases skin turnover, and reduces inflammation.
How does my treatment work for anti-ageing?
Tretinoin is a retinoid. It increases skin turnover, and reduces fine lines and wrinkles and reduces hyperpigmentation.

We won’t be testing you,
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How quickly does Tretinoin work?
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Ingredient
How quickly does Tretinoin work?
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How to layer your retinoid with your other skincare products
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Prescription retinoids vs. high street products