Helping People Achieve Clear Skin Since 2007

Helping People Achieve Clear Skin Since 2007

What Everyone With Acne Needs To Know About Retin-A

By Dr. Jaggi Rao, MD, FRCPC, Double board-certified dermatologist

Retin-A is a synthetic, acidic form of vitamin also known as all-trans-retinoic acid or ATRA, as well as tretinoin (short for trans-retinoin). It is used to treat cystic acne and a condition called keratosis pilaris, which causes patches of thick, rough skin on any part of the body except the palms of the hands and the soles of the feet. Retin-A is the brand name for tretinoin used to treat acne; the medication is also available under the trade names Aberela, Airol, Atralin, Refissa, Renova, or Stieva-A (not to be confused with the herb stevia). Tretinoin is also used in treating hair loss, age spots, leukemia, and Alzheimer’s disease.

Using retin a for acne
Retin-A usually gets rid of about 50% of blemishes.


  • Retin-A has been around since the 1960’s as a prescription treatment for acne. In the last few years, however, a form of Retin-A known as tretinoin topical has been available over the counter in the United States.
  • Tretinoin topical opens up clogged pores. The 0.05% strength you can get over the counter usually only open smaller cysts.
  • Neither Retin-A nor tretinoin topical gets rid of all your blemishes. It usually gets rid of about 50% of pimples, blackheads, and whiteheads.
  • Tretinoin topical is slightly more effective on fair skin than on dark skin, but it does not cause inflammatory pigmentation on any skin type.
  • You can combine tretinoin topical with benzoyl peroxide and other skin care products for greater effect.
  • Be sure to use sunscreen when you are using tretinoin topical.
  • Get rid of the rest of your blemishes by following a systematic approach to acne skin care like Exposed Skin Care.

How Retin-A Works

Vitamin A is well known for its importance to the skin. Without enough vitamin A in the diet, the skin dries out and becomes inflamed. Vitamin A has to be absorbed from food, but the form of vitamin A in food has to be chemically transformed by the human body into the forms that regulate the growth of the skin.

In the 1960’s, pharmaceutical researchers began to look for ways to increase the availability of vitamin A. They learned how to imitate the process the liver uses to transform the retinyl esters in food into retinol for use in the cells. They also learned that retinol could be treated to create forms of two forms of vitamin A that are even more available to the skin, retinal and trans-retinoic acid. The skin can use tretinoin as soon as it is absorbed, without enzymatic transformation.

Tretinoin is not just a vitamin. It is a hormone. It can activate specific sequences of DNA in the chromosomes of skin cells. The result of activating DNA in the skin has three effects:

  1. Tretinoin increases the production of skin cells in the outermost layer of the skin, the epidermis, so that it grows stronger.
  2. Tretinoin causes the compaction of skin cells in the epidermis so that it grows thinner.
  3. Tretinoin increases the production of glycosaminoglycans so that the skin lays down collagen fibers in a orderly fashion.

Tretinoin rejuvenates the skin. The skin grows more rapidly and pulls away from pores, allowing them to open and drain. The thin skin over acne cysts breaks open and lets them drain without need for lancing or surgery. Thickening of the skin can even out smooth lines and growth of skin can obscure the borders around rough skin.

The problem with tretinoin is that it causes the skin to open where it is healthy as well as where it is sick. The skin between cysts can be red and inflamed. The rapid growth of the skin can also, ironically, increase the number and activity of sebaceous glands that make oily, waxy sebum. New pores can clog even while old cysts open.

Another problem with tretinoin is that it makes the skin thinner before it makes the skin thicker. It makes the skin more susceptible to sunburn, and increases the likelihood of skin injury when it is waxed for hair removal. (If you have to have hair removed, threading will not injure the skin.)

It is a good thing to apply noncomedogenic sunscreen when you are using tretinoin and being out in the sun.

Should You Try Tretinoin Topical?

It is no longer necessary to get a prescription for the form Retin-A known as tretinoin topical. Even though it costs as much as US $80 for one-half ounce (14 grams), tretinoin topical only costs 10% to 20% of the price of a visit to the dermatologist and a prescription for Retin-A. It is not necessary to have blood tests to monitor for potential toxicity of tretinoin topical because only tiny amounts of the medication are absorbed through the skin. Any formulation of tretinoin topical that uses microsphere technology will be absorbed more slowly and do more good for the skin with fewer side effects.

What kind of results can you expect from tretinoin topical?

It’s important to understand that tretinoin topical will not get rid of all of your blemishes. People who have fair skin usually have 60% fewer pimples and 50% fewer blackheads and whiteheads after eight weeks. People who have dark skin typically have about 50% fewer pimples and 40% fewer blackheads and whiteheads after eight weeks—if not other treatments are used.

Variations In Ways To Use Over-the-Counter Tretinoin Topical

Some people use both tretinoin topical and benzoyl peroxide. Tretinoin is used to open the skin and benzoyl peroxide is used to kill acne bacteria as they are being released from deep pores. The effects of the two products are additive, but the side effects of the two products are also additive. Both benzoyl peroxide and tretinoin topical increase sensitivity to sunburn, so it is essential to use sunscreen during treatment.

Some people use both tretinoin topical and glycolic acid. One study even suggests that they are safe for dark skin—but be careful.  Use glycolic acid as a skin peel and rinse it off your skin before applying tretinoin topical. Be sure to use sunscreen if you use either product on your skin, especially if you have dark skin.

In the North America, Canada, Australia, and New Zealand, you need a prescription to get products that combine Retin-A and antibiotics. Usually products that combine tretinoin topical and clindamycin get the best results. Adding an antibiotic will get rid of about 20% more pimples and blemishes.

When tretinoin topical causes skin irritation, you can see your physician for a prescription for adapalene (marketed as Differin, Teva, and Pimpal). Tretinoin topical is available over-the-counter (and from Amazon) in the USA in concentrations ranging from 0.01% to 0.05%, but it’s usually best to try the 0.05% strength first. If you experience skin irritation, then switch to a lower strength.

If you really want to get rid of all of your pimples and blemishes, it is usually best to follow a systematic skin care routine. Use topical tretinoin to get stubborn pimples under control, and then use Exposed Skin Care to maintain your clear complexion.

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michele Reply

How/where can I get it over the counter?

October 6, 2014 at 9:33 pm Reply
Robert Reply

You can't. At least not in the US. Not legally. Retinol is often described as "over-the-counter" tretinoin. It is not the same chemical, and while it does help, it is MUCH less potent/effective than tretinoin. It's also much less irritating to the skin, however. Just see a doctor and get an Rx for 45mg tubes of tretinoin, starting at the lowest strength (0.025%). It will irritate most people's skin at first, until your skin becomes accustomed. One tube will last you almost three months if you use it correctly (just a pea-sized amount per night). The pharmacy will charge you $150-$200 for the tube, which is a lot. But my problem with Retinol is that the companies selling Retinol-based creams will charge you almost as month for 3-months worth of product, even though the Retinol is far less effective. If you actually have adult acne, and the doctor diagnoses you with it, your insurance will cover it. If it's just for wrinkles, you're on your own dime.

February 8, 2015 at 11:20 pm Reply
Wedad khairy Reply

Hi I have used retin a renova 0.025 for 3 months I stopped itnowfor 10 days because I experienced very large pores and scars ,a needs and also joints pain since I started my age is 60 years old female .i love what I had from glowing face from distance but the others effects make me very worried so I cut it off and I still have this side effects knowing that I used it very carefully reading all the recommendations about it .please help ,I like to continue for this glowing look that I had thank you

November 19, 2014 at 1:21 pm Reply
Christina Reply

I have been using atralin gel for 4 weeks. It is making me Oily and I am getting a lot of whiteheads. Is this normal.

August 19, 2015 at 12:30 am Reply
paige Reply

Hello, I came across your website and I was very impressed after reading a few of your posts. I have acne, serious stubborn whiteheads ( a lot of them ), a lot of dead skin, rough skin texture ( it's not smooth) & dark marks. But my main concern is My whiteheads and spots. Is it safe for me to use 0.5% benzoyl peroxide & 0.5% tretinoin?

February 1, 2016 at 2:21 am Reply
udo Reply

Retin a comes in different packet colours, please what is the difference?

June 14, 2016 at 8:47 pm Reply
Frankie Reply

Different colours are different strengths and concentrations of tretinoin. Like the article stated, start with the lowest strength which is 0.025 and use sparingly every other night.

July 30, 2016 at 4:56 pm Reply
Rachel Reply

Dont retinols interact negatively with benzoyl peroxide and AHAs? Most sources suggest using retinols in the evening and other products with active ingredients in the morning.

February 3, 2017 at 5:00 am Reply
CS Reply

I've been using Retin-A and benzoyl peroxide on my back, and I've found that if you use them too close together, they will burn your skin and leave a nasty, stubborn red mark, but if you wait long enough between using the one or the other, it's fine. I use one in the morning and one at night. Some times I'll do another application of benzoyl peroxide at some point, but I usually only use Retin-A once. I don't know if it would work differently on the face.

April 28, 2017 at 5:10 am Reply
Kate Reply

Hi Thanks for all the info that you shared here. I saw stieva-A helps winkles and photoaging but i am using Biacna which is clindamycine/tretroin. Do you think Biacna will work in the same way? And also what I worry is that clindamycine could kill the good bacterias on my skins.

November 16, 2017 at 6:57 am Reply
Liz janse Vav Rensburg Reply

I am 70 years old and I am using Retin-A for 4 months and my whiteheads seem worse. Not sure if I should continue.

February 22, 2018 at 7:04 pm Reply
Gracie Reply

Hi I use Rein A but makes my skin dry flaky do y’all recommend a good moisturizer?

January 20, 2019 at 4:16 pm Reply