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Treating Acne with Retin-A: Does It Work?

By Megan Griffith

Reviewed for medical accuracy by Dr. Jaggi Rao,
MD, FRCPC Double board-certified dermatologist

Retin-A is the world’s most commonly prescribed medication for the severe kind of acne that causes nodules and cysts. It is also particularly good for people who have a lot of blackheads and whiteheads, otherwise known as comedonal acne.

Using Retin A for Acne
Retin-A is the only treatment that addresses all the causes of acne.

Retin-A is the brand name for topical tretinoin, which falls in a class of medications called retinoids. Some retinoids are available over-the-counter, like adapalene, but most retinoids require a prescription because they are very powerful treatments and often come with some side effects that should be monitored by a dermatologist1. Retin-A is a topical retinoid, but oral retinoids in the form of isotretinoin (commonly known as Accutane) are also popular for treating especially severe, cystic acne. So what makes Retin-A so special? And can it really treat all kinds of acne, from cysts to blackheads? Read on to discover what Retin-A can (and can’t) do for your skin.

Summary:

  • Retin-A is a retinoid which works by pacing the life cycle of the skin cells.
  • The ideal candidate for Retin-A has oily, chemical-resistant skin.
  • Topical tretinoin combined with benzoyl peroxide does a better job of getting rid of acne bacteria.
  • Retin-A combined with a vitamin E product does a better job of preventing and treating brown spots, especially on Asian skin.
  • Even if you never burn, use sunscreen when you use Retin-A.
  • Don’t take St. John’s wort when using Retin-A.
  • Make sure you’re using a regular skincare routine, like Exposed Skin Care, while using Retin-A.

How Retinoids Work

Retin-A is a prescription-strength retinoid, which is a class of medications commonly used to treat acne. The reason they’re so popular is because they essentially function as a pace car for the skin cells2. This is vital for acne treatment because if the skin cells reproduce, grow, or die at the wrong pace, then pores can easily clog, leading to all kinds of acne. According to the latest research, Retin-A effectively suppresses oil production3 and successfully reduces both inflammatory acne (pimples and cysts) and non-inflammatory acne (blackheads and whiteheads)4. Retin-A is a relatively strong retinoid, which is why it’s often prescribed for more severe types of acne, like cystic acne. It will take regular use over a period of time before you start seeing any positive changes in your skin, though.

This regulation of the skin cell cycle has another added benefit for those who experience dark spots after acne heals. Retin-A encourages the shedding of damaged, pigmented skin cells to make way for new, healthy cells5, effectively treating and getting rid of dark spots left behind by acne, also known as post-inflammatory hyperpigmentation. Finally, it can also be used as an anti-aging treatment to reduce wrinkles and fine lines6 on your skin, making it an ideal treatment for those with adult acne who also want to prevent signs of aging.

Are You an Ideal Candidate for Retin-A?

The people who respond best to Retin-A for acne have oily skin that is not easily irritated by chemicals, and that tends to turn brown after irritation or sunburn. What kind of skin should be treated with Retin-A?

  • Skin affected by cysts, blackheads, and/or whiteheads.
  • Skin that turns gray or ash-toned when it is not moisturized.
  • Skin that does not break out when it is exposed to alcohol, botanicals, or essential oils.
  • Skin that does not flush during embarrassment or after drinking alcohol.
  • Skin affected by sunspots, age spots, and brown spots left when acne heals.

Retin-A is used on almost all skin types except the most sensitive. This is because of the common side effects of Retin-A, which include burning, peeling, itching, and irritation. In people with sensitive skin, these side effects would probably cause enough harm to make the Retin-A more or less useless as an acne treatment. But there are other retinoid options available for those with sensitive skin, like gentler, over-the-counter retinoids.

Is Retin-A the Right Retinoid For Your Skin?

As we mentioned before, Retin-A is the brand name for topical tretinoin, which is just one type of retinoid. If you read the above description and realized that your skin may be too sensitive for Retin-A, you may want to try adapalene. Adapalene is a synthetic retinoid that works more slowly than tretinoin, but is also far gentler. Adapalene can be found in a few different products, including Differin acne gel and Proactiv MD acne gel.

Retin-A Gel
Retin-A gel is just one type of retinoid; over-the-counter retinoids like adapalene might be more appropriate for sensitive skin.

Of course, the opposite problem is a possibility as well. What if you’ve tried Retin-A and it wasn’t strong enough for your acne? No need to worry, you have options too. Retin-A comes in a variety of prescription strengths, including 0.01%, 0.025%, 0.05%, and 0.1%. It’s always best to start with a low concentration to curb the likelihood of side effects, but if after several weeks of consistent use you find that your acne still isn’t improving, you can always reach out to your dermatologist and ask for a prescription with a higher concentration.

Some people may require an even more intense retinoid to treat their severe cystic acne, which is where isotretinoin comes in. Isotretinoin is commonly known as Accutane, and it is taken as a pill for several months. Isotretinoin is extremely effective when it comes to treating severe acne; studies show that after taking the drug for four months, 70-80% of patients never have severe acne again7. However, it comes with a fair share of side effects. First, it’s incredibly teratogenic, meaning it is highly correlated with increased risk of birth defects. In many countries, in order to take isotretinoin, you must sign an affidavit swearing to use two forms of birth control at all times. Second, there is a chance it could cause psychological side effects like depression and suicidal ideation, though the research in this area is conflicted8.

Secrets of Success for Using Retin-A for Acne

If you have decided you want to treat blemishes and acne spots with Retin-A, there are things you can do that will help the product work a lot better on your skin. Here are seven important suggestions.

  1. Be sure to use sun protection, even if you never burn. Retin-A (and other retinoids) increase photosensitivity and increase the likelihood of burning, peeling, and post-inflammatory hyperpigmentation when exposed to the sun.
  2. Don’t take St John’s Wort when using Retin-A because research shows that St. John’s Wort can also increase photosensitivity9
  3. Try using both Retin-A and a gentle benzoyl peroxide product at the same time. Together, these products can significantly decrease acne more than using either one on its own, plus some research has found that combining these treatments leads to fewer side effects10.
  4. If Retin-A and adapalene are both too strong for your skin, look for over-the-counter products containing retinol. It is even gentler, but may be less effective in treating acne.
  5. Make sure any retinoid or retinol product you purchase comes in an opaque container. Retinoids and retinol are photosensitive, and exposure to sunlight can deactivate their active ingredients, rendering them useless.
  6. Be sure to keep up with the rest of your skin care routine while using Retin-A. Although it is a powerful acne-fighting agent, it shouldn’t be your only acne treatment product. We recommend also following a gentle, consistent skincare routine that involves cleansing and moisturizing your skin, like the routine offered by Exposed Skin Care’s Expanded Kit.

References:

  1. Kim B. Safety Evaluation and anti-wrinkle effects of retinoids on skin. Toxicological Research. 2010;26(1):61-66.
  2. Futoryan T., Gilchrest B. Retinoids and the skin. Nutrition Reviews. 1994;52(9):299-310.
  3. Pan J., et al. A topical medication of all-trans retinoic acid reduces sebum excretion rate in patients with forehead acne. American Journal of Therapeutics. 2017;24(2):e207-212.
  4. Tirado-Sánchez A., et al. Efficacy and safety of adapalene gel 0.1% and 0.3% and tretinoin gel 0.05% for acne vulgaris: results of a single-center, randomized, double-blinded, placebo-controlled clinical trial on Mexican patients (skin type III-IV). Journal of Cosmetic Dermatology. 2013;12(2):103-107.
  5. Rossi A., et al. A pilot methodology study for the photographic assessment of post-inflammatory hyperpigmentation in patients treated with tretinoin. Journal of the European Academy of Dermatology and Venereology. 2011;25(4):389-402.
  6. Neill U. Skin care in the aging female: myths and truths. 2012;122(2):473-477.
  7. Rademaker M. Isotretinoin: dose, duration and relapse. what does 30 years of usage tell us? The Australian Journal of Dermatology. 2013;54(3):157-162.
  8. Bauer L., et al. Isotretinoin: controversies, facts, and recommendations. Expert Review of Clinical Pharmacology. 2016;9(11):1435-1442.
  9. Khalifa S. Photodynamic sensory neuropathy in a patient treated with St John’s Wort. The Primary Care Companion for CNS Disorders. 2015;17(4).
  10. Patel V., et al. Clinical assessment of the combination therapy with liposomal gels of tretinoin and benzoyl peroxide in acne. AAPS PharmSciTech. 2001;2(3):1-5.
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Amy Reply

I have been alternating Tretinoin .05% and Benzoyl Peroxide 2.5%, both every other night. What an amazing difference after just 2 months! I am 45 yrs old but have always been told I look 10 yrs younger. My eyes have fine lines, but no deep wrinkles. My T-zone was an oily mess with large pores & blackhead across my nose. My oil & blackheads have improved by about 50-60%. I am thrilled, as I've tried just about everything else & no other combination has worked like the Retin A + BPO. Definitely try it & be patient!!

July 1, 2016 at 5:24 pm Reply
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Minerxstore Reply

Thank you for information you provided and Yes, Tretinoin works effectively to treat acne. It is also medically know as Retin-A and Renova. It is topical retinoid and vitamin A form. Vitamin A helps to prevent acne coming on skin surface. It is FDA approved cream and has clinically proven that can work safely and effectively to remove acne. Tretinoin cream also used to treat scars, pimples, aging, wrinkles, blackand white heads etc. Minerxstore

July 14, 2016 at 6:33 am Reply
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charlie paul Reply

In about four months it has gotten a rid of about 85 percent of my scars and has cleared up the acne itself for the most part!

August 17, 2016 at 6:41 am Reply
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Gaby Reply

I use retin A and it making my skin super red and it hurts alot what can do. It burns

October 20, 2016 at 7:10 am Reply
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Julie Reply

I was told to put on an oil free moistureizer at the same time. So I kind of mix it together and it cut down the stinging. The results are far better than I ever imagined. I'm so happy.

December 11, 2016 at 6:55 am Reply
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Zoey Reply

I have gotten the same thing as Gaby and I do not know what to do! I have always been very sensitive and it has got worse after the baby I had, about 3 and a half years ago. I hear it is clearing the pimples after the 2nd use this time. It feels like my skin is on fire every time I put sunscreen on or get touched by the sun/walk in chilli conditions.

November 4, 2016 at 3:27 pm Reply
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chinonso Reply

mine it itches me i dont know weather to stop using it

June 17, 2017 at 12:33 am Reply
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chinonso Reply

I am using the rectinA but i noticed itching on right side of my face.should i discontinue using it...i need an ans thanks

June 17, 2017 at 12:34 am Reply
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Kat Reply

I am 40 years old, and have suffered from acne for most of my life. I am presently on a .05 dose of Tretinoin, and use it every other night. I started it two years ago went up to .01, found it was too harsh for my skin, and went back to .05. That works well for my skin and clearing up blemishes, however I am also sensitive to the sunscreen ingredient Octinoxate. I am also sensitive to niacinamide, so that greatly reduces my ability to use the often recommended CeraVe products.When I first started treatment I was using a Dermalogica moisturizer that was too light and Dermalogica's special cleansing gel (SLS). My face was severely dehydrated and caused dry spots on my cheeks . I then started using PCA skin care line, which has a cleansing cream that doesn't have SLS, and I've also been using a very emollient moisturizer both day and night. Of course, this moisturizer is now causing breakouts although it has corrected the dehydrating side effect of the Retin-A. I am just seeking a moisturizer with SPF, or two separate items, that will agree with my skin. No niacinamide, no Octinoxate.

June 24, 2018 at 8:59 pm Reply

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