Is Tretinoin An Effective Treatment For Acne?
Topical tretinoin for acne is the over-the-counter (or, more often, over the Internet) form of the best-known acne drug Retin-A. It is not as strong as prescription Retin-A, but sometimes it is exactly the right treatment for stubborn acne problems1.
- Topical tretinoin is the non-prescription form of Retin-A.
- It is always best to start with lowest strength of topical tretinoin you can find, although most people have minimal problems with 0.05%.
- Topical tretinoin is not recommended for children under the age of 12, or for women who are or who may become pregnant, or who are nursing.
- Tretinoin topical is best for treating stubborn blackheads and pimples that are beginning to be covered over with skin.
- Cleanse your skin 20 minutes before you put on tretinoin.
- Use a pea-sized amount of gel (about 1-2 grams) that you apply to blemishes with clean fingers.
- It is best to use tretinoin in the evening. If you use it during the day, avoid excessive sun.
- Don’t buy products that combine tretinoin with a skin-lightening agent such as hydroquinone or mequinol. If you are concerned about brown spots left after acne treatment, use arbutin instead, especially if you have Asian, brown, or black skin.
What’s Special About Tretinoin?
Tretinoin is an acid form of vitamin A. When it is delivered to the skin in a gel, it stimulates normal maturation of cells in the epidermis of the skin. Right as it does, it activates genes that cause them to live out a 21-day life cycle during which they are pushed to the surface of the skin. Assuming the problem in the skin was sluggish growth that kept pores tight and tough skin locked over blackheads, nodules, and cysts, stimulating the growth of the skin can be just the thing for hard-to-treat blackheads and small cysts.
Topical tretinoin, being comedolytic2, is also a great treatment for blackheads on oily skin. Many people who have oily skin don’t have acne problems until they spend too much time in the sun. The heat and dryness of the sun makes the skin flake. Some of these flakes get stuck in pores, where they mix with oil. The pore cannot produce enough oil to bring both dead skin and excess oil to the surface, so it quickly fills and creates a hardened plug of sebum that oxidizes, and turns black, with exposure to air.
Tretinoin stimulates skin growth around the clogged pore. The pore opens naturally with squeezing, tweezing, picking, poking, steaming, or detergent treatment. The “floppier” your skin, the better the results you will get from topical tretinoin. Tight skin does not respond as well to tretinoin, but tight skin also is less prone to whiteheads and blackheads.
Gels made with tretinoin are also also good for treating small, newly formed nodules and cysts that are covered with a transparent layer of skin. Encouraging the skin to grow around the nodule opens up the cyst without draining. If you have tough pink scar tissue over a knot, nodule, or cyst, however, the strength of tretinoin you can get over-the-counter probably won’t work.
Apart from treating acne, Tretinoin also has other benefits3. It helps in the healing of sun damaged skin, hyperpigmentation, makes your skin glow, reduces oiliness and minimizes wrinkles. The cream also helps in the formation of new blood vessels and new collagen, which will improve the overall appearance of your skin.
In order to see noticeable results on your skin, you have to use the cream on an ongoing basis for quite some time. Some of the side effects you may notice as a result of using this cream is redness of the skin or skin flaking. This is a result of the exfoliation that is taking place. To get rid of the dead cells on the skin, use a wet piece of cloth to gently clean your skin.
What Topical Tretinoin Does Not Treat
There are some acne skin care problems that don’t respond well to non-prescription topical tretinoin. Any nodule, cyst, or ingrown hair that is old enough to be covered with pink skin probably will not respond to topical tretinoin. In fact, treatment could make the cyst or nodule worse. There could be just enough growth in the skin over an old cyst to make it redder and more noticeable, but not enough growth to make the skin open up and drain the infection.
Larger pimples take longer to respond to topical tretinoin. Stimulation of skin growth over the pimple temporarily makes it redder. More skin has to be stimulated for the pimple to drain. Smaller pimples on tight skin, on the other hand, often are healed more quickly with the right amount of tretinoin.
How To Use Topical Tretinoin
Non-prescription tretinoin comes in 0.01%, 0.02%, 0.025%, 0.375%, 0.04%, 0.05%, and 0.10% strength. You will most commonly find the 0.05% strength offered on the Internet. Even the 0.01% strength of this drug is considered too strong for children under the age of 12. Like all other medicated skin gels and creams, it is always best to start with the lowest available strength product and increase strength every time you get another tube, to make sure it does not cause unacceptable irritation to your skin.
There is a tretinoin lotion called Renova, but this is primarily a treatment for sun-damaged skin4. There are also tretinoin creams, but they can clog pores. Gels are best. There are several brands of rub-ons available on the market including Aknemycin® Plus solution, which has erythromycin, an antibacterial agent. There’s also Treclin® gel, containing clindamycin, which has antibacterial properties. Most people experience some irritation when they use the 0.05% product, but they can adjust the amount they use so that any side effects are minimal.
It is essential to cleanse the skin before applying topical tretinoin. It is never a good idea5, whether you are using topical tretinoin or not, to clean the skin with a bar of soap wrapped in a washcloth or with a detergent that makes big, foamy bubbles. Washcloths are abrasive, causing tiny cracks in the skin, and soap bubbles can pull apart the skin where the edges of the bubbles touch the skin.
You don’t want to use a strong soap or a literal scrub to loosen up your skin. You want to use tretinoin to stimulate the growth of the skin so it accomplishes its own loosening. Wait 20 minutes after you have used a mild cleanser and rinsed it off, and, with clean fingers, apply a pea-sized amount of gel to the skin you want to treat. Don’t get the gel in your mouth or your eyes. Let the tretinoin dry on your skin, and wait another 20 minutes before applying makeup or sunscreen.
It takes about three to four weeks of continuous use before you can see any noticeable results on your skin. For brown spots, it will take about six to eight weeks to notice any difference. When you first start using the cream, it may seem like your skin is getting worse. If you are patient, things will start to reverse and you will start observing some positive improvement after sometime.
Sun And Tretinoin
The strengths of tretinoin you can get without a prescription won’t make your skin especially sensitive to sunlight. Even so, it is best to use tretinoin in the evening. If you use tretinoin in the morning, take care not to burn. Apply at least SPF-15 sunscreen6 even if you have black skin, and up to SPF-70 sunscreen if you have fair skin and you are going out in strong sun.
Some formulations of over-the-counter tretinoin include skin lighteners to treat the browning that can be left behind as acne heals. Most of these products are a really bad idea if you have Asian, brown, or black skin. Asian skin, in particular, may react badly to treatment with products that contain a combination of tretinoin and the skin-lightening agent hydroquinone. Sometimes this combination is fine, but sometimes it causes a skin reaction that leaves permanent black and blue marks on the skin, especially at the tip of the nose, sides of the cheeks, and on the ears.
When tretinoin is combined with another lightening agent known as mequinol, treated skin may look very pale. This is undesirable if you have fair skin, but it is completely unacceptable if you have brown or black skin. If you have colored skin, don’t use either mequinol or hydroquinone on your skin. It is a lot safer to use a separate skin treatment with arbutin to prevent pigmentation after tretinoin has helped you clear up blemishes.
Before you start using Tretinoin, you have to take extra care since it may not be suitable for people who have certain conditions. Don’t use Tretinoin without your doctor’s advice if:
- You are breastfeeding
- You are pregnant or you are actively trying to get pregnant. The drug may get absorbed in your skin and can harm your unborn baby7.
- You have other skin care problems, such as eczema or rosacea
- You had skin cancer before or if any of your close family members has had skin cancer
- You are on other medication, whether prescribed or not prescribed by a doctor
- You reacted allergically to any other medication before, especially Vitamin A related drugs, such as isotretinoin
You can use a moisturizing cream if your skin becomes very dry. Water based creams which are fragrance free are the best ones to use. Avoid oily creams, since they could cause your skin pores to get clogged again. It is also best to avoid any creams that may dry your skin or exfoliate it.
You can apply moisturizers and make up, as long as you do not apply them at the same time you are applying Tretinoin.
Avoid any cosmetic products that have alcohol, spices, lime and menthol as they can result in your skin stinging, especially when you are using Tretinoin for the first time.
Other things to avoid include other topical medications like benzoyl peroxide and salicylic acid. This can decrease the effectiveness of Tretinoin if they are applied at the same time Tretinoin is applied and it could lead to irritation of the skin. Dandruff shampoos which have resorcinol or sulphur should also be avoided.
Tretinoin Is Not Enough
Tretinoin can be just that extra something that helps you achieve clear skin, but it is never enough just to use tretinoin. You still need complete skin care to keep blemishes from coming back. That’s easiest with a skin care system like Exposed Skin Care.
- Schmidt N., Gans E.H. Tretinoin: A review of its anti-inflammatory properties in the treatment of acne. Journal of Clinical and Aesthetic Dermatology. 2011;4(11):22-29.
- Leyden J., Stein-Gold L., Weiss J. Why topical retinoids are mainstay of therapy for acne. Dermatology and Therapy. 2017;7(3):293-304.
- Sumita J.M., Gislaine Ricci Leonardi G.R., Bagatin E. Tretinoin peel: A critical view. Anais Brasileiros de Dermatologia. 2017;92(3):363-366.
- Appa Y. Retinoid therapy: Compatible skin care. Skin Pharmacology and Applied Skin Physiology. 1999;12(3):111-119.
- Correa M.C., Nebus J. Management of patients with atopic dermatitis: The role of emollient therapy. Dermatology Research and Practice. 2012.
- Gabros S., Zito P.M. Sunscreen and Photoprotection. StatPearls. 2019.
- Chien A.L., Qi J., Rainer B., Sachs D.L., Helfrich Y.R. Treatment of acne in pregnancy. Journal of the American Board of Family Medicine. 2016;29(2):254-262.
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