Learn tretinoin side effects and interactions—and how to avoid them

Tretinoin is a vitamin A derivative (retinoid) topical cream used to treat skin conditions like acne and facial discoloration. Although it’s mainly used topically on the skin, its oral form can be used with other chemotherapy drugs to treat acute promyelocytic leukemia. Tretinoin is only available by prescription because it’s stronger and more aggressive than a traditional retinol cream. Let’s take a deeper look at tretinoin to understand what it does, its side effects, warnings, and drug interactions.  

Common side effects of tretinoin

Even though tretinoin topical creams are great for treating acne, acne scars, fine lines, wrinkles, and skin discolorations, they can still cause side effects, just like any other medication. Here are some of the most common tretinoin side effects:  

• Blistering
• Crusty skin
• Dry skin
• Increased sensitivity to the sun
• Itching
• Pain surrounding the treated areas
• Peeling or flaky skin
• Redness
• Scaling of the skin 
• Skin irritation
• Skin discoloration
• Stinging or burning
• Swelling
• Worsening of acne

Many tretinoin side effects, like skin peeling, will go away within two to six weeks of treatment. Once the medication starts to stimulate new collagen production, it can begin to fade dark spots, treat pimples, tighten neck skin, and make the skin look younger overall. It may take anywhere from three to six months for someone to see their sunspots or fine wrinkles start to fade, but this is because tretinoin takes time to become effective.  

Serious side effects of tretinoin

Using tretinoin may cause more severe or long-term side effects. If any of the tretinoin side effects listed above become severe, contact your healthcare provider or dermatologist.

Unlike some other medications, most of the side effects of tretinoin are skin reactions. Topical tretinoin usually doesn’t cause side effects like hair loss, diarrhea, or weight loss, but it does irritate some people’s skin. Even though tretinoin is a vitamin A derivative, it isn’t stored in the liver, and it doesn’t cause chronic liver disease that’s often associated with excessive vitamin A intake.

In rare cases, tretinoin may cause side effects that require medical attention. If you’re using tretinoin and experience eye redness and swelling, severe swelling or burning of the skin, or blistering, it’s best to seek medical advice as soon as possible. 

If you start to have severe itching, hives, difficulty breathing, swelling of the face or throat, or lightheadedness, you should seek medical attention right away. You may be allergic to tretinoin. Allergic reactions can be life-threatening.  

“If side effects are experienced from the use of tretinoin cream, stopping abruptly is absolutely reasonable and recommended,” says Erum Ilyas, MD, a board-certified dermatologist and the founder of Montgomery Dermatology. “Once the product is discontinued, depending on the severity of the symptoms, it can take upward of a week to resolve completely. To help reduce the inflammation and heal faster, as this can feel like a chemical burn or sunburn at its worst, using topical hydrocortisone found over the counter twice daily for a week can help this clear quickly.”

Tretinoin warnings

Just like with any medication, tretinoin comes with warnings that anyone who uses it should be aware of:

• Indications: Tretinoin is safe for most people to use, but it should be used cautiously by people who have sensitive skin or eczema, as it may irritate their skin. 
• Age restrictions: It’s not yet known if tretinoin is safe for children under the age of 12, but it’s okay for children and adults 12 years of age or older. 
• Pregnancy and nursing: Pregnant women and women who are breastfeeding should talk to their dermatologist or healthcare provider about using tretinoin because it’s unknown how it affects fetuses or breastmilk.
• Strengths: Tretinoin creams (brand names include Retin-A , Avita, Renova, and Atralin) are usually available in different strengths such as 0.025%, 0.05%, and 0.1%. A cream with a higher strength may cause more irritation than a cream with a lower strength. For example, 0.025% tretinoin cream is typically used for mild cases of acne, whereas a more potent cream of 0.1% may be used for more serious skin concerns like wrinkles.

Tretinoin interactions

Don’t use tretinoin in combination with certain medications. Using tretinoin with any of the following medicines may cause a negative interaction to occur:

• Aminolevulinic acid
• Aminolevulinic acid topical
• Benzoyl peroxide
• Isotretinoin
• Methoxsalen
• Methyl aminolevulinate topical
• Porfimer
• Resorcinol
• Salicylic acid
• Sulfur topical
• Verteporfin

Other skincare and hair products

Using tretinoin with other acne products should be avoided unless otherwise instructed by a medical professional, according to the United States Food and Drug Administration (FDA). Combining products can cause severe skin irritation and dryness. The same goes for using fragrant lotions, peels, harsh exfoliants, astringents, and alcohol-based cleansers or hair removal products simultaneously as tretinoin. You might also avoid trying new make-up during treatment, as you won’t know how your skin could react to it. Your dermatologist will be able to help you pick products that won’t cause additional skin irritation.

Birth control

Tretinoin may interfere with oral contraceptives. If you are taking a birth control pill, let your healthcare provider know. Minipills may not be effective during tretinoin treatment.

How to avoid tretinoin side effects

One of the best ways to avoid possible side effects of tretinoin is to follow the drug information located on the package or in the medication guide. If your doctor or dermatologist writes you a prescription for tretinoin and the instructions they give you are different from the manufacturer’s instructions, then it’s best to follow your doctor’s instructions.

How to use tretinoin

Here are some best practices when using tretinoin products: 

1. Tretinoin is typically applied once per day in the evening. 
2. Apply tretinoin to affected areas in a thin layer on clean and dry skin. You should wait up to 30 minutes before applying tretinoin after cleaning your skin.
3. Once the cream absorbs into the skin, apply a moisturizer to soothe the skin and combat potential dryness.
4. Applying excessive amounts of tretinoin onto the skin to make acne go away faster will not work. This can make the skin worse by causing extreme dryness, peeling, or redness. 
5. It may take up to six weeks of tretinoin treatment to see results. 
6. Make sure to use sunscreen, especially in the summertime. Exposure to the sun can worsen peeling and other side effects. 

Note: Tretinoin should never be applied and then washed off because it’s meant to soak into the skin where it can start to work on problem areas. It’s unsafe to use tretinoin under the eyes or on the lips. It’s too strong for these sensitive areas and could cause serious eye irritation if it gets in or near the eyes.

How do I stop tretinoin purging?

Some people will experience tretinoin purging when they first start using it. Tretinoin purging is when the skin gets worse before it gets better. Tretinoin speeds up the skin cell turnover process, causing some initial breakouts, drying, and peeling. These symptoms eventually go away and leave clearer skin underneath. You can use a good moisturizer, stay hydrated, and use a sunscreen with at least SPF 30 to prevent tretinoin purging, but it may not be possible to avoid it entirely.

How often to use tretinoin

Tretinoin is safe to use every day, but using it often may cause irritation for some people. If you’re finding that daily use of tretinoin is irritating your skin, you might try using it every other day or every couple of days until the skin adjusts. Using too much tretinoin at one time can also cause irritation, so you could always try applying less of the cream each time you apply it.

Apply tretinoin to clean skin, followed by a moisturizer. Using a moisturizer after applying tretinoin will help prevent dry skin that many people experience from the product.

Even though tretinoin is a strong topical medication, it’s generally considered safe and effective for long-term use. Most people can expect to see results within four to six weeks and will continue to see results for as long as they use it. While it’s possible for tretinoin to eliminate some dark spots and discolorations, it’s also possible for acne to come back once discontinuing tretinoin. Tretinoin only treats the symptoms of acne. It can’t cure what’s causing acne or change how someone’s skin behaves. Everyone will react to the medication a little bit differently.   

When can I stop using tretinoin?

The amount of time someone needs to use tretinoin will vary on a case-by-case basis. Some people’s skin will clear up faster than others, which means they’ll use it for a shorter amount of time. Other people may have to use tretinoin longer to eliminate stubborn skin problems like dark spots or wrinkles. Most people stop taking tretinoin when their skin clears up or if it isn’t working after trying it for a while. A dermatologist is the best person to ask about when to start or stop taking tretinoin.