Tretinoin is one of the best-studied and most effective medications for treating aging skin. It’s also a powerful prescription medication that can impact your daily skincare practices in a variety of ways. In this piece, we’ll learn how tretinoin works and what you should know when beginning treatment.

What Is Tretinoin?

Tretinoin is a medication derived from vitamin A that is most often used as a topical cream or gel. It works by boosting the production of new skin cells and the shedding of old cells, thus increasing your skin’s turnover rate. Tretinoin is part of a larger group of chemicals called retinoids which have proven broadly useful in treating skin conditions. 

Although tretinoin has long been prescribed as a first-line acne treatment, it has recently seen growing popularity for its anti-aging properties. Note that tretinoin and other retinoids are often confused with retinol. Retinol is an over-the-counter medicine that’s found in many skincare products. Tretinoin is only available via prescription and is about 20 times more potent than retinol.

What Are the Skin Benefits of Tretinoin?

Reduces Acne

Tretinoin has been used for over 50 years as an acne-fighting agent. Its primary effect is to increase the rate of cell turnover, which can allow your skin to get rid of the material found within a forming or existing acne lesion. This can help clear up existing pimples while healing future pimples before they start. Tretinoin also has anti-inflammatory properties which can reduce the swelling and redness caused by acne.

Reduces Dark Spots

Tretinoin can help even out the dark spots that doctors call hyperpigmentation. These dark spots (which are a concentration of melanin) are the result of several factors, including sun damage, pregnancy, stress, thyroid disease, or use of certain medications (e.g. birth control pills, anti-seizure medications). Tretinoin can help decrease pigment in the skin while stimulating the growth of new skin cells, thus lightening the skin and making the melasma less noticeable.

Builds Collagen

Collagen is an important protein that gives strength, body, and elasticity to your skin. Tretinoin can stimulate the production of new collagen in your skin while simultaneously preventing the breakdown of old collagen. This may help improve your skin’s tone and restore a more youthful appearance.

Treats Fine Lines & Wrinkles

Tretinoin can help smooth out fine lines and small wrinkles by increasing your skin’s elasticity and filling out sagging skin with collagen. Note that tretinoin will not have much of an effect on deeper creases and wrinkles.

Who Should Use Tretinoin?

Tretinoin is FDA-approved for the treatment of both acne and photo-aging—i.e. wrinkles, roughness, fine lines, and hyperpigmentation. 

In recent years, the anti-aging benefits of tretinoin have made it increasingly popular among people approaching menopause. Menopause affects almost every organ and tissue in your body, and your skin is no exception. As your estrogen levels fall, your face may seem to age more rapidly than you’re accustomed to. And while this can be a difficult aspect of the menopause experience, a well-rounded skincare strategy can work wonders.

Note that you should not use tretinoin if you have an allergy or hypersensitivity to tretinoin or other retinoid drugs. And you should proceed with caution if your skin is frequently exposed to harsh conditions such as extreme wind, cold, sun, or UV from tanning beds.

Integrating Tretinoin Into Your Skincare Routine

Tretinoin causes mild skin irritation, so you may need to adjust your daily skincare regimen to accommodate it and get the most out of your treatment. And as with any new skin treatment, there can be a learning curve. You’ll need to work closely with your healthcare provider and figure out what’s best for your unique skin. Here are some high-level guidelines that most people find helpful.

Use at Night

Some tretinoin products degrade in the sunlight, so it’s best to apply your treatment at night before bed. This also allows the medication to work without interference from other cosmetic products (e.g. makeup) that you may wear during the daytime.

Start with a Good Cleanser

Before applying tretinoin, gently wash your face using warm water and a mild cleanser. Avoid harsh ingredients and bear in mind that cream-based products tend to be gentler than foaming cleansers.

Only Use a Pea-Sized Amount

Tretinoin medications tend to be potent, so only use the amount recommended by your healthcare provider. Spread it carefully over your forehead, cheeks, chin, etc., being careful to avoid sensitive areas like the skin around your nostrils and eyes.

Moisturize

Using a water-based moisturizer after applying tretinoin is generally recommended. This can help protect your skin from some side effects of the treatment, including dryness, peeling, and irritation. 

Start Slow (2-3 Nights a Week)

To minimize potential side effects, it’s best to go slowly and carefully with tretinoin. Begin by applying it twice a week or every other day and gradually work your way up. Daily tretinoin use is an ideal target for many people, but some may find that excessive. Follow your own comfort and work closely with your healthcare provider.

Always Apply Sunscreen in the Morning

Tretinoin will make your skin more sensitive to sunlight. That means it’s incredibly important to protect yourself from the sun’s damaging UV rays. Make sure to use a sunscreen with an SPF of at least 15 as part of your daily morning skincare practice.

How Long Does it Take to See Results?

If you’re taking tretinoin for anti-aging purposes, you can expect to see results in roughly three to six months. The exact time will depend on your current skin health, the strength of the medication, and how frequently you apply it. 

It’s best to think of tretinoin as a ‘slow and steady’ journey. You probably won’t see a dramatic overnight shift in your skin health. But if you’re patient and consistent with your daily treatments, you will see steady, gradual improvement.

What Are the Potential Side Effects of Tretinoin?

When you begin using tretinoin, there will probably be an adjustment period. This is sometimes called the “tretinoin purge.” Don’t worry—it’s just a temporary phase as your skin adjusts to its new chemical balance. During this time, it’s likely that you’ll experience a range of symptoms lasting anywhere from three weeks to six months. Here are some the typical side effects you may encounter:

Acne

Tretinoin is a very effective acne treatment. But initially, it can actually cause breakouts in a subset of people who use it. This is due to the increase in skin cell turnover when you first start using the medication. Be patient—tretinoin will help prevent breakouts in the long run.

Dryness & Skin Peeling

Tretinoin causes higher skin cell turnover. That means old cells are dying off rapidly as new ones replace them. When those dead cells are shed, they can clump together in large flakes—i.e. dry, peeling skin. Over time, your skin will resume normal shedding behavior.

Redness & Irritation

Tretinoin can directly activate receptors in your skin that trigger inflammation. This causes your skin to become mildly inflamed, leading to tenderness and redness. It can also make your skin more sensitive to other forms of irritation, like scratches and windburn. Note that redness is typically a short-term side effect that will pass when your skin gets accustomed to the medication.

Increased Sun Sensitivity

Using tretinoin will make your skin very sensitive to the sun’s UV rays. That means you’ll need to be very cautious to avoid sunburns and other forms of sun damage. So use lots of sunscreen and cover up, even on cloudy days.

Ingredients to Avoid in Your Routine

Some skincare products just don’t mix well with tretinoin—either because the active ingredients work against each other or because they are too similar, which can increase side effects. Phasing out or replacing these products is one of the trickiest parts of building your new skincare routine, but try to stay patient and hang in there! Here are some possible problem ingredients to watch out for if you want to reap the maximum benefits of tretinoin while staving off side effects:

Salicylic Acid

Salicylic acid is an exfoliating agent that dissolves dead skin cells and unclogs pores. This makes it very useful in the fight against acne. But tretinoin has a very similar effect, and combining the two can worsen irritation (redness, peeling, discomfort).

Alpha Hydroxy Acids (AHAs)

AHAs (such as lactic acid, glycolic acid, and citric acid) are a commonplace ingredient in skincare products. As acids, they kill off older skin cells which can stimulate new skin growth. In other words, they increase turnover rate—which is exactly what tretinoin is already doing. Combining the two ingredients can cause enhanced irritation, redness, and discomfort.

Retinol

Although it’s less potent than tretinoin, over-the-counter retinol has similar effects on your skin. That means combining the two can increase irritation. Check your daily skincare products and drop any that contain retinol.

How to Manage Tretinoin Irritation

If you’re struggling with the tretinoin irritation, the most important thing to do is talk with your healthcare provider. They’ll assess whether your reaction is normal and help you find strategies to cope with this temporary setback. Here a few other tips to manage the irritation tretinoin can cause:

• Switch to a Lower Concentration: Tretinoin creams come in a variety of strengths. Switching to a lower strength might be helpful as your skin adjusts.
• Lengthen Time Between Use: If daily applications are too much, give your skin more time to rest between treatments. You might want to start with 2-3 weekly applications and work upward from there.
• Use Mild Skincare Products: Tretinoin demands a lot of your skin, so use the gentlest possible version of everything else. That includes your moisturizer and cleanser.
• Don’t Use Too Much Tretinoin: Make sure you’re using the smallest possible amount of tretinoin cream to cover your skin. More isn’t always better!
• Always use Sunscreen: Sun damage can significantly worsen tretinoin irritation—and you may be surprised by how easy it is to get unintended UV rays. Make sure to include a sunscreen with an SPF of at least 15 to your daily skincare regimen.

The Bottom Line

Menopause brings a lot of changes—and for many of us, changes in appearance are the most challenging. The good news is that real, science-backed treatments are available to help you manage these symptoms. Ask your healthcare provider about tretinoin and find out whether it can strengthen your menopause skincare routine.