Acne is a very common skin condition that develops when oil and skin cells clog hair follicles. Sometimes bacteria can infect the follicles. This results in large, inflamed bumps called cystic acne. Acne can occur anywhere on the body.

There are many different topical prescription products on the market for treating cystic acne. One of the most popularly prescribed is a drug derived from vitamin A called retin-A. The generic name for retin-A is tretinoin.

Tretinoin falls under a class of medications called retinoids. Retinoids are derived from vitamin A. They can make skin cells grow and function more effectively.

Retinoids have been used to treat:

  • acne
  • psoriasis
  • skin aging
  • some cancers

Tretinoin is one of the strongest and most effective topical retinoids used to treat acne and skin aging.

There are several different band names of tretinoin on the market. All are used on the skin.

Tretinoin medications may come as gels, creams, or lotions.

  • Creams are thicker and usually contain the highest levels of medication, but tend to work more slowly and cause less irritation.
  • Gels are transparent in color and contain lower levels of medication, but work quickly and can irritate the skin.
  • Lotions tend to contain the lowest levels of medication and the highest levels of water, but are most easily absorbed.

Tretinoin products that contain higher percentages of tretinoin are usually used to treat cystic acne. This is the most severe type of acne. Your doctor can recommend a dermatologist who will help determine which kind of tretinoin is best for you.

The various formulations of tretinoin available in the United States include:

Brand namePercent of tretinoinType
Atralin0.05 percentgel
Avita0.025 percentgel or cream
Refissa0.5 percentcream
Renova0.02 percentcream
Retin-A0.025 percentgel or cream
Retin-A Micro0.04 percentgel or cream

Tretinoin is used to treat acne and its complications.

Cystic acne

Tretinoin is often used to treat cystic acne, an acne that erupts in boil-like infections on the skin. Cystic acne blemishes usually go deep into the skin, causing permanent acne scars when they heal.

It’s important to work with a good dermatologist to develop a treatment plan that helps keep your skin as healthy as possible and prevent long-lasting damage.

Acne scars

Some dermatologists also recommend using tretinoin to treat acne scars. Your dermatologist may recommend a technique called iontophoresis. This involves applying an electrical current to the skin where a medication is applied.

In the past, researchers have found that iontophoresis can help topical tretinoin better penetrate the skin. Many patients who receive this treatment experience a significant reduction in the appearance of their acne scars and a general smoothing of the skin’s appearance, according to systemic review of treatments.

Tretinoin works by unblocking the clogged follicles that cause cystic acne. In treatment, they’re usually used together with antibiotics. As the tretinoin opens up clogged follicles, the antibiotics enter and get rid of the bacteria that cause acne breakouts.

Tretinoin is usually applied in a thin layer on the skin that’s affected by acne once daily at bedtime for as long as the acne breakout lasts. Before you use tretinoin, wash your face with a mild soap and gently pat it dry. Wait 20 to 30 minutes before applying the medication.

When using tretinoin, be careful not to get it into your:

  • eyes
  • ears
  • nostrils
  • mouth

You can use cosmetics, but you should always wash your face before applying tretinoin.

There are some common side effects associated with tretinoin use. They usually go away after you end treatment. Side effects include:

  • burning or stinging of the skin, which may be severe
  • unexpected lightening of the affected skin area
  • chapping or peeling of the skin, which may be severe
  • redness of the skin, which may be severe
  • unusually warm skin
  • skin that’s easily sunburned

Much less commonly people experience a darkening of skin treated with tretinoin.

Researchers have found that exposure to sunlight after the application of topical retinoid medications is linked to skin cancer in animals. But human studies have not been able to find that same link. You may sunburn more easily when using tretinoin, so you should avoid direct sunlight.

As one of the most commonly prescribed topical medications for cystic acne, tretinoin is considered safe for most people. However, there are some cases where you should avoid using tretinoin because it can cause health problems.

Don’t use tretinoin if you:

  • are pregnant, trying to become pregnant, are at risk of becoming pregnant, or are breastfeeding
  • have eczema or have other chronic skin conditions, especially on the face
  • have a sunburn
  • are sensitive to sunlight
  • are taking photosynthesizing drugs (such as thiazides, tetracyclines, fluoroquinolones, phenothiazines, sulfonamides, and others)

In some cases, doctors may recommend retin-A for uses other than acne and acne scars. Retin-A has also been used to treat the following skin conditions:

To learn more about what it’s like to use tretinoin, we spoke to health and beauty writer Genevieve Monsma of Genevieve began using tretinoin cream for acne in high school, but found it less effective than Accutane.

Since her late twenties she resumed using it on and off for nearly two decades, and is currently using it today to treat occasional adult acne and early signs of aging like uneven tone and fine lines.

Genevieve says that she’s found tretinoin to be less effective at quickly treating acne breakouts than preventing the signs of aging. “I do think it has helped my skin age better,” she says. “I spent a lot of time in the sun as a teenager and have far less sun damage than I probably, rightfully should.”

One major drawback of tretinoin is that it can cause redness, peeling, and stinging, says Genevieve. This constant skin irritation is the major reason she stopped using tretinoin as a teen. But she’s found a workaround so she can continue using it without these side effects.

“I only use the lowest strength available (0.025), I apply it no more than three-to-four evenings per week, I always slather on an oil or cream before the tretinoin, and I use the cream in conjunction with a mild peeling agent, like glycolic pads to remove stubborn flakes.”

Besides skin irritation, another drawback to trentinoin is its cost, says Genevieve. “The cost can range from $60 to $200-plus, depending on your insurance or any coupons (the Good Rx app saved me $100 the last time I filled my Rx). And there is the inherent hassle of having to get the prescription from your doctor; you cannot just order it online or pop into a store and pick it up.”

Tretinoin is a very commonly prescribed topical medication used to treat a severe type of acne called cystic acne. In addition to acne, some doctors use it to reduce fine wrinkles on the face, as well as skin darkening and roughness.

Tretinoin is generally safe but should not be used by some people. To learn more about tretinoin and your acne treatment options, schedule an appointment with a doctor, or a dermatologist, if you have one.