Topical retinoids are prescribed to control blackheads and whiteheads, or comedonal acne. They also called retinoic acid or vitamin A acid.
This article looks at topical retinoids and how they work as an acne treatment. It also discusses side effects and precautions for using this medication.
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What Are Topical Retinoids?
Topical retinoids promote the exfoliation of dead skin cells and boost the production of new skin cells. The new cells push dead cells and excess oil out of blocked pores. Retinoids also have anti-inflammatory properties.
Two retinoids are prescribed for acne:
- Retin-A (tretinoin topical), also prescribed under other brand names including Avita
- Tazorac (tazarotene topical), also prescribed under the brand name Fabior
Both are available in generic formulations. Retinoids are also available in different forms, including:
- Gels
- Ointments
- Creams
- Foams
Differin (adapalene) is another acne medication that works as a retinoid but is gentler. It is available by prescription in a 0.3% formulation and over the counter in a 0.1% formulation.
Topical retinoids are not the same as retinols. Retinoids are stronger and available only by prescription. Retinols can be purchased over the counter. They are typically found in anti-aging products.
Retinoids may be prescribed on their own or in combination with other acne therapies, such as:
- Antibiotics
- Benzoyl peroxide
In 2023, the Food and Drug Administration (FDA) approved Cabtreo (clindamycin phosphate, adapalene, and benzoyl peroxide), the first-ever triple-combination topical gel for treating acne in people ages 12 and older.
What Are Topical Retinoids Used For?
Topical retinoids are approved by the FDA to treat whiteheads, blackheads, and acne lesions. They can be used by adults and children age 12 and older.
Topical retinoids are also prescribed to help reduce signs of aging, including:
- Hyperpigmentation or dark spots on the skin
- Fine lines and wrinkles
Retinoids sold for anti-aging purposes may have different brand names, such as Renova (tretinoin) and Avage (tazarotene). Retinoids are also sometimes used to treat other skin conditions such as keratosis pilaris and psoriasis.
Recap
Topical retinoids are used to treat acne and certain other skin conditions. They are also used to reduce the signs of aging.
Before Using Topical Retinoids
Retinoids may be used as a first-line treatment for acne or may be prescribed after trying other acne products. In some cases, your dermatologist will want you to try other remedies before prescribing a retinoid. These may include products with ingredients like:
- Salicylic acid
- Benzoyl peroxide
- Sulphur
- Other active ingredients and/or antibiotics
Your doctor will also want to know about your medical history. If you have eczema, for example, you may not be able to use topical retinoids. If you are pregnant, planning to become pregnant, or breastfeeding, you should also avoid this medication. This is because the oral form of retinoic acid, isotretinoin (formerly sold as Accutane), is known to cause severe birth defects.
Recap
Topical retinoids are usually only prescribed if other acne medications haven't worked for you. You should not use them if you're pregnant, breastfeeding, or planning to become pregnant.
Topical Retinol Dosage
Topical retinoids came in various strengths depending on the formulation:
Tretinoin
- Available as a cream in three strengths: 0.025%, 0.05%, and 0.1%
- Available as a gel in 0.01% and 0.025% strengths
- Available as a liquid (the most potent) in a 0.05% strength
- Available as Retin-A Micro 0.1%, a slow-release option that is less irritating to the skin
Tazarotene
- Available as a gel in 0.05% and 0.1% strengths
Differin
- Available as a prescription gel in 0.3% strength
- Available as an OTC gel in 0.1% gel
These dosages come from the drug manufacturers. Always check your prescription and talk to your doctor to make sure you're taking the right dose for you.
Oral Retinoids
Oral retinoids are available by prescription only.
Isotretinoin is formerly known as Accutane. It is an oral retinoid sometimes prescribed for severe acne. Because it is associated with miscarriage and birth defects, it should never be taken while pregnant, breastfeeding, or during the month prior to conception.
How to Take and Store
Topical retinoids for treating acne are applied directly to affected areas. The skin should be clean and completely dry. Apply in a very thin layer with clean hands. Most dermatologists direct patients to use retinoids once a day, in the evening.
A retinoid should not be used on broken, infected, or sunburned skin. It should not be applied to the eyes, nose, mouth, or genitals.
Potential Side Effects
Topical retinoids are generally regarded as safe. Like all medications, though, they may have some side effects.
Common
You may experience mild side effects when you first start using a retinoid. These usually subside after two to four weeks. Side effects may include:
- A warm sensation on the skin
- Mild skin irritation such as itching, peeling, scaling, and burning
- Worsening acne that usually resolves in a couple of weeks
- Darkening of small areas of irritated skin, called retinoid dermatitis
- Increased sensitivity to cold and heat
The most important side effect of retinoids is an increased sensitivity to ultraviolet rays. This can lead to severe sunburn. When using a retinoid it is very important to be vigilant about sun exposure. Use sunscreen, wear hats and sunglasses, and stay out of direct sunlight as much as possible.
Rare
- Worsening acne that does not subside after two to four weeks of use
- Eczema or contact dermatitis caused by an allergic reaction
Severe
It is possible to have a severe allergic reaction to this medication. Seek immediate medical care if you have any of these symptoms:
- Stinging
- Burning
- Extreme dryness
- Swelling
- Itching
- Peeling
- Blistering
- Difficulty breathing
Recap
Most side effects are mild and resolve in a few weeks. In rare cases, topical retinoids can cause a severe allergic reaction. Seek immediate medical care if you have symptoms like blistering or trouble breathing.
Warnings and Interactions
Retinoids should not be used with certain other acne treatments. Combining a retinoid with a product containing salicylic acid, for example, can result in irritation, redness, and peeling.
It is generally recommended to avoid using retinoids and benzoyl peroxide at the same time as the benzoyl peroxide may degrade the retinoid and make it less effective. Certain prescriptions may combine these ingredients, but it is always best to talk to your healthcare provider before adding other medications to your routine, even OTC ones.
Summary
Topical retinoids are a prescription acne treatment. They help unclog pores by boosting the production of new skin cells.
These medicines are usually only prescribed after other acne treatments have failed. They may have side effects like mild skin irritation. They can also make you more prone to sunburn.
Don't use topical retinoids if you are pregnant, breastfeeding, or plan to become pregnant.