If you’ve done any high quality research on acne treatments, chances are you would have already heard about topical tretinoin. This drug has been in the dermatologist’s arsenal for close to 50 years, and it looks like it will be that way for decades to come.
Despite the breadth of scientific studies and anecdotal evidence supporting topical tretinoin’s efficacy at clearing the skin, people are still intimidated to use it. The fear of its associated side effects such as stinging pain, redness, dryness, and the purge are enough to scare many away.
But never fear! By understanding how topical tretinoin works and how it is meant to be used, you can harness the power of this drug without experiencing the horror stories you’ve heard before.
What is tretinoin?
Tretinoin is a topical retinoid or Vitamin A derivative. If you’ve heard of tazarotene or adapalene, they’re in the same class of drugs. Isotretinoin is another famous retinoid, although this is administered orally rather than topically.
Tretinoin usually comes in gel, microsphere gel, or cream form. The lowest available concentration is 0.01%, but it can go as high as 0.1%.
How does topical tretinoin work?
Tretinoin is very effective at suppressing acne because it targets the very first step: a blocked pore. By nipping it in the bud, it takes care of both comedones and pimples.
A quick review of how acne forms: Dead skin cells and the protein that they produce, keratin, are naturally sloughed off from the skin to be replaced by a new layer. This debris is usually excreted out of our pores, along with facial oil or sebum. When the sloughing off takes too long, skin cells, keratin, and oil accumulate and eventually block the opening of the pore--if it’s partially blocked, it’s a blackhead. If it’s completely blocked, it’s a whitehead. It could stay this way for a while, or else it could become a prime breeding ground for Propionibacterium acnes. This bacteria produces substances that tell our body that something is wrong, and our body reacts with inflammation. And voila, you have a pimple.
What tretinoin does is make sure that the sloughing off of dead skin cells and the replacement of new ones occurs at a faster rate. It also inhibits the enzyme that is responsible for making cells stick to each other into large chunks that easily block pores. Tretinoin also inhibits pro-inflammatory chemical messengers, which helps keep redness and swelling down.
What are the benefits of topical tretinoin?
With these crazy superpowers, it’s easy to see why dermatologists reach for tretinoin as a first-line treatment against acne. But as if it’s blemish-clearing effects aren’t enough to land this drug a prized spot on our vanity tables, tretinoin has been proven to do even more.
Studies have found that it prevents the breakdown of collagen and supports the deposition of hyaluronic acid. If these substances sound familiar to you, it’s because these are often used in marketing anti-aging products. Topical tretinoin is not just used by the acne-prone, but also by those who want to preserve the suppleness of their skin. It stops and prevents photoaging, which refers to the process by which the skin most exposed to the sun gets saggy and wrinkly.
Tretinoin also helps create an even skintone by dispersing the melanin in the epidermis. If you struggle with the dark remnants of breakouts past, then this must be heaven to your ears. A product that helps erase past zits, targets current zits, and prevents future zits? Count me in!
How can you minimize side effects?
But if you have had a long or severe history of acne, by this time you’re probably already thinking that tretinoin is way too good to be true. And we don’t argue with that, because scientific studies have indeed shown that this powerful drug must be used correctly to avoid a host of adverse side effects.
Skin irritation
If you feel a stinging sensation when you apply topical tretinoin, know that it’s normal the first few times. The best thing you can do to keep it from being unbearable is to ease yourself slowly into the treatment.
High concentrations of tretinoin are more strongly associated with side effects, so you may want to start with a tube of 0.01% and see how your skin takes it. Remember that moisture enhances the penetration of the product, so make sure to allow your face to completely dry before applying it the first few times. If your skin is sensitive, you might consider applying it once every 2-3 days, then slowly move your way up to nightly use.
As your skin adjusts to the product, you can increase strength. Learn to take cues from your body and either lessen frequency or lessen concentration as needed.
Dryness and peeling
Tretinoin will ramp up the rate at which your skin exfoliates. Naturally, this will mean your skin will be dry, scaly, and flakey. For some, it lasts a couple of days while others need to cope with it for a few months.
To ease your discomfort, make sure that all the products you’re using do not exacerbate the problem. Typically, dermatologists encourage retinoid newbies to keep their skincare to the bare minimum to avoid any additional irritants. Products labelled “mild”, “gentle”, or “non-irritating” are your best bets.
If you are using other anti-acne treatments, check with your dermatologist if it should be continued. Combining tretinoin with drugs that target acne bacteria, such as benzoyl peroxide or topical antibiotics, has proven more effective than using tretinoin alone. However, there are guidelines that must be followed to make sure other treatments do not inactivate tretinoin.
Many people find that the right moisturizer can do wonders for dry-tight skin. Do your research among tretinoin forums--or best, act your derma!--about what options are available for you.
The purge
Among the most feared side effects of tretinoin is the dreaded purge. This is an initial worsening of the acne that can last for a week for the lucky ones, and a month or so for the less fortunate. Though research hasn’t yet uncovered why this happens, a good hunch would be that the initial boost in skin cell production blocks the pores. It’s like when you do spring cleaning: you have to mess things up before you tidy things up.
No one has found a way to avoid the purge, but everyone who has been through it will say that the end result is well worth the pain. If you need inspiration to keep going when you’re at the lowest of the so-called retinoid uglies, try watching videos and looking at before-and-after pictures of those who have known that hell. Reminding yourself that there is a light after the tunnel might make it easier for you to get through this.
Photosensitization
Retinoids thin out your skin, which means you’ve got less protection against the sun. You should always use tretinoin at night, as it may predispose your skin to sun damage--plus the fact that sunlight is known to deactivate its effects.
While wearing sunscreen should be done by every single person in the world, it becomes even more crucial to those who are using tretinoin. Choose a broad-spectrum variety with at least 30SPF. Apply everyday before going out, and reapply every 4 hours (or less, if you’ve been out in the sun and sweating).
Other side effects
If you experience the above symptoms to a more severe degree and for more than a month with no improvement, you should see a medical professional. Nearly all drugs available in the market will cause a small portion of the population to react negatively, and tretinoin is no different. Knowing what it’s supposed to do and for how long can help you determine when to visit the doctor.
Conclusion
The saying “With great power comes great responsibility” applies perfectly to tretinoin. The safety and efficacy of this drug has been proven time and time again, but there’s not much that can be done if it is used the wrong way.
It would help if you thought of tretinoin as a pharmaceutical drug, rather than a skincare product. In some countries, it’s even a prescription drug that is tightly controlled by the medical community. As such, you can rest easy knowing that it has gone through clinical trials and approval from regulatory agencies. If you educate yourself about tretinoin and go into it knowing full well what you’re getting into, then there is no reason to be intimidated by this drug.
And with proper and consistent use, tretinoin might just be the pimple vanquishing product you’ve dreamed of.
This content is for general information only and is not a substitute for medical advice.
Resources:
Boswell C. B. (2006). Skincare science: update on topical retinoids. Aesthetic surgery journal, 26(2), 233–239. https://doi.org/10.1016/j.asj.2006.02.003
Leyden, J., Stein-Gold, L. & Weiss, J. Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatol Ther (Heidelb) 7, 293–304 (2017). https://doi.org/10.1007/s13555-017-0185-2
Mukherjee, S., Date, A., Patravale, V., Korting, H. C., Roeder, A., & Weindl, G. (2006). Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Clinical interventions in aging, 1(4), 327–348. https://doi.org/10.2147/ciia.2006.1.4.327
Schmidt, N., & Gans, E. H. (2011). Tretinoin: A Review of Its Anti-inflammatory Properties in the Treatment of Acne. The Journal of clinical and aesthetic dermatology, 4(11), 22–29.
