Acne is a common skin condition that affects 80% of people between 11-30 years old and 5% of adults older than 29 years old. Many people with acne also experience some type of scarring. Tretinoin (Retin-A) is a prescription-only topical (applied to the skin) retinoid used to treat acne. It can also greatly improve the appearance of acne scars.
You should notice improvement in acne scars after several months of using tretinoin. If you do not notice any improvement after a few weeks to months, talk to your dermatologist.
Acne scarring occurs when inflammation from acne damages the deeper layer of skin (the dermis). As the body attempts to repair this damage, the healing process may not be complete or smooth, resulting in scars. The severity of scarring depends on the type of acne, your skin and immune health, and habits such as picking or touching blemishes.
Collagen is a protein that provides structure, strength, and flexibility to your skin. It also plays a key role in cell turnover—the process of replacing old, dead skin cells with healthy new ones. When collagen breaks down during the healing phase, scars can form.
When more collagen is broken down than collagen created, it can cause sunken (also called atrophic) scars.
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Too much collagen can lead to keloid (raised) scars.
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Retinoids, a class of compounds derived from vitamin A, are commonly used for acne treatment. They work by reducing inflammation, unclogging pores, and promoting cell turnover. This turnover not only helps prevent new breakouts but also supports the replacement of damaged skin with healthier tissue.
The two main types of retinoids are tretinoin and retinol:
- Tretinoin: This product requires a prescription because it is more potent than other options. With consistent use, it increases collagen production, thickens the dermis, and improves skin firmness and texture, helping smooth out acne scars.
- Retinol: This product is available over-the-counter (OTC) and does not need a prescription. It is gentler but less effective than tretinoin. It can still aid in treating acne and mild scarring, though results may take longer.
Tretinoin is available as a cream, gel, and lotion. If you have never used tretinoin or other retinoids before, your healthcare provider will likely start with a low strength (0.01%) and go up as needed. Depending on why you are using the product and your skin health, they may decide to prescribe a higher strength. The highest strength available is 0.1%.
It is best to apply tretinoin at night. This is to limit your exposure to sunlight and avoid mixing tretinoin with other skincare products you may be using during the day.
Follow these steps when applying tretinoin:
- Cleanse your face: Wash your face and hands with a mild cleanser. Pat your skin dry and wait a few minutes before applying tretinoin.
- Apply a pea-sized amount to the affected area: Apply a pea-sized amount of tretinoin to the area. One thin layer is enough. Do not apply more or less of the product, unless your healthcare provider recommends you do so.
- Use a moisturizer: Tretinoin can dry your skin. Adding a moisturizer to keep the skin hydrated can help lower irritation and improve tretinoin absorption.
Here are a few more tips to keep in mind when using tretinoin:
- Give your skin time to adjust: When first starting tretinoin, consider applying the product 2-3 times a week. As your skin gets used to it, you can start applying it every night. When you first start using tretinoin, your skin may seem worse. You may notice more redness, peeling, and acne. Two to three weeks of regular use is usually needed before you notice any improvement.
- Apply sunscreen daily: Your skin becomes more sensitive to the sun and ultraviolet light while using tretinoin. Use a sunscreen with an SPF of 15 or higher every day, even on cloudy days.
- Avoid skincare with potentially irritating ingredients: For instance, topical products with alcohol, spices, menthol, or lime can burn and sting your skin if you are also using tretinoin. You should also avoid using products with benzoyl peroxide, salicylic acid, and other acne treatments, unless told by your healthcare provider.
- Do not let tretinoin get in sensitive areas: When applying the product, be careful to keep it out of your eyes, mouth, ears, nostrils, or lips. Also, avoid applying tretinoin to areas of skin that are sunburnt.
The most common side effects caused by tretinoin are skin irritation symptoms, such as:
- Burning, itching, or stinging of the skin
- Unusual dryness
- Peeling
- Redness
- Pain
The risk of skin irritation is more common with higher tretinoin strengths. Side effects are common when you first start using tretinoin. After a few weeks to months, your skin will adjust to the medication, and you should experience less irritation.
Tretinoin can also make your skin more sensitive to the sun and ultraviolet (UV) light. Avoid unnecessary or prolonged exposure to sunlight or UV light, like tanning beds. Wear protective clothing, sunglasses, hats, and sunscreen when you are outside in the sun.
People who are pregnant should not use tretinoin. Also, some people may be allergic to ingredients in the product, making it unsafe to use. Talk with your doctor if you become pregnant while using tretinoin.
Talk to your dermatologist or primary care provider if you notice these symptoms while using tretinoin and they do not go away on their own:
- Stinging of the skin
- Lightening or darkening of the skin
- Red, scaly skin
- More acne sores
- Swelling, blistering, or crusting of the skin
- Dryness, peeling, redness, or flaky skin
If you experience itching, hives, or pain in the treatment area, see a healthcare provider immediately. You may be allergic to tretinoin or another ingredient in the product.
If your skin does not improve at all after three months of using tretinoin, speak to your dermatologist. They can help you decide if tretinoin is a good option for your treatment, or if another product would work better.
Tretinoin is a prescription-only topical retinoid used to treat acne and acne scars. When tretinoin is used consistently, it raises collagen production, thickening and smoothing your skin. Tretinoin can cause skin irritation and make you sensitive to sunlight and ultraviolet light.
Talk with your doctor if you are interested in using tretinoin for acne scars. They can help you decide if the product is a good option for you.
