Tretinoin has been a widely recognized and respected skincare ingredient since the 1960s. It has made waves in both the beauty industry and medical community with its incredible before-and-after effects on the skin. It is considered a first-line treatment for acne patients and the gold standard of anti-aging ingredients.
It wasn’t until the 1980s that tretinoin became “popular”. It has a long history of safe and effective use in treating various skin conditions and is approved by the FDA to treat the signs of aging and acne. Its safety profile, backed by decades of research and clinical experience, makes it a trusted choice for both cosmetic and medical skincare regimens. With over 2 million prescriptions written annually, tretinoin is an effective ingredient, resulting in remarkable before and after results.
In this article, I'll debunk some tretinoin myths, discuss potential side effects and how to prevent them, plus discuss ways to enhance the results achieved with this game-changing compound. Dermatologists regularly recommend tretinoin for its proven efficacy in treating various skin conditions, making it a staple in both cosmetic and medical treatment plans.
UNDERSTANDING TRETINOIN AND ITS EFFECTS ON THE SKIN
The Science Behind Tretinoin
Let’s review how tretinoin affects the cells! Also known as retinoic acid, tretinoin is a derivative of vitamin A. It boosts cell turnover and collagen production, leading to smoother and more youthful-looking skin. Tretinoin penetrates the skin's deeper layers to repair and stimulate skin cells, producing remarkable improvements over time.
At the cellular level:
- Tretinoin is a derivative of vitamin A, also known as all-trans retinoic acid.
- It binds to specific retinoic acid receptors (RARs) on skin cells upon application.
- This binding activates intracellular signaling pathways, influencing gene expression.
- Tretinoin promotes collagen synthesis and can enhance the expression of genes related to procollagen, thus boosting skin firmness and elasticity.
- It modulates keratinocyte differentiation and proliferation, accelerating epidermal turnover and preventing the formation of microcomedones.
- Tretinoin can reduce inflammation and affect melanogenesis, leading to reduced skin redness, decreased hyperpigmentation, and improved skin tone. However, it is worth noting that tretinoin may initially cause some irritation and redness before these improvements are seen.
- Through these molecular mechanisms, tretinoin promotes cellular renewal, repair, and rejuvenation, resulting in smoother, firmer, and more youthful-looking skin.
Enough with the Science Talk…How does tretinoin transform the skin in plain English?
Tretinoin has gained recognition due to its proven before and after effects on addressing various skincare concerns including acne, aging, sun damage, melasma, etc. Let’s review…
Removes dead skin cells: Tretinoin helps remove dead skin cells by normalizing how skin cells regenerate. It also prevents clogged pores and contributes to a smoother skin texture.
Improves skin pigmentation: Tretinoin speeds up the turnover of skin cells on the surface, helping to improve hyperpigmentation and even skin tone. Studies show that retinoids effectively treat the dark spots left over from acne and sun damage.
Reduces inflammation: Tretinoin has anti-inflammatory properties that help decrease redness and swelling associated with acne while preventing the formation of new acne lesions. As noted previously, tretinoin may initially cause irritation and redness before these improvements are seen.
Boosts collagen production: Collagen forms in the deeper layers of the skin. This helps reduce the appearance of fine lines and wrinkles, acne scars, and skin texture.
Although tretinoin is primarily prescribed for the treatment of acne, its benefits extend well beyond acne control. One of the key advantages of tretinoin is its ability to diminish fine lines and help fade discoloration from sun damage. Tretinoin is highly effective in combating signs of aging skin due to its ability to stimulate collagen production and enhance skin cell turnover. By accelerating the shedding of old, damaged skin cells and promoting the growth of new ones, tretinoin improves skin texture, reduces the appearance of fine lines and wrinkles, and enhances overall skin tone and clarity. Moreover, tretinoin can help reverse sun damage by fading dark spots and hyperpigmentation, resulting in a more youthful and radiant complexion. Its proven efficacy in addressing various signs of aging makes tretinoin a cornerstone in dermatological anti-aging regimens, offering visible and long-lasting results when used consistently over time.
WHAT TO EXPECT WHEN STARTING TRETINOIN
When starting tretinoin, it's common to experience some initial side effects as your skin adjusts to the treatment. These may include:
Dryness and flaking: As tretinoin starts working, you might feel burning, stinging, itching, or flaking, especially if you have dry or sensitive skin.
Redness: Your skin may become red or irritated, especially in the first few weeks of use.
Increased sensitivity to the sun: Tretinoin can make your skin more sensitive to the sun. That’s why it’s best to use tretinoin at night and always wear a broad-spectrum sunscreen with at least SPF 30 during the day (which you should do anyway!). See below for some sunscreen recommendations.
Increased breakouts (purging): When you first start using tretinoin, you may (or may not) experience an initial increase in acne. This happens because the fast turnover of skin cells can block pores and irritate the skin, leading to breakouts. This is part of the cleaning out process and is temporary.
Gradual improvement: While you may not see immediate results, consistent use of tretinoin can lead to noticeable improvements in fine lines, skin texture, tone, and acne.
It is worth noting that tretinoin is not a one-size-fits-all solution. Different individuals may respond differently to this medication, and it is essential to consult with a dermatologist to determine the most suitable concentration and frequency of use for your specific needs. Additionally, following the prescribed instructions and avoiding excessive use is key, as this can lead to skin irritation and other unwanted side effects.
MYTH #1 Only High Strength Tretinoin is Effective!
There is a myth (floating around social media) that the higher the strength of tretinoin, the better the results. This theory is fundamentally flawed because it overlooks the delicate balance required for effective and safe skincare. While it may seem intuitive to assume that higher concentrations yield quicker and more dramatic results, this overlooks the potential for increased irritation, inflammation, and other adverse effects that may compromise the skin barrier.
Tretinoin, even at lower strengths, is a powerful ingredient and can cause significant dryness, redness, and flaking, especially when starting treatment. Higher concentrations can exacerbate these side effects, leading to discomfort and potentially weakening the skin barrier. Therefore, the key to successful tretinoin therapy is finding the right balance between efficacy and tolerability, which often involves starting with lower strengths and gradually (over 3-6 months) increasing the strength as tolerated. Your before and after results can be disappointing if you push too hard!
"The tretinoin cream has been helping me. It hasn't yet helped with my hyperpigmentation, but I am going to keep putting it on in hopes that it will. It has helped with preventing new breakouts, but I think I need more time with it to see even better results." Piction Patient
“I have only been able to use the tretinoin every 3 days because daily use had my skin peeling, but I am building up tolerance. The regimen of that as well as the clinda gel and spironolactone had rapid results for me which was so wonderful. Within a week my skin was clearer." Piction Patient
IRRITATION WHEN USING TRETINOIN
Here are a few suggestions to help avoid peeling/dryness/irritation when starting tretinoin. Note: Please contact your prescribing medical provider and let them know you're experiencing irritation/dryness/peeling. The following suggestions should not replace your personal medical provider's advice.
- Start out slowly, using it every 2-3 days, and increase use as tolerated. Ideally, you’ll eventually be able to use it every night or every other night.
- Wet skin = irritation! Apply tretinoin to clean, dry skin to control the absorption rate and minimize potential side effects.
- Avoid applying tretinoin to the upper and lower eyelid area. The skin is fragile and irritates easily, so using an over-the-counter retinol or non-retinol eye cream in these areas may be all you need.
- Avoid the base of the nose. This area tends to be moist due to breathing and interacts with the tretinoin.
- Avoid the corners of the mouth for the same reason as the base of the nose.
- If needed (especially for sensitive skin), apply a gentle moisturizer before the tretinoin. It can “buffer” the tretinoin while still allowing absorption.
- If needed, apply a barrier cream in the morning. It can reduce dryness and hydrate the skin. Here are a few suggestions you might like.
- CeraVe: Moisturizing Cream for Normal/Balanced to Dry Skin with Ceramides
- Tower 28 Beauty: SOS Daily Skin Barrier Redness Recovery Moisturizer
- La Roche Posay Cicaplast Balm Vitamin B5 Soothing Therapeutic Cream for Dry Skin and Irritated Skin
SUNSCREEN! SUNSCREEN! SUNSCREEN!
Consistent sunscreen use is strongly recommended when using tretinoin due to increased skin sensitivity to sunlight. Why does this happen? Tretinoin works by speeding up cellular turnover. Old skin cells are replaced with new ones at a faster rate, making the skin more susceptible to sunburn and damage from UV radiation. Those dead skin cells help create a natural “barrier” protecting skin from the sun. When using tretinoin, there are fewer dead cells, thus less protection.
Also, keep in mind that sunscreen helps reduce the risk of sunburn, premature aging, and skin cancer. Make sure to use a broad-spectrum sunscreen with a SPF 30 or higher. Apply it generously every morning (even on cloudy days) to ensure adequate protection while using tretinoin. Remember to reapply! Here are a few sunscreen/sunblock suggestions:
Sunscreen- Dry to Normal skin
- Cetaphil Daily Facial Moisturizer, UVA/UVB Defense, SPF 50
- Neutrogena Clear Face Liquid Sunscreen Lotion SPF 30
- EltaMD UV Clear Broad-Spectrum SPF 46 (do not use the tinted version)
- Differin Oil Absorbing Moisturizer SPF 30
- CeraVe Face Moisturizer with Sunscreen, AM Facial Moisturizing Lotion for Normal to Dry Skin - SPF 30
Sunscreen- Oily skin
- Neutrogena® Clear Face Serum Sunscreen with Green Tea Broad Spectrum SPF 60+ Fragrance Free
- Neutrogena Invisible Daily Defense Sunscreen Face Serum
- Hydro Boost Water Gel Lotion SPF 50
Sunscreen- Melanin Rich skin
The following sunscreens limit white cast and are recommended for melanin-rich skin:
- MDSolarSciences Mineral Tinted Creme SPF 30
- CoTZ Flawless Complexion SPF 50
- Supergoop! Glowscreen SPF 40
- Anthelios Mineral Tinted Sunscreen for Face SPF 50
- Beauty of Joseon Relief Sun: Rice + Probiotics
MYTH #2 It doesn’t matter what time of day tretinoin is applied
Tretinoin should only be applied at night. Let me repeat this…tretinoin should only be applied at night. When exposed to sunlight, tretinoin breaks down and becomes less effective. Applying tretinoin at night allows it to work without interference from sunlight, thus maximizing its effectiveness. Additionally, applying tretinoin at night gives the skin time to absorb the medication. Overall, nighttime application is a standard practice to ensure optimal results and safety when using tretinoin.
LIFESTYLE CHANGES CAN (USUALLY DO) AFFECT THE SKIN
Don’t overlook the impact that lifestyle changes can have on your skin! Making specific lifestyle changes can improve your skin too. Focus on the following:
- Ensure you're getting enough sleep
- Get regular exercise
- Practice stress management techniques
- Follow a balanced diet rich in antioxidants
- Stay hydrated
- Avoid excessive and/or regular use of alcohol
- Avoid smoking
- Avoid excessive sun exposure…especially without SPF/wide-brim hats.
Now that you have learned more about the before-and-after effects of tretinoin on your skin, you may be inspired to begin your journey to radiant skin.
PICTION ONLINE DERMATOLOGY CARE FROM THE PRIVACY OF YOUR HOME
If you're seeking expert guidance and personalized advice, consider taking advantage of Piction Health's online dermatology care. Their team of experienced dermatologists will provide professional insights and tailor-made recommendations to help you confidently achieve your skincare goals. Say hello to the remarkable changes tretinoin can offer!
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