10 Things to Know Before You Start Using Tretinoin

Kristin Hall, FNP
Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 9/14/2020

Are you considering tretinoin as an acne or anti-aging treatment? Used for decades as an acne prevention and anti-aging medication, tretinoin is arguably one of the most well-known, most effective topical skin medications on the market.

Despite this, it’s important to be aware of how tretinoin works before you start using it for acne prevention or anti-aging. Below, we’ve listed 10 things you should know before you start using tretinoin, from the initial “purge” period to the amount of time you’ll need to wait to see results. 

Your Skin Might Look Worse Before it Gets Better

Tretinoin is infamous for its “purging” effect — a period lasting anywhere from a few weeks to several months in which your skin can look red, irritated and less aesthetically pleasing than normal.

It’s completely normal to experience some degree of purging when you begin to use topical tretinoin. The purge effect of tretinoin occurs as a result of the medication’s impact on your body’s skin cell turnover process, which controls skin exfoliation.

Because tretinoin speeds up your rate of skin cell turnover, it can result in irritated skin in your first few weeks or months of use.

In short, your skin might look worse for several weeks after you start using tretinoin before it begins to look better. However, for most people, your skin will get better.

Starting With a Low Dose of Tretinoin Can Help Limit Side Effects

Worried about dealing with the tretinoin purge? One of the easiest ways to reduce your risk of experiencing dryness, skin irritation or purging when using tretinoin is to start with a relatively low dose of the medication. 

Topical tretinoin is available in a variety of strengths ranging from .01 percent to .1 percent tretinoin. 

In clinical studies of 0.01 percent and 0.025 percent concentration of tretinoin, researchers observed no statistically significant difference in efficacy of the two concentrations (both showed “statistically significant overall improvement” in photoaging), there was a positive correlation between dose and side effects experienced (the 0.025 percent group experienced greater side effects than the 0.01 percent group).

If you want to limit your risk of experiencing side effects from tretinoin, it’s often worth starting with a lower strength, for instance 0.01 percent or 0.025 percent cream.

As you get used to tretinoin and have time to gauge your skin’s reaction to the medication, you may consider switching to a higher strength tretinoin cream for improved results.

Alternatively, if you notice dryness, itching and other side effects after using 0.05 percent or 0.1 percent cream, switching down to a less concentrated form of tretinoin may reduce skin irritation, flaking and other annoyances.

Either way, the best thing to do is speak to your healthcare provider if you’re experiencing side effects from tretinoin. You have options.

It Can Take Some Time to  See Results From Tretinoin

While tretinoin starts working as soon as you apply it to your skin, it can take several months for the medication to produce noticeable results.

Studies of tretinoin show an improvement in acne after three months of regular use.

In two separate studies which observed tretinoin therapy for acne in 0.1 percent and 0.025 percent dosages, researchers found that by 12 weeks, there was an 80 percent and 35 percent reduction (respectively) in microcomedones — which are clogged hair follicles and the primary sign of acne in humans.

Used for anti-aging, studies of tretinoin also show a three-month period for improvements in fine wrinkles and thickening of the epidermal. 

However, this doesn’t mean that you’ll definitely see a drastic improvement in your skin after using tretinoin for three months. 

Other studies of tretinoin show continual improvement for up to 12 months, meaning if you’re committed to using it regularly, your skin may keep getting better over time. 

Tretinoin Can Make Your Skin More Sensitive to Sunlight

Your skin can become significantly more sensitive to sunlight while using tretinoin, especially during the beginning of treatment. Spend a few minutes too long in the sun and there’s a real risk of your skin looking red and sunburned by the end of the day.

Because of this, it’s important to protect your skin from UV exposure while using tretinoin. If possible, limit the amount of time you spend in sunlight to just a few minutes per day. If you need to spend time outside, use sunscreen and a hat to protect yourself.

Our guide to the common and uncommon side effects of tretinoin lists several ways to prevent your skin from sun damage while using tretinoin cream. 

After a few months of tretinoin use, studies show that skin gradually begins to adjust to sunlight and photosensitivity returns to normal. Even after the initial “purge” period, it’s still important to protect your skin with an SPF of 15 or higher sunscreen and avoid overexposure to limit sun damage. 

Moisturizer Can Mitigate Skin Dryness From Tretinoin

If you notice that your skin is overly dry, itchy, flaky or irritated after using tretinoin, you could try applying an alcohol-free moisturizer to the affected area to help mitigate the dryness.

To maximize your results from tretinoin and reduce your risk of side effects, it’s best to pick a moisturizer that’s 100 percent free of alcohol, benzoyl peroxide, artificial fragrances, salicylic acid or any other peeling agent or ingredient that has irritated your skin in the past.

If you need to use moisturizer, wait to apply it (between 20 minutes to an hour) after using tretinoin to make sure your skin has absorbed the tretinoin.

Our guide to using tretinoin and moisturizer together goes into more detail on the benefits of using moisturizer as part of your skincare routine, with a range of tips to help you get the best results from moisturizer and tretinoin at the same time.  

Your Skin Will Get the Best Results by Maintaining Healthy Habits Along with Your Skincare Routine

While tretinoin has been shown to be effective at treating acne and the signs of aging, it isn’t a magic solution to all of your skincare woes. 

For optimal results, the best approach is to maintain healthy, skin-friendly habits in addition to your tretinoin treatment.

This means eating a balanced and nutrient-rich diet, drinking enough water to stay hydrated and healthy, sleeping well and even taking steps to minimize your stress levels. It means staying active and taking your overall health — not just your skincare — seriously.

In short, it means maintaining healthy habits. Preventing acne, wrinkles and other skin problems is a multifactorial process, and topical retinoids such as tretinoin are just one potential solution to the problems.  

Tretinoin is Most Effective When Applied Shortly Before Bed

Tretinoin degrades quickly when exposed to sunlight, meaning you probably won’t get the best results by using it in the morning.

Instead, the best time to apply tretinoin is at nighttime — usually 20 to 30 minutes after cleansing your face before you go to bed. This gives the tretinoin cream or gel time to soak into your skin, all while providing six to eight hours of sunlight-free time for the active ingredient to start working.

Our guides to using tretinoin for acne and for anti-aging, linked at the bottom of this article, explain the best ways to apply tretinoin to your face or other affected skin before sleep. 

You Don’t Need to Use Tretinoin Every Day to See Results

Worried about dryness, itching and other potential side effects from using tretinoin? While most dermatologists recommend tretinoin as a once-daily treatment, your healthcare provider may recommend using the medication less frequently if you’re concerned about side effects.

If your skin becomes dry or sensitive when you first start using tretinoin, consider talking to your healthcare provider about changing your tretinoin usage schedule. In some cases, it’s okay to apply tretinoin every other day instead of using it daily. 

It Can Take Several Months to “Dial In” Your Tretinoin Routine

Tretinoin is most effective as a long-term skincare treatment, meaning the results you notice in the short term don’t always accurately reflect what the medication will do six months or a year from when you first begin using it.

Because tretinoin can take several months to produce solid results, it can take quite a lot of time to “dial in” your tretinoin routine and work out which dosage and application frequency is best for you.

It’s best to think of your first few months of using tretinoin as a learning period in which you’re simply getting used to the medication. Over the course of three, six or 12 months, you’ll learn more about how tretinoin affects your skin and “dial in” your dosage and usage habits. 

If you start noticing adverse effects from tretinoin, the best thing to do is speak to your healthcare provider or dermatologist. They’ll be able to guide you through this learning curve.

Over the Long Term, Tretinoin Works

The first few months of using tretinoin can be a stressful experience. Results may not be major and the infamous “purge” can seriously affect your skin, potentially leaving your skin worse off than when you started.

The key to making progress with tretinoin is remembering that usually, over the long term, it works. In countless studies, tretinoin has produced impressive results as both an acne and anti-aging treatment. 

However, it’s not an overnight process.

From breakouts to dry skin, irritation, itchiness and more, the temporary side effects of tretinoin can make it easy to want to give up after a few weeks. When you use tretinoin, stay focused on the long term and think about your results in three months, six months or one year. 

In short, focus on the long term.

Learn More About Tretinoin

Interested in using tretinoin to prevent acne or reduce the signs of aging? Our guides to tretinoin as an acne medicine and as an anti-aging treatment go into detail on the two most popular uses of topical tretinoin, with simple how-to instructions to help you get the most from the treatment.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.