Topical retinoids

Retinoids are a type of vitamin A. They were initially prescribed by doctors for the management of acne, but discovered to have positive effects on skin texture and appearance, including smoothing the skin, fading pigmentation and reducing fine wrinkles.

A range of topical retinoids are available. Many are available over the counter and include:

• Retinyl palmitate.
• Retinol.
• Retinaldehyde.
• Adapalene.
• Trifarotene.
• Tretinoin.
• Tazarotene.

Tretinoin is a cost-effective treatment used extensively in the management of sun-damaged skin. In general, on this page where we discuss topical retinoids, we are referring to topical tretinoin.

How do topical retinoids work?

Tretinoin helps remove dead skin cells, allowing new cells to rise to the surface more efficiently. This stimulates collagen production and helps to reverse the effects of long-term sun exposure¹.

Tretinoin should be used for at least 6 months for maximum effect. After two years of continuous tretinoin treatment, there is marked improvement in fine and coarse wrinkles, lentigines (“age spots”) and mottled pigmentation. There is also an increase in the production of collagen, which improves the texture of the skin⁴.

There is some evidence that it helps to treat and prevent solar keratoses, a common pre-cancer skin condition, but this evidence is not conclusive⁸.

How to use topical retinoids

Do not use tretinoin if you are pregnant, planning pregnancy or breastfeeding.

Do not use tretinoin on broken or sunburnt skin, or skin affected by eczema, psoriasis or other rashes.

• Apply topical retinoids at night, usually before bedtime.
• Before applying, wash the area to be treated (usually face and/or chest) with a mild soap-free cleanser and pat dry.
• Apply the cream after drying the skin.
• Dispense a single measured pump from your dispenser, or use an amount the size of a pea. This should be sufficient for the entire face and neck.
• Apply a thin layer of cream to the affected area.
• Only use on intact skin. Do not use on open wounds or skin affected by eczema.
• Avoid contact with your eyes, mouth and lips.
• Do not use on sunburnt skin.
• After application of tretinoin, use a moisturiser as needed to soothe areas of dry, flaky skin⁵.

Usual dosage regimen

In the early stages of using tretinoin, your skin may become dry, red and irritated. To minimise this side effect, start by applying tretinoin for a short time and gradually increase the length of time it remains in contact with your skin. Start with a lower concentration and increase to 0.1% tretinoin if the lower concentration is well tolerated.