Tretinoin is a type of vitamin A, used to treat sun-damaged skin.
How tretinoin works
Tretinoin has three main effects:
- Improving smoothness of skin
- Fading excess pigmentation causing blotchy skin
- Reducing fine wrinkles associated with sun damage (Goldfarb, 1990)
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 exposure.
Tretinoin should be used for at least 6 months for the maximum effect. (DermNet NZ, 1997)
There is some evidence that it helps to treat and prevent solar keratoses, a common pre-cancer skin condition, but this evidence is not conclusive. (Ianhez M, 1988)
How to use tretinoin
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 tretinoin at night, usually before bedtime
- Before applying tretinoin, wash the area to be treated (usually face and/or chest) with a mild soap-free cleanser and pat dry
- Apply tretinoin after drying the skin
- Dispense a single measured pump from your dispenser. This amount should be the size of a pea and is sufficient for the entire face and neck.
- Apply a thin layer of cream to the affected area.
- Only use tretinoin 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 skin
(iNova Pharmaceuticals 2018a)
Usual dosage regimen
In the early stages of using tretinoin, your skin may become dry, red and irritated. To minimise this side effect, star by applying tretinoin for a short time and gradually increase the length of time it remains in contact with your skin.
Night 1: Apply, leave on for 5 minutes then wash off
Night 2: Apply, leave on for 10 minutes then wash off
Night 3: Apply, leave on for 30 minutes then wash off
Night 4: Apply, leave on for 1 hour then wash off
Night 5: Apply, leave on for 1 ½ hours then wash off
Night 6: Apply, leave on for 2 hours then wash off
Following night 6, if your skin is not red, sensitive or irritated, you can leave tretinoin cream on overnight and wash it off the next morning.
Tretinoin cream is usually well tolerated but consult your doctor if you experience side effects. Some redness and irritation may be expected initially. Some types of skin will be too sensitive for tretinoin. If severe irritation occurs, especially in the early stages of treatment, discuss with your doctor.
Protect your skin when you are in the sun. If you are outdoors, wear protective clothing and apply a broad-spectrum SPF 30+ sunscreen. Reapply sunscreen regularly.
Avoid exposure of the treated area to excessive sunlight, sunlamps, strong wind, dry air, skin peels, harsh soaps and exfoliants.
(iNova Pharmaceuticals 2018b)
Reactions to tretinoin are common but usually minor. The most common side effects are:
- Redness of the skin
- Dry, flaking skin
- Skin irritation, tenderness, pain or a burning feeling
These effects are normal. If they are troublesome, try using tretinoin less often, or stop using it for a few days and then start again.
Rare side effects include:
- Sensitivity to sunlight
- Darkening of fair skin and lightening of darker skin
- Rash or swelling at the site of application
- Thinning of the skin
If any side effects become severe, notify your doctor.
(iNova Phamaceuticals 2018a)
How to store tretinoin
Tretinoin cream should be stored at less than 25°C
- Dermnet NZ, 2007. Topical retinoids. https://dermnetnz.org/topics/topical-retinoids/ (Accessed 23 December 2020)
- Goldfarb, MT, Ellis, CN, Voorhees JJ. Topical tretinoin: its use in daily practice to reverse photoageing. British Journal of Dermatology (22) s35, April 1990. p87-91. https://doi.org/10.1111/j.1365-2133.1990.tb16131.x (Accessed 23 December 2020)
- Ianhez M, et al. Retinoids for prevention and treatment of actinic keratosis. An Bras Dermatol. 2013 Jul-Aug; 88(4): 585–593. https://doi.org/10.1590/abd1806-4841.20131803 (Accessed 23 December 2020)
- iNova Pharmaceuticals Australia. ReTrieve cream consumer medicine information. Updated 2018. https://www.nps.org.au/medicine-finder/re-trieve-cream (Accessed 23 December 2020)
- iNova Pharmaceuticals Australia. Australian product information – ReTrieve (tretinoin) cream. http://www.guildlink.com.au/gc/ws/ia/pi.cfm?product=iapretri10918 (Accessed 23 December 2020)