Tretinoin Cream

Tretinoin (all-trans retinoic acid) is the oldest topical retinoid. It has been used to treat acne since the 1960s.

Unlike newer retinoids such as adapalene, tretinoin is not photostable and must be applied in the evening. It is more irritating than adapalene. Many people know it by the brand name Retin-A®.

Tretinoin is also used off-label for anti-aging treatment.

Tretinoin binds directly to retinoid receptors:

Mechanism of action:

• Binds to RAR (retinoic acid receptors)
• Activates specific genes
• Alters gene expression in skin cells

Effects on acne:

• Normalizes keratinization in the follicles
• Prevents microcomedone formation
• Dissolves existing comedones
• Has anti-inflammatory properties

Effects on the skin:

• Accelerates skin turnover
• Stimulates collagen production
• Thins the stratum corneum
• Thickens the epidermis

Important: Since tretinoin is light-sensitive and makes the skin more sensitive, evening application and sun protection are essential.

Tretinoin is suitable for:

• Acne vulgaris (all forms)
• Comedone-predominant acne
• Anti-aging treatment
• Hyperpigmentation

Advantages:

• Dual: acne + anti-aging
• Long-term use possible

Limitations:

• Stronger irritation than adapalene
• Not photostable (evenings only)
• Not during pregnancy
• Longer adjustment period needed

Concentrations:

• 0.025% (low – for getting used to it)
• 0.05% (standard)
• 0.1% (high – if well tolerated)

Dosage forms:

• Cream (for dry skin)
• Gel (for oily skin)
• Solution (for scalp/large areas)

Recommendation: Start with a low concentration (0.025%) and increase if well tolerated.

Application (evening): 1. Cleanse your face with a mild cleanser 2. Wait 20-30 minutes (important for dry skin!) 3. Spread a pea-sized amount over the entire face 4. Avoid sensitive areas (eyelids, corners of the mouth) 5. Wait 20 minutes, then apply a moisturizer if needed

Adjustment schedule:

• Weeks 1-2: Every 3rd day
• Weeks 3-4: Every 2nd day
• From week 5: Daily (if tolerated)

Important:

• Apply only in the evening (light-sensitive)
• Sun protection SPF 30+ in the morning
• Avoid retinol products
• No peels, no other acids at first

Do not use in case of:

• Pregnancy (teratogenic!)
• Breastfeeding
• Hypersensitivity to retinoids
• Acute eczema, sunburn
• Perioral dermatitis, rosacea

Pregnancy prevention: Women of childbearing age must use reliable contraception. If you wish to have children, stop using it at least 1 month beforehand.

Use with caution in case of:

• Sensitive skin
• Atopic dermatitis
• Simultaneous use of other irritating products

Very common (retinoid dermatitis):

• Dry skin
• Peeling
• Redness
• Burning, stinging
• These reactions improve after 2-4 weeks

Common:

• Increased sensitivity to sunlight
• Initial worsening of acne (purging)
• Itching

Uncommon:

• Hyperpigmentation (with incorrect use)
• Contact dermatitis

Purging: In the first 4-8 weeks, acne may get worse. This is normal!

Do not combine with:

• Other retinoids
• Benzoyl peroxide (possible if applied at different times)
• AHA/BHA in high concentrations (at first)
• Sulfur, resorcinol

Can be combined after the adjustment period:

• Benzoyl peroxide (in the morning)
• Azelaic acid
• Niacinamide

Note: Vitamin C (L-ascorbic acid) can inactivate tretinoin – apply separately (vit. C in the morning, tretinoin in the evening).