Disclaimer: This article is for informational purposes only and does not constitute medical advice. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition.
Overview
Tretinoin is a retinoid, a medicine related to vitamin A, that is applied to the skin. Health Canada has authorized it for the treatment of acne. In Canada it is sold as Retin-A cream and gel, and as Retin-A Micro, a gel that holds the medicine in tiny porous beads. Both are prescription products made by Bausch Health.
This page covers tretinoin applied to the skin for acne. It is not the same medicine as isotretinoin (Accutane), which is taken by mouth.
Tretinoin needs a prescription. BC residents can speak with a BC-licensed doctor by phone through Avee Health to ask whether it is appropriate for them. The doctor decides based on your health history. A prescription is not guaranteed.
In Canada, Retin-A and Retin-A Micro are authorized for:
- Acne (acne vulgaris), including blackheads, whiteheads and red, inflamed spots
They are not authorized in Canada for wrinkles, sun damage or other cosmetic uses.
Age: the safety and effectiveness of Retin-A have not been established in people under 18. For Retin-A Micro, they have not been established in children under 12.
Tretinoin
Topical retinoid
skin care
Prescription required
Available
How Tretinoin Works
Acne starts when dead skin cells and oil build up and block the pores. Tretinoin acts on the cells that line the pores:
- It makes these cells less sticky, so they are less likely to clump together and plug the pore.
- It speeds up the turnover of these cells, which helps clear blackheads and whiteheads and reduces the tiny blockages that become new spots.
In the first weeks, acne can look worse as deeper spots come to the surface. This is an expected effect of the medicine and is not usually a reason to stop.
Dosage Instructions of Tretinoin
Your doctor sets your dose, including the product and strength. The usual directions in the Canadian product monographs are:
- Apply once a day. Retin-A is usually applied in the evening. Retin-A Micro can be applied at any time of day or at bedtime.
- Wash with a mild, non-medicated soap and gently pat the skin dry. With Retin-A, wait 20 to 30 minutes so the skin is completely dry before applying.
- Use about a pea-sized amount and spread a thin layer over the whole affected area. With the Retin-A Micro pump, two full presses give about a pea-sized amount.
- Keep it away from the eyes, eyelids, lips, mouth, the corners of the nose and any area you are not treating.
- If you also use another acne product, such as benzoyl peroxide or a topical antibiotic, do not apply it at the same time of day as tretinoin.
Using more, or applying it more often, does not work faster or better. It only adds redness, peeling and discomfort.
Strengths: Retin-A cream 0.01%, 0.025%, 0.05% and 0.1%; Retin-A gel 0.01% and 0.025%; Retin-A Micro gel 0.04% and 0.1%.
Results: some improvement may show after about 2 weeks, but a clear benefit usually takes more than 4 to 6 weeks. In clinical trials, people used Retin-A Micro for 12 weeks.
Missed dose: with Retin-A, skip it and apply your usual amount the next evening. With Retin-A Micro, apply it when you remember, unless it is almost time for the next application. Do not apply extra to make up for a missed dose.
Storage Instructions
Store at 15°C to 25°C and keep the container closed when not in use. Protect Retin-A Micro pumps from heat. Retin-A gel is flammable, so keep it away from heat and flame. Do not keep it in the bathroom or in a car. Keep out of reach of children.
Side Effects of Tretinoin
Some skin irritation is expected, especially in the first weeks. In clinical trials of Retin-A Micro 0.04%, these effects were reported:
- Peeling: 67.6%, compared with 27.0% with the same gel without medicine
- Redness: 64.0%, compared with 53.5%
- Dryness: 59.6%, compared with 31.9%
- Itching: 32.4%, compared with 18.6%
- Burning or stinging: 31.1%, compared with 11.5%
A feeling of warmth on the skin is also common. These reactions are usually mild to moderate and ease over time, although dryness often continues. A moisturizer that does not block pores can help. Skin can become temporarily darker or lighter if irritation is severe; this goes away after stopping. Eye irritation, swelling, blistering and crusting are rare.
Stop using tretinoin and get medical help right away if you have:
- A severe skin reaction, with marked redness, swelling, blistering or crusting
- Signs of an allergic reaction, such as hives, a spreading itchy rash or sores where you applied it
Important Safety Information About Tretinoin
- Pregnancy: do not use tretinoin if you are pregnant, think you may be pregnant or plan to become pregnant. If you could become pregnant, talk to your doctor about birth control before you start. If you become pregnant, stop using it and contact your doctor.
- Breastfeeding: it is not known whether tretinoin passes into breast milk. Talk to your doctor before using it while breastfeeding.
- Allergy: do not use it if you are allergic to tretinoin or any ingredient in the product.
- Damaged skin: do not apply it to sunburned, broken or severely inflamed skin. Use it with great caution if you have eczema, where it can cause severe irritation.
- Sun: treated skin burns more easily. Limit time in the sun, do not use sunlamps, and use a sunscreen of SPF 15 or higher and protective clothing on treated areas.
- Weather: wind and cold can dry out and irritate treated skin.
- Hair removal: plucking, waxing and hair removal creams can be used, but not on the night you apply tretinoin.
- Swallowing: tretinoin is for the skin only. If it is swallowed, contact a doctor or your poison control centre. Anyone who could be pregnant should ask about a pregnancy test.
- Flammable: Retin-A gel is flammable. Keep it away from heat and flame.
Drug Interactions
Tell your doctor and pharmacist about everything you put on your skin. Use these with caution, because they can add to dryness and irritation:
- Acne products with benzoyl peroxide, sulfur, resorcinol or salicylic acid. If you have been using one, let your skin settle before starting tretinoin.
- Medicated or abrasive soaps and cleansers, and soaps and cosmetics that strongly dry the skin
- Products with a lot of alcohol, astringents or spices, and the peel of limes
- Perm solutions, waxing products, and medicated soaps and shampoos
No interactions with medicines taken by mouth are known for Retin-A. Still, tell your doctor about all your medicines, because some can make the skin more sensitive to sunlight.
Brands & DIN Number of Tretinoin
Brand Names
- Retin-A
- Retin-A Micro
Key Takeaways
- 1Tretinoin is a prescription retinoid applied to the skin. Health Canada has authorized it for acne.
- 2In Canada it is sold as Retin-A cream and gel and as Retin-A Micro gel.
- 3Apply a thin, pea-sized amount once a day to clean, dry skin. A clear benefit usually takes more than 4 to 6 weeks.
- 4Dryness, peeling, redness and stinging are common, and acne can look worse in the first weeks.
- 5Do not use tretinoin if you are pregnant or planning a pregnancy.
- 6Treated skin burns more easily, so limit sun exposure and use sunscreen.
- 7BC PharmaCare may cover tretinoin for acne through Special Authority. Cosmetic use is not covered.
Frequently Asked Questions
Avee Editorial
Avee Editorial Team