Tretinoin: What is it? Benefits? How to Use it, and Everything Else.

by | Mar 19, 2017

Tretinoin, a.k.a. what Tina Fey says is a great way to ensure large chunks of peeling skin. Besides turning people into lizards, it’s touted as one the best anti-aging ingredients in dermatology.

With continued use, it promises to tighten skin, increase collagen production, reverse the signs of aging, treat acne and hyperpigmentation. Heck, you name it and it probably does it. But is it true? Let’s find out!

What is Tretinoin?

tretinoin cream 0.1

Tretinoin (also known as all-trans retinoic acid) is a pharmaceutical derivative of vitamin A. Retinoic acid is a necessary component of human biology that facilitates growth and development.

It can be found in foods like salmon, egg yolks, grassfed butter and cream, cod liver oil, and my personal favorite — beef liver (sarcasm). If you’ve never tried it, I can’t say I recommend. Quick story about that (feel free to skip ahead).

So beef liver is the most nutrient dense food on planet earth. 100 grams of that stuff has 53,400 IU of Vitamin A! To give you some perspective, think about carrots a.k.a. the thing people always harp on about having a ton of vitamin A. Well, 100 grams of carrots only contain 40 IU of Vitamin A.

  • Beef liver (100 g) = 53,400 IU of Vitamin A
  • Carrots (100g) = 40 IU of Vitamin A

Isn’t that NUTS? So of course when impulsive me found out about how nutritious this delicious succulent treat was, I decided to buy 7 pounds of it!

Note: at this point, I had never tried beef liver in my life.

Got home, cooked up a nice hefty chunk, set up the dinner table, put on some romantic music, lit some candles  — I did the whole shebang. I took my first bite and nearly vomited. It was awful.

You can only imagine how mortified I was knowing I had 6 more pounds of that stuff in the fridge. Long story short: I froze it for 14 days to kill off pathogens, cut it into little bite sized pieces, and swallowed the whole 6 pounds raw. Oh yeah, that’s a thing.

Anyway… about tretinoin.

It is considered one of the most powerful retinoids available. The most recognized prescription name for it is Retin-A, but there are other brands too: Atralin, Refissa, Tretin-X, Renova, Avita etc. All of these require a doctor’s prescription. However, weaker retinoids can be found over the counter and will be listed as retinyl palmitate, retinol, or retinaldehyde in a product’s ingredient list.

Fun fact: Accutane, is simply an oral form of retinoic acid. Hence the pharmaceutical name Isotretinoin.

Tretinoin’s bioavailability isn’t the best, meaning it isn’t easily absorbed by the skin. In fact, upwards of 80% of it remains on the skin’s surface. As an aside, tretinoin cream has been shown to penetrate a little bit better than tretinoin gel (by about 5%). (1)

Benefits of Tretinoin.

I might get criticized for saying this, but besides the anti-aging aspects of tretinoin I think it’s pretty overrated. Don’t worry, I will explain myself. Let’s start with the positives.

  • Kicks Aging in the Ass

Tretinoin is considered the gold standard anti-aging ingredient in dermatology. (2)

How effective is it, you ask? Check out what this 61 year old woman looks like after using tretinoin for 28 years! Full video here.

28 years of tretinoin woman

I KNOW RIGHT?! Like, zayum gurl! You looking GOOD.

“But yeah, that’s just one person. Maybe she got lucky or eats kale for dinner. What do we know? What about the science, buddy!” Yes yes, I hear you. Let’s talk about that.

A very well controlled study involving 360 participants found significant improvements in fine lines and wrinkles after 24 weeks of using tretinoin cream 0.025%. (3) Other studies have been replicated with similar findings. (4) Despite most improvements occurring with fine wrinkling, a reduction in deeper wrinkles and tactile roughness is also observed.

On a side note, 0.025% tretinoin cream is on the lower end of the strengths available. Some people use a full 0.1% daily (that’s 4 times the potency)! However, using this high of a percentage may be unnecessary altogether.

One study found there was “no clinical or statistically significant difference” between 0.025% and 0.1% tretinoin after 48 weeks, besides the severity of irritation (0.1% tretinoin obviously being more irritating). (5) So if you decide to use Tretinoin for anti-aging purposes, know that you will still be getting the benefits with smaller dose prescriptions.

The assumption is that tretinoin works by tightening the skin and increasing collagen production, which leads to epidermal thickness. (6)(78) Collagen being a structural protein that provides strength, flexibility, and resilience to the skin.

Unfortunately this lovely protein decreases overtime and becomes a main culprit in aging. For some perspective, collagen production slows down by about 1% every year after a person turns 20. As a result, skin becomes less elastic and thinner with age, making it more prone to sagging and wrinkling.

Point being, that the more collagen we can produce the more we slow down the aging process. Hence, why tretinoin is awesome — i.e. it increases collagen production.

Tretinoin also reverses photodamage (the adverse effects of sun exposure), and increases hyaluronic acid production in the epidermis.(91011) Hyraluronic acid is another necessary component of human skin. It speeds up wound healing and is a potent humectant that hydrates the skin by drawing water from the environment and dermis (deeper layer of skin). (1213) This in turn gives a “plumping” effect that reduces fine lines and wrinkles.

Perhaps you noticed how long the studies I listed above were (i.e. 24 to 48 weeks). This is because tretinoin works gradually over time. Don’t expect to see results quickly; this medication requires patience, time, and persistence.

On the upside, improvements never seem to slow down. In fact, one study found that there was still improvements being made in collagen organization and production after 2 years of continued use! (14)

tretinoin gel 0.1

Tretinoin is somewhat effective against PIH, though not terribly impressive in this department. It works by inhibiting tyrosinase (an enzyme that produces melanin), interfering with pigment transfer, and speeding up cell turnover rate. (1516)

One study assessed its efficacy in treating liver spots (a.k.a age spots); the brown or black spots you commonly see on elderly folks. It was 10 months long and involved 58 patients, 24 of which used tretinoin cream 0.1% daily. At the end of the study, 83% of the tretinoin users saw a reduction in age spots. (17) Another similar study found improvement in 68% of patients after 10 months of daily tretinoin cream 0.1%. (18)

In my opinion, 10 months and no improvement in nearly 20% to 30% of patients isn’t groundbreaking. Especially considering these participants were using the strongest prescription tretinoin available.

Tretinoin’s ability to treat melasma has also been assessed. One study found a 32% improvement across all patients after 10 months of daily tretinoin cream 0.1%. (19) Again, I don’t know about you, but 10 months for a 32% improvement — ain’t nobody got time for that.

Sorry if I sound overly critical here, :p but in my humble opinion tretinoin is a bit overrated in it’s ability to reduce hyperpigmentation. And if used excessively, it can actually cause or make erythema like PIE worse! One study found “moderate side-effects of erythema” in 88% of patients treated with tretinoin! (20) The researches ended up ruling that tretinoin helps, but improvement is slow.

  • Treats Acne (Meh).

Tretinoin is a well established acne treatment. In the U.S. alone, it’s prescribed in 12.5% of all acne cases. Benzoyl peroxide and adapalene being the most prescribed at 12.8% and 14.4% respectively. (2122) As an aside, don’t ever use tretinoin and benzoyl peroxide together. Tretinoin is an unstable molecule and oxdizes in the presence of benzoyl peroxide.

Research shows that tretinoin reduces both inflammatory and noninflammatory acne. (23) But again, I’m gonna have to throw some shade at it and say it works marginally at best. Sorry tret! You’re still a wonderful anti-aging ingredient though! 🙂

Okay, so why am I not impressed with tretinoin’s acne treating prowess?

In a very well controlled study with 178  patients, 0.04% tretinoin gel reduced acne by about 36% after 3 months. (24) To me, that isn’t very impressive. Three months for a 36% reduction on average? That means that you’ll still have about two thirds of your acne after using medium strength tretinoin for 3 months. Lame.

Compare that to something like azelaic acid, which in one study reduced acne on average by 60% after only 45 days. (25) In other words, it did double the work in half the time.

And if you think it was just one study showing tretinoin is meh, think again. A few studies have had similar results. For example, a 3 month long study found tretinoin gel 0.05% reduced acne on average by about 34.9%, with a whopping success rate of only 19%! (26) (Sarcasm.)

I terms of treating acne, I think tretinoin is better served for it’s comedolytic properties more than anything else — that is, it’s ability to prevent clogged pores rather than treat inflammatory acne. (27)

Overall, I wouldn’t really recommend tretinoin for treating acne per se. In my opinion, something like benzoyl peroxide, salicylic acid, or azelaic acid are better suited for this. However, if blackheads, clogged pores, or congestion are your main issues than tretinoin is good option. Otherwise, it’s meh.

But hey, it’s still a kick ass anti-aging ingredient!

Side Effects.

Unfortunately Tretinoin is pretty irritating. Tina Fey didn’t say you’ll see wafting chunks of peeling skin when using it for no reason.

retin a micro gel

The most frequent side effects are erythema (redness), peeling, and dryness. This occurs in approximately 60% of patients. (28) So be warned, you might become a lizard.

If you start using it daily, the irritation and dryness becomes especially bothersome during weeks 3 and 4. (29)

How to Use Tretinoin.

Don’t go all out with this stuff! Less is more here. Using too much could lead to inflammation, cause redness, and make hyperpigmentation worse!

Make sure that your skin is absolutely dry before applying it. Ideally, you should wait 20 minutes after washing your face to use it. Damp skin increases it’s topical permeability, which will make it more irritating.

Use it before your moisturizer. You only need to apply a pea-sized amount for the whole face. Yes, that is enough! It may not seem like it, but trust me: it is.

To reduce the side effects, simply begin incorporating it into your skincare routine more slowly. You can start using it once or twice a week and work your way up. For example, on week one use it Monday and Thursday. Week two on Monday, Thursday, and Saturday. Week three Monday, Wednesday, Friday, Sunday. So on and so forth.

Using products containing Niacinamide (e.g. CeraVe PM or EltaMD AM Therapy) have been shown to minimize its irritating effects. (30)

Because tretinoin will increase your sensitivity to the sun, it’s important that you wear sunscreen! And last but not least, make sure to apply it at night! Tretinoin degrades in sunlight.

To summarize: start slowly, use a pea-sized amount at night on dry skin before moisturizing, and wear sunscreen during the day. Use products with niacinamide to counteract irritation.

Where Can I Buy Tretinoin?

Unfortunately tretinoin is a prescription only drug, meaning you need a dermatologist’s referral to get it. However, you might have some luck finding it on the bay of e… if you catch my drift. Alternatively, you can try getting a tretinoin prescription from curology.

curology prescription

If you can’t find it online or don’t have access to a dermatologist, you can always opt out for over the counter retinoid products. These are generally weaker but have a lot of the same benefits, and is a good place to start if you’ve never used retinoids before. J

ust because it’s weaker, doesn’t mean it isn’t potent! If you decide to dabble with retinoids start slowly and patch test first! Two products I know that can be found on amazon and have retinol are Missha’s Time Revolution Night Repair Serum, and Paula’s Choice CLINICAL 1% Retinol Treatment.

UPDATE: and now you can get Differin! It’s a prescription strength retinoid that I”m currently using

Well that does it for tretinoin! Hope you’ve enjoyed this reading.

Warmly,

—f.c.

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