Tretinoin: What You Need to Know
A guide to this prescription retinoid and how it works
Tretinoin is one of the most extensively studied ingredients in dermatology. First introduced in the 1970s, it has been used for decades to treat a range of skin conditions, from acne to the visible signs of sun damage and ageing.
In this article, we explain what tretinoin is, how it works, and what to consider if you’re thinking about whether it might be suitable for you.
What Is Tretinoin?
Tretinoin, also known as all-trans retinoic acid, is a derivative of vitamin A. It belongs to a class of compounds called retinoids, which play an important role in regulating skin cell growth and turnover.
Unlike over-the-counter retinol products, tretinoin is a prescription-only medicine in the UK. This means it can only be obtained following a consultation with a qualified healthcare professional, such as a doctor or prescribing pharmacist.
How Does Tretinoin Differ from Retinol?
Tretinoin and retinol are often confused, but they work differently.
Retinol, found in many cosmetic skincare products, is a precursor to retinoic acid. When applied to the skin, it must be converted through a two-step process before it becomes active. This makes retinol gentler but also less potent.
Tretinoin is already in its active form — retinoic acid — so it does not require conversion. This allows it to work more directly, but it also means it can cause more irritation, particularly when first starting treatment.
How Does Tretinoin Work?
Tretinoin works by binding to specific receptors in skin cells, influencing gene expression and cellular behaviour. Because it is already in its active form, it begins working as soon as it is absorbed — unlike retinol, which must be converted by the skin first.
This direct mechanism is why tretinoin typically produces visible results within 4–12 weeks, whereas similar improvements with over-the-counter retinol may take 12–24 weeks or longer.
Proven Benefits of Tretinoin
Tretinoin has been extensively studied in clinical trials over several decades. Research has demonstrated its effectiveness for several skin concerns:
Reduces Fine Lines and Wrinkles
Clinical studies consistently show that tretinoin can improve the visible signs of photoageing. It works by stimulating collagen production, promoting the formation of new dermal collagen and blood vessels, and regulating the proliferation of skin cells. Over time, this can lead to smoother, firmer-looking skin.
Treats Acne Effectively
Tretinoin accelerates skin cell turnover, preventing dead cells from accumulating and clogging pores. It also helps regulate sebum flow and possesses anti-inflammatory properties that can reduce the severity of breakouts. Research confirms that topical retinoids are highly effective for both inflammatory and non-inflammatory acne.
Improves Skin Texture and Tone
By encouraging the shedding of damaged surface cells and promoting the growth of healthier cells beneath, tretinoin helps create a more even, refined skin texture. Many patients notice improved radiance and smoothness within the first few months of treatment.
Reduces Hyperpigmentation
Tretinoin helps disperse melanin more evenly throughout the skin, which can fade dark spots caused by sun damage, melasma, and post-inflammatory hyperpigmentation from acne scarring.
What Conditions Is Tretinoin Used For?
Tretinoin is licensed in the UK for the treatment of acne. It is also prescribed for other skin concerns, including:
- Fine lines and wrinkles associated with sun damage (photoageing)
- Hyperpigmentation, including melasma and post-inflammatory marks
- Rough or uneven skin texture
The decision to prescribe tretinoin, and for which indication, is made by a healthcare professional based on an individual assessment.
Why Prescription-Strength Matters
Cosmeceutical products containing retinol, retinaldehyde, or retinyl esters are classified as cosmetics rather than medicines. This means they are not subject to the same rigorous clinical testing required for prescription medications.
While some over-the-counter retinoid products may offer modest benefits, the clinical evidence behind tretinoin is far more robust — validated through decades of controlled studies published in peer-reviewed medical journals.
For patients who have tried cosmetic retinol products without achieving the results they hoped for, prescription tretinoin may offer a more effective alternative. However, because it is more potent, it also requires proper medical supervision to ensure it is used safely and appropriately.
What Should You Expect When Using Tretinoin?
If tretinoin is prescribed for you, it’s important to understand that results take time and there is typically an adjustment period.
Initial side effects Many people experience some degree of dryness, peeling, redness, or sensitivity when they first start using tretinoin. This is sometimes referred to as the “retinisation” period and usually improves as the skin adapts over several weeks.
Gradual improvement Visible improvements are generally not immediate. Depending on the condition being treated, it may take several weeks to a few months of consistent use before changes become noticeable.
Sun sensitivity Tretinoin can make the skin more sensitive to ultraviolet light. Daily use of a broad-spectrum sunscreen is strongly recommended during treatment.
Application Tretinoin is typically applied once daily in the evening to clean, dry skin. Your prescriber will advise on the appropriate strength and frequency for your situation.
Is Tretinoin Suitable for Everyone?
Tretinoin is not appropriate for all patients. There are certain circumstances where it should not be used or where caution is required:
Pregnancy and breastfeeding Tretinoin should not be used during pregnancy due to potential risks to the developing baby. Women who are pregnant, planning to become pregnant, or breastfeeding should inform their healthcare provider before starting treatment.
Sensitive skin conditions Patients with eczema, rosacea, or very sensitive skin may find tretinoin too irritating and may require alternative approaches.
Other medications Certain other topical treatments, such as benzoyl peroxide or products containing alpha hydroxy acids, may increase irritation when used alongside tretinoin. It’s important to discuss your current skincare routine with your prescriber.
Tretinoin and Other Treatment Options
Tretinoin is one of several options available for managing skin concerns. Depending on your individual needs, a healthcare professional may recommend alternative or complementary treatments, which could include:
- Other topical retinoids (such as adapalene)
- Topical or oral antibiotics for acne
- Azelaic acid for pigmentation or mild acne
- Chemical peels or other in-clinic procedures
- Combination formulations tailored to your skin
The most appropriate approach will depend on your skin type, medical history, the condition being treated, and your personal preferences.
The Importance of Medical Supervision
Because tretinoin is a prescription medicine, it should only be used under the guidance of a qualified healthcare professional. They can assess whether tretinoin is appropriate for you, recommend the right formulation and strength, and monitor your progress over time.
Self-treating with prescription medicines obtained without proper consultation — for example, from unregulated online sources — carries risks including incorrect dosing, counterfeit products, and lack of appropriate medical oversight.
Considering Your Options
Considering Your Options
If you have concerns about your skin — whether that’s acne, signs of ageing, pigmentation, or texture — the first step is to speak with a healthcare professional who can assess your individual situation.
At Waterfront Private Hospital, our dermatology team and aesthetic practitioner offer consultations to help you understand your skin and explore the treatment options that may be suitable for you. We take a personalised approach, ensuring that any recommendations are tailored to your specific needs and circumstances.
To book a consultation, please contact us.
This article is intended for general information only and does not constitute medical advice. Treatment suitability varies between individuals. Always consult a qualified healthcare professional before starting any new treatment.
