What is Retin-A (tretinoin)?

Retin-A (tretinoin) is a derivative of vitamin A used on the skin (topically) to treat mild to moderate acne, fine wrinkles, and dark spots (hyperpigmentation) on skin that has been damaged by excessive exposure to the sun. 

Retin-A irritates the skin and causes the cells of the skin to grow (divide) and die more rapidly, increasing the turnover of cells. The number of layers of cells in the skin actually is reduced. In patients with acne, new cells replace the cells of existing pimples, and the rapid turnover of cells prevents new pimples from forming. 

By a similar mechanism, Retin-A can reduce some wrinkles, areas of darkened skin, and rough areas of skin, all of which occur in sun-damaged skin.

Common side effects of Retin-A include:

Other side effects of Retin-A include:

  • increased sun sensitivity,
  • darkening or lightening of the skin, and
  • initial acne flare-up.

Drug interactions of Retin-A include other topical acne medications (for example, salicylic acid), which if used with Retin-A, may lead to excessive skin irritation. Use of abrasive soaps or cleansers, astringents, skin waxes, and other products that irritate the skin may add to Retin-A-induced skin irritation. 

Medications that cause sun sensitivity (for example, tetracycline) should not be combined with Retin-A because of additive sun sensitivity. 

There are no adequate studies of topical Retin-A use during pregnancy. Physicians must weigh the potential risks and benefits before prescribing Retin-A during pregnancy. 

It is unknown if Retin-A is secreted into breast milk. It also is unknown if topically applied Retin-A accumulates to an extent sufficient to be of concern in the infant. Since oral tretinoin is not recommended during lactation, it probably is prudent to avoid breastfeeding during treatment with topical Retin-A.

What are the important side effects of Retin-A (tretinoin)?

Following the application of tretinoin to the skin, there often is local inflammation. This reaction disappears when treatment is stopped. Mild stinging or a sensation of warmth also can occur when applying tretinoin.

The common side effects of tretinoin are:

  • Excessive dryness
  • Scaling
  • Itching
  • Redness

Other side effects of tretinoin include:

  • Increased sun sensitivity
  • Darkening or lightening of the skin
  • Initial acne flare-up

Retin-A (tretinoin) side effects list for healthcare professionals

The skin of certain sensitive individuals may become excessively red, edematous, blistered, or crusted. If these effects occur, the medication should either be discontinued until the integrity of the skin is restored, or the medication should be adjusted to a level the patient can tolerate.

True contact allergy to topical tretinoin is rarely encountered. Temporary hyper- or hypopigmentation has been reported with repeated application of Retin-A. Some individuals have been reported to have heightened susceptibility to sunlight while under treatment with Retin-A.

To date, all adverse effects of Retin-A have been reversible upon discontinuance of therapy.

What drugs interact with Retin-A (tretinoin)?

  • Concomitant topical medication, medicated or abrasive soaps and cleansers, soaps and cosmetics that have a strong drying effect, and products with high concentrations of alcohol, astringents, spices or lime should be used with caution because of possible interaction with tretinoin.
  • Particular caution should be exercised in using preparations containing sulfur, resorcinol, or salicylic acid with Retin-A.
  • It also is advisable to “rest” a patient's skin until the effects of such preparations subside before use of Retin-A is begun.

Summary

Retin-A (tretinoin) is a derivative of vitamin A used on the skin (topically) to treat mild to moderate acne, fine wrinkles, and dark spots (hyperpigmentation) on skin that has been damaged by excessive exposure to the sun. Common side effects of Retin-A include local skin inflammation, mild stinging or a sensation of warmth, excessive dryness, scaling, itching, and redness. There are no adequate studies of topical Retin-A use during pregnancy. It is unknown if Retin-A is secreted into breast milk or if topically applied Retin-A accumulates to an extent sufficient to be of concern in the infant.

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Medically Reviewed on 5/14/2020
References
FDA Prescribing Information

Professional side effects and drug interactions sections courtesy of the U.S. Food and Drug Administration.
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