I started tretinoin and my skin is getting irritated. What should I do?

Topical tretinoin is one of the most important medications we have to treat acne/fine lines. Unfortunately, it can cause skin irritation in the form of redness, dryness, and peeling, especially if it’s your first time using this medication or if you haven’t used it in a while. Your skin will acclimate to treatment, but it can take up to 10 weeks. Tretinoin is such an important and effective medication, it’s worth getting over this initial hump.  Starting out gradually using it every other night for the first 2-4 weeks will prevent most problems. If your symptoms are mild, you can continue using the medication with liberal use of moisturizers, and the irritation will resolve on its own. 

If you are having more severe irritation (i.e. very dry, red, flaky skin): 

- Discontinue your tretinoin treatment for 3-7 days until your irritation clears. 

- After 3-7 days, you can begin applying your tretinoin twice a week (e.g. Mondays and Thursdays) on top of your moisturizer after cleansing and drying your skin.

- After 2 weeks, you can begin applying it every other night on top of your moisturizer, based on your tolerability.

- After 2 weeks, you can then begin applying it every night on top of your moisturizer, based on your tolerability. 

- After 2 weeks, you could consider applying it under your moisturizer.

Make sure you are using a small, pea-sized amount (or a chocolate chip-sized drop) for the entire face, avoiding the skin around your eyelids and by the corners of your nose and mouth. Using a moisturizer is very important to prevent irritation from tretinoin and does not make it less effective. 

You should avoid other acne washes, peels, masks or other skin care treatments for now, except for the ones recommended by your doctor.

If you are still unable to use your medication consistently, you should submit a follow-up visit with your dermatologist. A lower strength may be more appropriate for your skin. As a reminder, any visit costs are applied to future prescription orders.