Retinoids are among the most effective acne treatments available, and dermatologists recommend them for almost every type of acne. They are also one of the most misunderstood, because they take time to work and can cause irritation at the start. This guide explains how retinoids work, which one to choose, and how to start without damaging your skin.
What are retinoids?
Retinoids are compounds related to vitamin A. Applied to the skin, they speed up the turnover of skin cells and stop dead cells from sticking together and plugging pores. Because blocked pores (comedones) are the starting point of nearly all acne, retinoids help prevent blackheads, whiteheads and inflamed pimples before they form. They also have anti-inflammatory effects and can help fade the dark marks that spots leave behind.
Types of retinoids for acne
- Adapalene 0.1%: available without a prescription in many countries. It is gentler than older retinoids and is the usual first choice for mild to moderate acne.
- Tretinoin: a prescription retinoid available in several strengths. It is effective for acne and for signs of sun damage but can be more irritating.
- Tazarotene: a strong prescription retinoid used for more stubborn acne.
- Retinol and retinaldehyde: found in many cosmetic products. They are milder and better studied for ageing than for acne, so they are not a substitute for adapalene or tretinoin if you have true acne.
- Oral isotretinoin: a tablet for severe or scarring acne, prescribed and monitored by a dermatologist. It is very effective but has important side effects and must never be taken during pregnancy.
How to start a retinoid
- Start slowly. Use it two or three nights a week for the first two weeks, then increase to every other night and finally every night if your skin tolerates it.
- Use a pea-sized amount for the whole face. More product does not work faster; it only causes more irritation.
- Apply to dry skin. Wait a few minutes after washing your face so the skin is fully dry.
- Avoid the corners of the nose, mouth and eyes, where skin is thinner and irritates easily.
- Moisturise. A plain, non-comedogenic moisturiser after the retinoid (or before it, if your skin is sensitive) reduces dryness.
- Wear sunscreen every morning. Retinoids make skin more sensitive to the sun.
What to expect
Retinoids work gradually. Most people see clear improvement after 8 to 12 weeks, and results continue to improve over several months. During the first few weeks it is common to have dryness, mild peeling and redness. Some people notice a temporary increase in spots, often called “purging,” as existing blocked pores come to the surface. This should settle within about four to six weeks. If irritation is severe, reduce how often you apply it rather than stopping altogether.
Combining retinoids with other treatments
Retinoids pair well with benzoyl peroxide, which targets bacteria and inflammation. Many people use benzoyl peroxide in the morning and the retinoid at night. Some prescription gels combine adapalene and benzoyl peroxide in one product. Avoid using retinoids on the same night as strong exfoliating acids or scrubs when you are starting out, as this increases irritation. See our comparison of salicylic acid and benzoyl peroxide for more on combining actives.
Who should be careful
- Pregnancy and breastfeeding: topical tretinoin and tazarotene are generally not recommended, and oral isotretinoin must not be used. Speak to your doctor before using any retinoid if you are pregnant, trying to conceive or breastfeeding.
- Very sensitive skin or eczema: start with adapalene a couple of nights a week, or ask a dermatologist for advice.
- Before waxing or procedures: retinoids thin the outer skin layer, so tell your beautician or doctor you are using one.
When to see a dermatologist
If over-the-counter adapalene has not helped after three months of consistent use, or if you have painful nodules, cysts or scarring, a dermatologist can prescribe stronger retinoids or other treatments. Read more about when to see a dermatologist for acne.
This article is for general information only and is not a substitute for medical advice.