How to use Topical Retinoids

Retinoids are compounds that are chemically related to vitamin A.  Dermatologists frequently use retinoids to treat skin conditions such as acne, skin aging and sun damage.  The most commonly used over-the-counter retinoid is retinol, but there are several prescription retinoids that are stronger, and may be more effective.  All retinoids lead to exfoliation, and can cause skin irritation, especially if not used properly. 

In acne, retinoids work by unplugging "clogged" pores, including "blackheads" and "whiteheads", and by preventing new pimples. They also thicken the skin, promote new collagen production, treat fine lines and reduce hyperpigmentation.  A great deal of research has shown that retinoids are both safe and effective, and for these reasons they are probably among dermatologists' favourite compounds.  

Prescription retinoids frequently used by dermatologists include tretinoin (Retin-A®, Stieva-A®, Retin-A Micro®, Renova®), adapalene (Differin®), and tazarotene (Tazorac®). In my experience, people freqently stop using their retinoids after a week or two because their skin is red and flaky.  This is most commonly a result of skin irritation rather than allergy, and it can usually be avoided by following the following guidelines.

Tips for Using Topical Retinoids:

1. Start slow.  Start by using your retinoid cream or gel two nights per week.  Increase slowly as tolerated.  It usually takes several weeks for your skin to "get used to" using a retinoid. Those with sensitive skin may only be able to use a retinoid 2-3 times per week.

2. Apply a pea-sized amount to the entire face.  More than this does not result in improved results but increases the risk of skin irritation.  Avoid applying a retinoid to the skin immediately around the eyes, nose and mouth.

3. Apply to clean, dry skin at night.  Before applying a retinoid, wash your face and allow it to completely dry over 10-15 minutes.  Retinoids that are applied to wet or damp skin are more likely to cause irritation.  Tretinoin is degraded by sunlight and so should be used before bed.

4. Apply a moisturizer before applying your retinoid.  Studies have shown that this reduces irritation without making the retinoid less effective.

5. Take a break. If your face is flaking and red take a few days off. When you resume the retinoid, use it every third or fourth night. 

6. Always wear sunscreen when you’re using a retinoid, even in winter, as it makes your skin more sensitive to the sun.


Note: women who are pregnant or nursing should not use retinoids.


Michelle Levy

Dr. Michelle Levy is a board-certified dermatologist specializing in medical and aesthetic dermatology. A graduate of the University of Toronto's Faculty of Medicine, Dr. Levy provides a full spectrum of dermatologic services in Toronto, Canada. Education: M.D., University of Toronto, 1999 Residency in Dermatology, University of Toronto, 1999-2004 Employment History: Self-employed, North York, Ontario, 2005-Present Medcan. Consultant Dermatologist. 2007-Present