How to use a topical retinoid
A step-by-step guide to starting tretinoin, adapalene, retinol or retinaldehyde without irritating your skin
At Midland Skin our consultant dermatologists prescribe and supervise topical retinoids for patients in Birmingham, Solihull, Coventry, Wolverhampton, Worcester and the Midlands.
Quick Facts about topical retinoids
Best for
Acne, texture, pigmentation
Apply
At night, after cleansing
Start with
Every third night
Build up to
Nightly
Avoid in
Pregnancy
Prescribed by
Consultant dermatologist
Who this factsheet is for
Follow these instructions if you have been prescribed:
- Tretinoin – 0.025%, 0.05%, 0.1%, or any bespoke concentration prescribed by our doctors
- Any bespoke cream containing tretinoin, such as creams prescribed for hyperpigmentation
- Treclin Gel – tretinoin 0.025% with clindamycin 1%
- Aknemycin Plus Liquid – tretinoin 0.02% with erythromycin 4%
- Differin – adapalene 0.1%
- Epiduo – adapalene 0.1% or 0.3% with benzoyl peroxide 2.5%
- Aklief – Trifarotene 0.005%
Retin-A was a brand name for tretinoin. Retin-A cream was discontinued in the UK in 2008 and Retin-A gel in 2012. Tretinoin cream remains available from our clinic in various concentrations.
The same instructions can be followed for over the counter retinol and retinaldehyde products.
Why have I been prescribed a topical retinoid?
Topical retinoids are prescribed for:
- acne
- acne scarring
- skin ageing and texture
- other conditions including hyperpigmentation, melasma and keratosis pilaris
Topical retinoids have been recommended by dermatologists for almost 50 years and are strongly recommended in current international acne guidelines.
Patience and consistency get results
Two things take time with a topical retinoid: your skin getting used to it, and seeing the result.
It usually takes 3 to 6 months for acne or skin texture to improve. The results are cumulative – the longer you use it, the greater the benefit.
Retinoids can also irritate the skin, causing redness, dryness, itching and increased sensitivity. This is why the product is introduced gradually rather than started every night.
How easily your skin adjusts depends largely on your skin type.
Is your skin resilient or sensitive?
You are likely to have resilient skin if:
- Your complexion tends to be oily
- Your skin doesn’t feel tight or dry – after a foaming cleanser or soap
- You rarely react to skincare products – and can use most things on your skin
- You have no history of eczema or hives
You are likely to have sensitive skin if:
- your skin tends to be dry
- you need to moisturise regularly to stop your skin drying out
- your skin feels tight and dry as soon as you have used a foaming cleanser or soap
- you react easily to skincare products
- you have a history of dry skin, eczema or hives
Most people with sensitive skin can still use a topical retinoid, provided it is introduced slowly and the skin barrier is supported. A small number of people find their skin is simply too sensitive to tolerate one, and we will discuss alternatives with you if that turns out to be the case.
Principles of using a topical retinoid
- Start with small quantities and build up gradually
- Apply less frequently to start with and build up gradually
- Protect your skin from irritation from the outset
- Apply at night only – after cleansing, with nothing else on top
How to use your topical retinoid
Step 1. Apply every third night for 3 weeks – one night on, two nights off. Use half a fingertip for the whole face, or a quarter of a fingertip for half the face.
Step 2. Apply on alternate nights for 3 weeks – one night on, one night off.
Step 3. Apply every night.
Step 4. After 3 weeks, increase from half a fingertip to three-quarters of a fingertip.
Step 5. After a further 3 weeks, increase to a whole fingertip.
Adjusting the schedule to your skin:
- If you have very resilient skin, you can start at Step 2 and move up every 2 weeks
- If you have very sensitive skin, start at Step 1. If Step 1 is still too irritating, contact the office – we can dispense a weaker strength of tretinoin
- If moving up a step irritates your skin, drop back to the previous step for 6 weeks before trying again. If it irritates a second time, stay at the highest step you can tolerate comfortably
How to protect your skin from irritation
It is far easier to prevent irritation than to treat it. Put all of these measures in place from the very beginning, before there is any sign of irritation.
- Avoid soaps and foaming cleansers. Cleanse with a thin moisturising lotion such as CeraVe Lotion, Cetaphil Lotion, or Sukin Oil Free Moisturiser if you prefer a vegan option. These hydrate as they cleanse and help repair the skin barrier. Cleanse twice a day – morning, and evening before applying the retinoid.
- Remove make-up gently, using something like micellar water.
- Pause other actives. Stop toners, vitamin C, AHAs, BHAs, niacinamide, other acne treatments and anti-ageing serums. These can be reintroduced one at a time once your skin tolerates the retinoid.
- Support the skin barrier during the day by applying a thin moisturiser such as CeraVe Lotion or Cetaphil Lotion three to four times a day.
- Do not apply moisturiser immediately before or after the retinoid.
Protect the hotspots on your face
Some areas irritate easily because the product collects in creases and folds. Protect these areas before applying the retinoid to the rest of your face.
- Eyelids – avoid retinoids on the upper and lower eyelids. Apply a moisturiser, or a thin layer of Vaseline or Aquaphor, around your eyes first to stop the product spreading.
- Corners of the nose, the lips and the corners of the mouth – apply a thin layer of Vaseline or Aquaphor first.
- If these areas become very dry despite this, a mild topical steroid may be used with caution and under guidance.
Protect yourself from the sun
Topical retinoids are likely to make your skin more sensitive to the sun. Avoid direct sunlight and wear a hat. Use sunblock judiciously – applying too much can aggravate acne and cause irritation.
Pregnancy, breastfeeding and allergies
Do not use a topical retinoid if you are pregnant or planning a pregnancy. If you become pregnant while using one, stop the treatment and tell your doctor as soon as possible so that follow-up can be arranged.
Do not use a topical retinoid if you are allergic to the active substance or any other ingredient. The full ingredient list is in the leaflet supplied with the product, which you should read carefully.
If you are breastfeeding, discuss this with your dermatologist before starting or continuing treatment.
Practical FAQs
My skin is red, dry and flaky. Should I stop?
Mild dryness and flaking in the first few weeks is common and usually settles as your skin adjusts. Do not stop – drop back to the previous step for 6 weeks, keep using a thin moisturiser through the day, and protect the hotspots.
If your skin is genuinely sore, swollen or burning rather than simply dry, contact the office.
My acne looks worse since starting. Is that expected?
Some people notice more spots in the first few weeks as the retinoid brings existing blockages to the surface. This usually settles.
Because acne can also flare for other reasons, let us know if it is getting worse rather than better after 6 to 8 weeks.
Can I use my other skincare or acne treatments at the same time?
Not at the start. Pause other actives while your skin adjusts, then reintroduce them one at a time once the retinoid is being tolerated nightly.
Your dermatologist will advise which products are worth reintroducing for you.
How long will I need to keep using it?
Retinoids work while you use them, and the benefit builds over time. Most people continue long term, sometimes at a reduced frequency once the skin has improved. Your dermatologist will discuss this at your review.
Will I be reviewed after starting treatment?
Yes. A review consultation is required to assess how your skin has responded and to decide whether the treatment should be continued, adjusted or changed. It is also when we plan reintroducing other products and discuss longer-term use.
What if I cannot tolerate it at all?
Contact the office. We can dispense a weaker strength of tretinoin, adjust the schedule, or discuss a different treatment approach with your dermatologist.
Getting a topical retinoid at Midland Skin
Topical retinoids are prescription medicines and are not suitable for everyone. At Midland Skin they are prescribed after assessment by a consultant dermatologist, who will consider your skin type, the condition being treated, what you have already tried and any other medications you use.
Strength and formulation are chosen for you rather than taken off a shelf – including bespoke tretinoin concentrations dispensed by our clinic. A review consultation is then required to check how your skin has responded and adjust treatment where needed.
References used for this article
- Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1–1006.e30. doi:10.1016/j.jaad.2023.12.017.
- Milosheska D, Roškar R. Use of retinoids in topical antiaging treatments: a focused review of clinical evidence for conventional and nanoformulations. Adv Ther. 2022;39(12):5351–5375. doi:10.1007/s12325-022-02319-7.
About the Author
This page has been written and/or medically reviewed by Dr Sajjad Rajpar, Consultant Dermatologist and Medical Director of Midland Skin, Birmingham.
Dr Rajpar is on the GMC Specialist Register in Dermatology and has over 20 years’ experience in clinical dermatology. He provides clinical oversight to ensure the information on this page is accurate, balanced and consistent with current dermatology practice.
Dr Sajjad Rajpar
Date last updated: 26th Sep 2026
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