How to use a topical retinoid - Factsheet

How to use a topical retinoid

This fact sheet explains how you should use a topical retinoid. You should follow these instructions if you have been prescribed the following products:

• Tretinoin –  Tretinoin 0.025%, Tretinoin 0.05%, Tretinoin 0.1% or any other bespoke concentration of Tretinoin prescribed to you by our Doctors
• Any bespoke cream containing Tretinoin as one of the ingredients – such as creams prescribed for hyperpigmentation
• Treclin Gel which contains Tretinoin 0.025% with Clindamycin 1%
• Aknemycin Plus Liquid which contains Tretinoin 0.02% and Erythromycin 4%
• Differin which contains Adapalene 0.1% or Adapalene 0.3%
• Epiduo which contains Adapalene 0.1% or 0.3% with Benzoyl Peroxide 2.5%
• Retin A was a brand name for Tretinoin. Retin A cream was discontinued in 2008 and Retin A Gel was discontinued in 2012 in the UK. Tretinoin cream is still available from our clinic in various concentrations.

These instructions can also be followed if you are using an over the counter product such as Retinol and Retinaldehyde.

Why have I been prescribed topical retinoids?

Topical retinoids are prescribed for

• Acne
• Scarring
• Anti-ageing
• Other dermatological conditions such as hyperpigmentation, melasma, and keratosis pilaris

Patience and consistency get results

Topical retinoids are fantastic medications, and they have been recommended by Dermatologists for almost 50 years.

However, it takes time for your skin to get used to topical retinoids. It also takes time for results to be seen.

It can take 3 to 6 months for acne or skin texture to improve. You, therefore, have to be patient for the results to show. The results are cumulative – that means the longer you use the product, the greater the benefit that you will see.

It can also take time for your skin to get used to topical retinoids. This is because retinoids can irritate the skin. Irritation can lead to redness, dryness, itching and increased sensitivity.

If you have a resilient skin type, you will have no problems getting your skin used to topical retinoids. If you have sensitive or borderline sensitive skin however, there can be issues with topical retinoids.

How do I know if I have resilient skin?

You are likely to have resilient skin if:

• Your complexion tends to be oily
• Your skin doesn’t feel tight and dry after using a foaming cleanser or soap
• You generally don’t react to skin care products and can use pretty much anything on your skin
• You don’t have a history of eczema or hives

How do I know if I have sensitive skin?

You are likely to have sensitive skin if:

• Your skin tends to be dry
• You need to moisturise regularly to stop your skin from drying out
• You feel tight and dry as soon as you’ve used a foaming cleanser or soap during the day
• You easily react to skin care products
• You have a history of dry skin or eczema or hives

Most of those with sensitive skin will be able to use a topical retinoid to some degree. However, around 10% of the population cannot tolerate a topical retinoid because their skin is just too sensitive.

Principles of using a topical retinoid

The principles of using a topical retinoid are to:

• Use small quantities to start with and build up the quantity gradually
• Apply the topical retinoid less frequently to start with and build up gradually
• Protect your skin from developing irritation from the topical retinoid
• Apply the topical retinoid at night – make sure it goes on your skin after cleansing and that you put nothing else on afterwards

How to use your topical retinoid

Step 1. Apply the topical retinoid every third night for 3 weeks– this means you apply the topical retinoid on one night then miss two nights. Apply half a fingertip to cover the whole face.  If treating half the face, use a quarter of a finger tip.

Step 2. Apply the topical retinoid on alternate nights for 3 weeks – this means you apply it one night, and then you miss the next night.

Step 3. Apply the topical retinoid every night.

Step 4. 3 weeks later, increase the quantity from half a fingertip to three-quarters of a fingertip.

Step 5. 3 weeks later, increase the quantity from three-quarters of a fingertip to a whole fingertip.

If you have very resilient skin, you can start at Step 2 and do the increments every 2 weeks. If you have very sensitive skin you should start at step 1. If you find Step is 1 too irritant, contact the Office, and we will be able to dispense a weaker version of Tretinoin to you.

If you find that moving to a new step causes your skin to become very irritated, then drop back down to the step before for another 6 weeks before trying again to go up a step. If you try again and your skin still gets irritated a second time, stay at the highest step you can tolerate without irritation.

How to protect your skin from developing irritation

These are the things you should do to support your skin so that it can tolerate a topical retinoid.

1. Avoid soaps and foaming cleansers. Instead, cleanse your face with a thin moisturising lotion such as Cerave Lotion, Cetaphil Lotion or if you are looking for something vegan, then Sukin Oil Free Moisturiser. These moisturisers will hydrate your skin as they cleanse and help repair the skin barrier. Cleanse your face twice a day – once in the morning and once in the evening before applying the topical retinoid.
2. Remove make-up using as gentle a product as possible such as micellar water
3. Avoid all other actives known to produce irritation, including toners, vitamin C, AHAs, BHAs, Niacinamide, other acne treatments, antiageing serums etc. These can be reintroduced later, one by one, once your skin is tolerant to the topical retinoid.
4. Boost the skin barrier throughout the day by applying a thin moisturiser such as  Cerave Lotion or Cetaphil Lotion between three and four times a day.
5. Do not apply a moisturiser before or after applying the topical retinoid.

Protect the hotspots on the face

Some areas on the skin are very prone to irritation from a topical retinoid and need to be protected.

• The eyelids – avoid retinoids on the upper and lower eyelids. Put a moisturiser or a thin layer of Vaseline or Aquaphor around your eyes first before applying the retinoid to your face to prevent spread.
• The corners of the nose, the lips and the corners of the mouth. These areas are prone to irritation as the topical retinoid can build up in these crevices and grooves. Apply a thin layer of Vaseline or Aquaphor to these areas before applying the retinoid to the rest of the face.
• If you get very dry skin in these areas, you may need to use a mild topical steroid with caution.

Remember, it is better to prevent irritation than to treat it once it has occurred. Apply all the precautionary measures from the very beginning before there are any signs of irritation. This will reduce the chance that your skin becomes irritated.

Pregnancy and breast-feeding

• If you are pregnant
• If you are planning a pregnancy

Allergies

Protect yourself from the sun

Topical retinoids are likely to make you more sensitive to the sun. Avoid going into direct sunlight, and always wear a hat. Use sunblock judiciously – too much sunblock can aggravate acne and cause irritation.

Author details

Author: Dr Sajjad Rajpar

Date last reviewed: 10 Jan 2023

Conflict of interest and disclaimer