When my dermatologist prescribed me Tretinoin for cystic acne six years ago, I only had one question: How do I incorporate it into my skin care routine? I was brand new to the world of retinoids and honestly put off by them due to side effects I’d heard people talk about on social media. But with some coaching from my doctor and a little trial and error, I figured out how to build a Tretinoin skin care routine. It’s simple and revolves around gentle, hydrating, noncomedogenic products that support my skin while letting the medication do its thing.
Below is the Tretinoin skin care guide I wish I had when I started using the medication. I’m walking you through the best products to pair with Tretinoin, what order to use them in and how to get through the dreaded retinoid uglies. I also spoke to four dermatologists about literally everything you’d want to know about Tretinoin so you can find all the answers in one place.
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What’s the ideal Tretinoin skin care routine?
To give you an idea of what a basic skin care routine looks like while on Tretinoin, I’m breaking down the one I follow every morning and evening below. I talked to dermatologists to make sure it aligns with their recommendations, and I included their advice for each step (learn more about how to build a Tretinoin skin care routine below).
For context, I’ve been using Tretinoin cream at a 0.025% concentration since 2020, and I’m also on Sprinolactone. Prior to starting Tretinoin, I had severe cystic acne and acne scars, and I’d tried every over-the-counter product you can think of, including Differin. I have sensitive, acne-prone, combination skin that leans dry, and I apply Tretinoin every other night. I’ve done most of this skin care routine since I started the medication, and I’ve added to it over the years as my skin adjusted to being on Tret. It’s important to note that while this routine and these products work for me, everyone’s skin is different, so consult your dermatologist for personalized recommendations.
A.M. Tretinoin skin care routine
Step 1: cleanser
Washing your face in the morning gets rid of dirt, oil and debris that accumulated overnight, experts told me. It essentially wipes the slate clean, giving products the best shot at absorbing into your skin and working as effectively as possible. Pick a cleanser that just cleans and, if possible, hydrates skin — it shouldn’t have additional exfoliating ingredients in it, like alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs).
I use micellar water as my morning cleanser — I’d rather soak a cotton pad and wipe it across my face than lather a cleanser and rinse it off when I’m still half asleep. I also find micellar water to be refreshing, hydrating and soothing. I religiously buy Bioderma’s Sensibio Micellar Water because it’s fragrance- and alcohol-free, and I swear I feel it lifting grime off my skin as I use it. I get the bottle with the pump cap (a jumbo size of which I add to my cart at Costco), which helps me control how much micellar water I dispense at a time.
Step 2: vitamin C serum
“Vitamin C helps counteract what we call reactive oxygen species, which are unstable free radicals found in pollution and other exposures like UV light,” says Dr. Emily Milam, a board-certified dermatologist at NYU Langone Health. Exposure to reactive oxygen species can damage skin and speed up aging by breaking down collagen and elastin, but vitamin C serums help protect skin to prevent these issues.
Since I live in New York City, which is highly polluted (no shade — it’s just the truth), and I run over 30 miles a week, mostly outdoors, I figured using a vitamin C serum could only benefit me. I added one to my routine about a year into my Tretinoin treatment when my skin was used to the medication. “Vitamin C serum can certainly be used with retinoids like Tretinoin, but some acne-prone people don’t tolerate them,” says Milam. Finding the right one for you might take some time — I went through a handful before finding one that I liked. Milam also recommends only applying vitamin C serum in the morning, separating it from Tretinoin application at night.
I tried a few vitamin C serums made with L-ascorbic acid, the most effective and active type of vitamin C, but I found every single one irritating. My already sensitive skin is even more sensitive on Tret, so it just couldn’t handle the strong ingredient. I eventually moved to products made with more gentle, inactive forms of vitamin C and had the most luck with Summer Fridays’ vitamin C serum, so I’ve stuck with it ever since. It’s formulated with two types of vitamin C (3-O-ethyl ascorbic acid and ascorbyl glucoside), as well as niacinamide, and I’ve noticed that my skin looks brighter and has a more even tone with consistent use. The serum comes in a pump bottle, which helps me dispense a pea-sized drop every time, and it has a super smooth, non-greasy and non-sticky feel. It absorbs into my skin quickly so I can quickly layer other products on top.
Step 3: hyaluronic acid serum
My skin typically needs a thick, rich moisturizer to really prevent dryness, but lightweight options layer better under makeup, in my experience. For an extra boost of hydration, I use a hyaluronic acid serum every morning and pair it with a lightweight moisturizer, which essentially gives me the benefits of a thick, rich moisturizer without actually applying one. It’s a trick my dermatologist taught me, and one that comes recommended by Dr. Mona Foad, a board-certified dermatologist and founder of MONA Dermatology.
Because I constantly slather hyaluronic acid serum on my face (sometimes I’ll reapply during the day or use it at night if my skin feels extra dry), I wanted a relatively affordable, yet still effective, option I wouldn’t mind rebuying all the time. The Ordinary’s is exactly that. It’s under $10, so I toss it in my cart without hesitation — I couldn’t even tell you how many bottles I’ve bought at this point. When I apply the serum, which is made with five types of hyaluronic acid as well as ceramides and B5, I feel my skin drinking it up immediately. It really does feel plumper, smoother and tighter in seconds like the brand says. The serum comes in a dropper bottle, is very lightweight and it dries in less than a minute.
Step 4: moisturizer
Keeping your skin hydrated while using Tretinoin is extremely important — if it dries out too much, you can start breaking out, says Foad. In addition to using a noncomedogenic moisturizer, also make sure it’s fragrance-free — fragrances can irritate the skin, especially when it’s vulnerable like it is when you’re on a retinoid, says Dr. Amy Wechsler, a board-certified dermatologist and psychiatrist who’s also the co-founder and CEO of Spotless Clinics. Additionally, try to buy a ceramide-based moisturizer that’s sold in a tub, which tends to be more hydrating than ones sold in a pump or tube, says Milam.
My skin was so sensitive, flaky and irritated for the first few weeks after I started Tretinoin that most moisturisers stung when I applied them. Kiehl’s fragrance-free Ultra Facial Cream is one of the only ones that didn’t, so I became a repeat buyer and still am today. It’s made with squalane, ceramides and glacial glycoproteins, all ingredients that hydrate skin, repair the barrier and prevent water loss, according to the brand. The moisturizer is very rich and creamy, but it isn’t thick or greasy, and it feels lightweight on my skin, which soaks it up in seconds. I apply makeup directly over it without issues. The cream has a slight cooling effect, too, and it soothes and softens my skin no matter what condition it’s in. Once you finish a jar, you can refill it.
Step 5: sunscreen
Sunscreen is a nonnegotiable part of everyone’s skin care routine, but it’s even more crucial to wear daily if you’re on Tretinoin. The medication makes your skin extra sensitive to the sun, so your threshold to get a sunburn is much lower, says Milam. Per the American Academy of Dermatology, use a face sunscreen that has an SPF of at least 30 and offers broad-spectrum protection, which means it shields you from UVA and UVB rays. Also pick a formula that aligns with your skin type, be it acne-prone and sensitive or oily, for example.
I wear tinted sunscreen as a base for my makeup every day — using foundation daily is way too much makeup for my acne-prone skin, and having SPF built into the product I use to reduce redness and blur imperfections cuts out an additional step in my routine. Tower 28’s tinted sunscreen is one of my top picks (as is the brand’s Swipe Serum Concealer). The fragrance-free, lightweight, broad-spectrum, mineral formula has buildable coverage and a natural matte finish — one layer is usually plenty to correct my skin tone, calm down redness and cover up scarring and acne. The SPF is also specifically designed for acne-prone and sensitive skin like mine, which makes me feel extra confident that it won’t irritate when I use it.
P.M. Tretinoin skin care routine
Step 1: double cleanse
Always apply Tretinoin to clean, dry skin, which ensures that the medication maintains its potency and will be the most effective, says Milam. I find double cleansing to be the best way to get rid of dirt, oils, skin care products and makeup at the end of the day. It involves two steps: washing your face with an oil-based cleanser to remove surface-level products like makeup and sunscreen, and then washing your face again with a water-based cleanser that removes everything else.
Farmacy’s cleansing balm melts even the heaviest, most caked-on makeup and skin care products off my face. I gently massage it into my skin and watch everything lift off the surface as the balm becomes milky, and then I soak a Clean Skin Club cloth in warm water and wipe it all off. I don’t need to rub or scrub — the cleansing balm does all the work and leaves my skin soft and hydrated. It has a buttery feel, but it’s not greasy or pore-clogging. Farmacy also sells a scented version, but I recommend the fragrance-free one for sensitive, acne-prone skin.
CeraVe’s cleanser is as basic as they come, which is why I use it. It has a creamy, non-foamy feel — the brand describes it as lotion-like, which I agree with. The fragrance-free cleanser removes any grime left on my face after I wipe off the cleansing balm, and it hydrates my skin with hyaluronic acid, ceramides and glycerin. My face feels so clean that it’s bare after I use it, and that’s how I know I’m ready to continue on with the rest of my routine.
Step 2: eye cream
Do you need to use eye cream? Absolutely not, says Milam — many of them don’t add major benefits to your skin. But as long as you apply one that’s purely hydrating and not made with active ingredients like retinol, it can’t hurt. I mainly use eye cream at night because it creates a barrier around my under eyes, reminding me not to apply Tretinoin in that very sensitive area.
This is one of the only under-eye products I’ve ever been loyal to. I go through multiple tubes a year and never hesitate to re-buy it because it has consistently made my under-eye area less dry, which was an issue I was struggling with after I started Tret, as well as less puffy. The brand also says the cream helps brighten dark circles and smooth out fine lines, but I haven’t noticed those effects as much. The cream has a lightweight, gel-like texture, and it’s made with hydrating ingredients like hyaluronic acid and niacinamide. I apply it under my eyes and by each corner, which reminds me where to not put Tretinoin.
Step 3: Tretinoin (plus an optional chemical exfoliant on alternate nights)
It’s best to use a retinoid like Tretinoin at night because sunlight can deactivate it and make it less effective, says Milam. To properly apply Tretinoin, use a pea-size amount and place tiny dots across your face to evenly distribute it, then rub the thin layer into your skin. Avoid sensitive areas that tend to get dry, like the corners of the mouth, nose and lips, as well as too close to the eye. Using too much of Tretinoin makes irritation more likely, so don’t overdo it.
While they don’t work the same way, Tretinoin and chemical exfoliants lead to similar results, like acne management, improved texture and a brighter tone. Because of this, you don’t necessarily need to use an additional chemical exfoliant if you’re on the medication, says Wechsler. That said, you can add one to your routine on non-Tretinoin nights to help get rid of dead skin cells and reduce flakiness, further unclog pores and enhance radiance, experts told me. But only do so once your skin builds up a tolerance to the retinoid, and so long as the chemical exfoliant doesn’t cause irritation.
After five years of being on Tretinoin, I was still getting what I felt like were too many blackheads in my T-zone, and my dermatologist gave me two options: upping my Tret concentration or using a gentle chemical exfoliant every other night. I opted for the latter since my skin has responded so well to the medication otherwise. I now use The Ordinary’s mandelic acid serum on nights when I don’t apply Tretinoin, and it’s made a big difference. The lightweight serum is gentle enough that it has never irritated, but effective enough that I don’t notice as many blackheads anymore, and my skin texture is even smoother now. The fragrance-free, fast-absorbing serum is formulated with 10% mandelic acid, which is an AHA, as well as hydrating hyaluronic acid. It has a barely-there feel.
Step 4: moisturizer
Like I do in the morning, I apply Kiehl’s Ultra Facial Cream at night to prevent dryness.
How to reset your skin barrier while on Tretinoin
If your skin ever gets excessively dry, flaky and irritated, you likely need to pause using Tretinoin, as well as products with other strong active ingredients, for a few days. As Foad mentioned above, super dry, irritated skin can lead to breakouts, so don’t push it. Strip back your skin care routine to just the basics: gentle cleanser and moisturizer. Let the skin barrier reset and get back to its baseline, and then slowly reintroduce the retinoid and other products in your regimen.
Consider swapping out your usual nighttime moisturizer for a thick barrier cream if you’re dealing with Tretinoin-related irritation, says Dr. Aegean Chan, a board-certified dermatologist and dermatopathologist. I reach for Glossier’s fragrance-free After Baume in that situation. It’s so thick and buttery that it’s essentially a paste, and a little goes a long way in terms of application — as it warms up on my skin, it thins out, making it easy to spread across my face. It’s rich and luxurious, and it leaves my skin super dewy, which always makes me feel like there’s a moisturizing shield over it. Because I’m so shiny after I use the After Baume (yes, like a glazed donut), I only apply it at night. When I wake up the next morning, my skin is always much softer, less flaky and more hydrated.
How to spot treat acne while on Tretinoin
The goal of Tretinoin is to ultimately prevent you from getting acne, but you might get a pimple from time to time, or go through a purge when you first start using it (read more about “the purge” in the FAQ section below). In those cases, don’t throw the kitchen sink at active breakouts. Instead, rely on pimple patches and over-the-counter salicylic acid spot treatments to calm down the lesions, says Wechsler. Use the spot treatments on nights you’re not using Tretinoin, and only apply a small dot to the pimple, not your whole face. If you’re breaking out very badly, consult your dermatologist, who may prescribe an antibiotic or inject a low-dose steroid into large cysts, says Milam.
As someone who had severe cystic acne for years, I’ve covered my face in hundreds of pimple patches at this point, so I’ve tested them all. Hero Cosmetics’ hydrocolloid Mighty Patch is hands-down the best of the best. Once I stick them to my face, they don’t move whatsoever, whether I’m going about my day-to-day life, doing Pilates or sleeping. They shrink the size and height of inflamed zits by sucking gunk out of them, but most importantly, they prevent me from picking at and popping pimples, which I’m definitely guilty of. I find The Original Mighty Patch to work best, but if you feel like those are too noticeable during the day, the Invisible+ Mighty Patch is great, too.
I always keep a bottle of this spot treatment at home in case I need it. On nights I’m not using Tretinoin, I’ll skip my chemical exfoliator and instead put Mario Badescu’s Drying Lotion on any pimples that really need help drying up. It’s made with salicylic acid and sulfur, ingredients that exfoliate and cleanse pores while absorbing excess oil, according to the brand. The treatment also has soothing calamine in it, which is why the lotion is pink and slightly chalky on your skin (another reason I use it at night). I drip a cotton swap in the bottle, making sure it reaches the bottom, and I dab the lotion on each pimple. Overnight, my blemishes always get smaller and less angry.
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How to build a skin care routine on Tretinoin
There’s a few key rules to abide by while building a skin care routine if you’re on Tretinoin:
- Strip it back when you’re starting the medication: “Tretinoin on its own can irritate your skin, so you want to take out all other confounding factors and anything that could make your skin more sensitive,” says Chan. “You also want to know how well your skin is responding to it without anything else getting in the way.”
- Keep it simple: Using too many products at once can cause irritation, so don’t overdo it, says Milam. The less steps your skin care routine has, the better.
- Prioritize hydrating, gentle, noncomedogenic products: Dryness is one of the main Tretinoin side effects, so pair the medication with non-irritating products that help restore hydration to the skin using ingredients like ceramides, hyaluronic acid, glycerin and squalane, says Milam. Also, make sure everything you use is noncomedogenic, which means it’s less likely to clog pores and cause breakouts.
- Don’t directly combine Tretinoin with other strong active ingredients: Once your skin builds up a tolerance to Tretinoin and you’re not experiencing constant dryness, breakouts and irritation (read more about that in the FAQ section below), you can reintroduce other active ingredients into your routine, like chemical exfoliants, peptides and antioxidants. Just be careful about when and how often you apply them to avoid excess dryness and irritation. For example, if you want to use a vitamin C serum, do so in the morning and apply Tretinoin at night, says Foad. Or if you want to use chemical exfoliants like AHAs and BHAs, do so every other night and alternate with Tretinoin.
Frequently asked questions
Tretinoin (all-trans retinoic acid, to be technical) is a prescription-strength topical retinoid that falls in the vitamin A family, says Chan. It’s one of the most potent and directly active forms of a retinoid — the skin doesn’t need to convert it into a purer form before using it, which means it works faster and more intensely than over-the-counter retinoids, says Foad.
Tretinoin typically comes in three concentrations: 0.025 percent, 0.05 percent and 0.1 percent, says Foad. Your dermatologist will likely start you on the lowest one, gauge your progress for a few months and adjust from there. The medication is also available in several bases, like a water-based cream and an alcohol-based gel, letting your doctor further customize it to your skin type. For example, cream bases have more moisture than gels, making them best for people with dry skin, says Foad. On the other hand, gels are more drying, so they’re ideal for people with oily skin.
The U.S. Food and Drug Administration approved Tretinoin as an acne treatment in the early 70s, and it was invented even before that, so dermatologists have the largest body of evidence behind it, says Chan. That’s why it’s the gold standard in terms of treating acne, as well as addressing signs of aging. “Any time a new molecule gets developed, its efficacy gets determined by studying it against Tretinoin since there’s the most research around it,” she says.
The actual Tretinoin molecule works by binding with retinoic acid receptors inside skin cells and adjusting how they function, says Chan. “Tretinoin is resetting the instruction manual for your skin cells or changing out the machinery,” she says. “You’re not going to get overnight results — this is a gradual process with long-term benefits.”
Over time, Tretinoin speeds up skin cell turnover and decreases sebum (an oily substance) production to help prevent clogged pores that can lead to acne; gently exfoliates the skin’s surface; and corrects hyperpigmentation from acne scars, melasma, sun damage and more, says Wechsler. It also has anti-aging benefits. There’s an enzyme in skin cells called metalloproteinase, which is responsible for collagen breakdown, says Foad. Tretinoin inhibits that enzyme, slowing down collagen breakdown to keep skin supple and improve the appearance of fine lines and wrinkles.
Dermatologists mainly use Tretinoin to treat acne and address signs of aging like fine lines and wrinkles, but it’s a workhorse, says Chan. It can also treat pseudofolliculitis barbae (a condition that occurs when hair curls back into skin), keratosis pilaris (small bumps that occur due to keratin buildup) and hyperpigmentation, including melasma, sun damage and acne scars, for example.
Below are some of the most common side effects of Tretinoin, a combination of which people often refer to as the “retinoid uglies,” says Chan. Everyone’s experience with the medication is different, so there’s no guarantee you’ll deal with the below, but it’s helpful to know what to expect.
- Dryness, since Tretinoin reduces oil production, says Wechsler. Chan says some of her patients get what she calls the “Tretinoin beard,” which is dry, flakey skin around the mouth.
- Increased skin sensitivity, redness and irritation, which may temporarily make it feel slightly stingy.
- Purging, a.k.a. a temporary increase in breakouts that may make you feel like Tretinoin is making your acne worse. That’s totally normal and temporary. “Any pre-acne lesions from clogged pores that are waiting in the wings suddenly speed up and come out at once when you start using Tretinoin,” says Chan. The purge doesn’t happen to everyone, despite what you may see on social media — Chan says about 40 to 50 percent of her patients experience it. If you slowly introduce Tretinoin into your skin care routine, you have a lower chance of it happening.
Tretinoin is only available through a prescription. You’ll have to visit a dermatologist in-person or meet with a dermatologist through telemedicine platforms like Walgreens Virtual Healthcare, Goodrx and Amazon One Medical to get the medication.
If your skin tolerates it, you should use Tretinoin every night and build up to doing so over time, according to the dermatologists I spoke to. But that’s not realistic for everyone: Frequency depends on how long you’ve been using the medication for, your skin type and even the weather. For example, some people need to use Tretinoin less often in the cold, dry winter, or during the summer when they’re constantly exposed to strong sun.
Because irritation is so common, starting slow and building up a tolerance to Tretinoin is important when you first add it to your skin care routine, says Wechsler. She usually has her patients use it one to two nights a week, and, so long as their skin reacts positively, gradually increasing the frequency to every other night or every night. However, you don’t need to use Tretinoin every night for it to be effective, and you should not apply it more than once a day.
If you’re using Tretinoin to treat acne, it usually takes about six to eight weeks to see results, at which point you’ll likely begin noticing a reduction in breakouts, says Wechsler. If you’re using Tretinoin for anti-aging, it usually takes about six to 12 months to see results, says Chan. “When you start Tretinoin, you have to have a no pain, no gain mentality,” she says. “It’s a long-term investment and a very effective medication, but you’re going to feel like it doesn’t work at first. Then, all of a sudden, the clouds part and the angels sing.”
How long you should use Tretinoin varies per person, says Wechsler. The only time you absolutely can’t use it is while pregnant. “There’s a lot of people who will fall in love with it for its anti-acne properties, and then consistently stay with it for its anti-aging properties,” says Wechsler. But there’s also people who only use it to get through a specific period of their life, or start and stop it depending on their skin issues and goals. Discuss your personal Tretinoin timeline with a dermatologist.
Yes, you should stop using Tretinoin about five days before any sort of cosmetic procedure, including exfoliating facials, chemical peels, microneedling and laser treatments, says Foad. Waxing also falls into this category. If you’re getting your eyebrows or lip waxed, for example, don’t use Tretinoin for five days prior — the medication makes your skin barrier thinner since it increases cell turnover, and hot wax could leave a burn, says Foad.
Yes, you can use the retinol sandwich method with Tretinoin, says Foad. That involves applying a thin layer of moisturizer and layering Tretinoin on top — the moisturizer creates a barrier between the skin and the medication, which essentially makes it less strong and reduces the potential for irritation. It’s best to use the retinol sandwich method when your skin is building up a tolerance to Tretinoin and slowly eliminating it afterward.
No, you cannot use Tretinoin (or any other retinoid) while pregnant, says Chan. You can, however, use it while breastfeeding, says Milam.
Meet our dermatology experts
At NBC Select, we work with experts who have specialized knowledge and authority based on relevant training and/or experience. We also ensure that all expert advice and recommendations are made independently and with no undisclosed financial conflicts of interest.
- Dr. Emily Milam is a board-certified dermatologist at NYU Langone Health.
- Dr. Mona Foad is a board-certified dermatologist and founder of MONA Dermatology.
- Dr. Amy Wechsler is a board-certified dermatologist and psychiatrist who’s also the co-founder and CEO of Spotless Clinics.
- Dr. Aegean Chan is a board-certified dermatologist and dermatopathologist.
Why trust NBC Select?
I’m a reporter at NBC Select who has covered skin care for over five years, including topics like ingrown hair, sunburns, razor burn, tinted sunscreen and sunscreen for acne-prone skin. For this article, I interviewed four dermatologists about how to properly incorporate Tretinoin into your skin care routine, as well as side effects, benefits and other important information about the retinoid. I’ve been using Tretinoin for six years, so I also shared my personal experience with the medication and what products support my acne-prone, sensitive skin.
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