Acne is a skin disease suffered by millions of people across the globe. Typically thought to emerge during adolescence, acne can also affect babies, and for some, acne doesn’t even appear until their adult years, when it can be quite an unwelcome surprise. With so many people affected, many methods of acne treatment have emerged, including hundreds of over-the-counter acne products. Tretinoin comes as a cream, gel, or ointment, and is the derivative for many of the most popular topical acne treatments on the market these days.
Acne is considered to be a condition of the sebaceous glands that occurs when pores in the surface of the skin become blocked. These blockages are usually due to either excess sebum production, or to dead skin cells that should have been sloughed off but instead plug the pores. Excess sebum production is associated with hormones, namely an increase in androgens within the system, or an over-sensitivity to the androgens already present. Retention of dead skin cells is referred to as abnormal epithelial desquamation, desquamation being the shedding of the outer layer of skin. Acne treatments often focus on addressing either hormones or pore blockages, and Tretinoin’s focus is on keeping the pores clear.
Tretinoin is a first-generation retinoid that was released as a topical acne treatment in the US in 1971. Retinoids are chemically very similar to vitamin A (retinol), which is an essential nutrient required for healthy skin. Used primarily for comedonal acne, in addition to other skin disorders, tretinoin keeps pores open through two mechanisms. It decreases the “stickiness” of epithelial cells so that they are exfoliated more easily, and it increases the turnover rate of epithelial cells, so that the cells are shed more quickly before comedones (blocked pores) can form. Without dead cells to plug the skin’s pores, acne is much less likely to form.
One important thing to note about using tretinoin to treat acne is that skin problems may get worse before they get better. This can include redness, scaling, an increase in acne lesions, and itching or burning sensations that may persist for a few weeks before the acne begins to clear. Reports vary between 2 and 9 weeks to see an initial improvement, and sometimes as many as 12 weeks before the full improvement is noticeable. This is often the case, even if tretinoin is used on a daily basis. One other side-effect linked to tretinoin, in addition to acne worsening initially, is thinning of the skin. This effect is also noted in another first-generation retinoid, isotretinoin. Thin skin may not be too much of an issue, however, if certain activities can be avoided, namely hair removal by waxing. Also, sunscreen with an SPF 15 or higher is recommended if sun exposure is expected.
Although still used in many acne treatments, tretinoin has been somewhat upstaged by newer second and third-generation retinoids, which are more specifically targeted towards acne problems. It is still used, however, in many common topical acne treatments, including Avita, Renova Emollient, Retin-A, and Retin-A Micro, all well-known products. When trying to treat acne, retinoids are very useful in preventing the clogging of pores that can lead to acne problems. They should not be used in combination with certain products and medications, so if you’re interested in trying tretinoin, speak to a dermatologist or doctor to develop an acne treatment plan that is tailored to your skin.