People think this anti-acne product does everything from skin brightening to erasing lines & marks. Is it true?

It’s 1513. Spanish explorer Juan Ponce De León is sailing across the deep waters of the Puerto Rico Trench. Picture him looking through a spyglass telescope far out into the distance, hoping his search was coming to an end. His treasure awaited – the mythical Fountain of Youth. Instead, he reached Florida. Historians have debunked the story as yet another fable of an explorer searching for the secret to eternal youth. But if anyone were to go looking for it today, all they’d need to do is walk into the local chemist store and ask for a tube of tretinoin. That is, if skincare connoisseurs and enthusiasts are to be believed. 

This product is believed to hold the answer to every skin woe. Hyperpigmentation, acne, uneven texture, acne scars, fine lines, sun damage — you name it and someone out there will say that tretinoin solved the problem. There are blogs dedicated to it, YouTube channels, Reddit groups, and endless skincare threads with users swapping tips, advice and encouragement to get through the ‘purge uglies’ and make it to the desired ‘tret glow’. 

“We prescribe tretinoin to treat severe acne. It has grown to become more than that. People use it for anti-ageing and other skin ailments like acne scars, retexturing skin and more. But reading about other people’s successes online, they also get carried away running after those same results,” says Dr Hemlatha Kanodia. 

When Dr Albert Kligman was studying the chemical in the ’60s he discovered its amazing effect on treating acne. Through studies, experts saw the side effects of more even skin texture, a repair of sun damage, and increased collagen production, all of which left people with healthier-looking skin. 

Kanodia says that she’s not against people using it for purposes other than acne treatment — it is one of the most effective and studied skincare ingredients that can slow down signs of skin ageing – but like any medication, it comes with side effects and requires a doctor’s guidance to use.

She has seen numerous patients with self-inflicted burns and skin damage caused by improper use of tretinoin. “Despite being a prescription medication, it’s very easily available in the market, most times with no prescription needed.” 

So, if you are going to use tretinoin, here’s how to do it right and save your skin barrier from severe damage (here’s how you can repair it if the damage is already done), rashes, and chemical burns. 

What is tretinoin and how does it work?

Tretinoin goes by many brand names – retino-A, tretin, A-ret – but they’re all a class of compounds that derive from vitamin A, known as retinoids in cosmetics that are applied topically.

There are four main categories, explains Kanodia. Retinyl esters, retinol, retinaldehyde, and retinoic acid. This last one is the most potent and skin-irritating form, available in the form of tazarotene and tretinoin.

Retinoic acid is the pure, biological form of the chemical, and our skin has retinoic acid receptors which these products bind to and activate to then change our skin cells, triggering massive skin cell turnover (AKA exfoliation). As a result of this increased skin cell turnover, the appearance of newer skin cells gives us a smoother, clearer complexion. “It also stimulates collagen production which, as we age, starts to slow and break down. But it is retinoic acid which in its pure form is the most impactful for these results,” says Kanodia.

The further we go down the list of derivatives, the less potent it gets, and the more steps get added to our skin’s task list to convert retinol and retinyl esters, for example, into retinoic acid to reap the benefits. This also means that the derivatives are less irritating on the skin and are likely to cause fewer side effects.

What’s the deal with the ‘purge’? 

Some experts debunk the idea of a ‘tretinoin purge’ while others, like Kanodia, believe there are different strokes for different folks. Scrolling through the Reddit forums on tretinoin you’ll see most people complain about the purge. They call it ‘tret uglies’ and their ‘lizard phase’, while others, who are clearly god’s favourite, claim to have experienced no adverse effects at all. 

Using tretinoin makes you shed the upper layers of your skin and causes new skin cells from the inner layers of the epidermis to come up to the surface, all at a much faster pace than our skin’s natural exfoliation process. “Picture it as all the gunk that’s hidden in the layers of your skin being thrown out in the form of pimples,” says one tretinoin user on the thread. However, Kanodia says the ‘purge’ – that is, acne breakouts, skin redness and peeling – are most likely due to extreme skin irritation and dryness which are common side effects of tretinoin. 

“You may notice dry patches in some places or all over your face and a lot more redness than before. That’s why it’s important to keep your skin moisturised, protected from the sun and go slow with the tret to keep potential damage to the minimum,” she says.

It’s going to get worse before it gets good, and experts say the purge can last anywhere from 2-4 months, depending on your usage. It could be a pimple here or there for some people, full-on acne blow-outs and skin peeling for others. Using tretinoin is playing the long game.

Won’t retinol and retinal give me the same benefits?

Retinol, and now retinal (retinaldehyde), which has made an entry into the market have a mass following of their own. Experts say that they both hold very similar benefits but primarily differ in terms of the degree and speed of delivering the results. 

“The difference lies in how fast you’ll see results. Tretinoin gives more dramatic and faster results, in comparison, but can also have more drastic and severe side effects,” explains Kanodia. 

She highly recommends consumers opt for retinol rather than tretinoin, especially when unsupervised by professionals. “With retinol too, you may experience slight acne breakouts and you need to take all the same precautions of keeping the skin moisturised and protected from the sun. But the impact on the skin if you don’t take the precautions won’t be as severe as they would with tretinoin, which is highly concentrated and potent.”

What’s the right way to use it?

When using tretinoin, always remember that less is better. This is not an ointment you’re slathering all over your face unless you want it to peel off. You should not be using it if you’re pregnant, trying to get pregnant, breastfeeding, have sensitive skin or have a prior skin condition that you’re getting treated for without consulting a specialist first.

Retinoids should only be used at night as it makes your skin photosensitive. All you need is a pea-sized amount. You can try Dr Sam Bunting’s dotting technique to make sure you’re applying an even layer of the product all over your face. After a month or so, once your skin has gone through retinisation and become used to the retinoids, you can take it up to twice a week from once.

“For absolute beginners, start at the lowest concentration of 0.025% once a week. Start with a gentle face wash and wait till your skin is dry. You can try the sandwich method to reduce initial irritation by applying moisturiser before and after tretinoin. You can also try short-contact treatment where you apply it for 30 minutes to an hour and then wash the tretinoin off,” says Kanodia. Keep the product away from your delicate undereye area, corners of your mouth and nasolabial folds where it can settle, concentrate and cause immense irritation.

While there are three concentrations of tretinoin, she says that for anything other than the treatment of acne, you don’t need to use more than 0.025%. “This is a game of patience and consistency. You’ll be eager to try a higher percentage, but studies have shown that for anti-ageing or reducing sun damage, it’s not necessary that the higher you go, the better the results.”

Don’t forget the most important part of using tretinoin: sun protection. Without the protection of sunscreen the next day (and the days after that) you’re negating any positive effect of the tretinoin, causing more skin damage in the process.

What about the rest of my skincare routine? 

The less is more philosophy applies here too. As a powerful exfoliator in itself, you don’t need to use any other chemical or physical exfoliator while using tretinoin. Kanodia recommends stripping your routine to its bare bones. A simple cleanser (and makeup remover if you regularly wear makeup), moisturiser and sunscreen with a minimum SPF of 50 (our favourites).

“I would avoid anything with fragrance and essential oils too. Your skin is already going to be vulnerable and irritable. Fragrance in skincare is not a problem for most people but why add more ingredients that could potentially trigger allergies or irritation?”

People with dry skin types will experience even more dryness when using tretinoin. She says to opt for a heavy-duty moisturiser, or you could incorporate a hydrating toner or serum into your skincare routine. Apply before your first layer of moisturiser.

For the ones whose skin feels drier than the Thar dessert, you could try the internet’s latest favourite trend of ‘slugging’. Finishing off your skincare routine with a layer of petroleum jelly like vaseline acts as a seal to hold all the moisture in while you’re sleeping. Remember to give your face a rinse in the morning after, as you don’t want any product building up in your pores.

Tretinoin is a powerful ingredient to have in your skincare arsenal. But with great power comes great responsibility. If you’re going to use it for fine lines or combatting pigmentation then start slow with a pea-sized amount. Always wear sunscreen and remember that your patience is going to be seriously tested. But you can reap the benefits of using this powerful retinoid, as long as you’re doing it safely.

A note of caution: This story is for educational purposes with inputs from trained experts. Please consult your healthcare provider to know what suits your needs best.