Key takeaways:
Retinoids are very effective acne treatments because they prevent clogged pores and help exfoliate your skin.
All retinoids are safe. But oral retinoids (tablets or pills) can have more side effects than creams.
Topical retinoid side effects can include skin irritation, redness, peeling, or burning. These side effects are less likely when the medications are used properly.
Isotretinoin (an oral retinoid) can have different side effects, including skin dryness, birth defects, and liver inflammation. These risks can be lowered with regular checkups and blood work.
Save on related medications
Retinoids are very effective treatments for all types of acne. For mild acne, retinoid creams may be enough to prevent pimples from forming. For more severe acne that causes scarring, retinoid pills can be a game changer when other treatments haven’t worked.
But retinoids come with some pretty strict instructions for how to use them. Because of this, some people worry about their safety.
Fortunately, people have safely used retinoids for decades. With the right follow-up and precautions, retinoids are definitely worth the effort. They remain one of the most cost-effective treatments for hard-to-treat acne. Let’s dig into the evidence.
What are retinoids?
The term “retinoids” refers to naturally occurring vitamin A (retinol) and all chemicals related to vitamin A. In your body, retinol is converted to retinoic acid, a more powerful form of vitamin A.
You can apply retinoids directly to your skin (topical) for anti-acne and skin rejuvenation effects. They can also be taken as a pill to treat severe acne.
Topical retinoids
Topical retinoids work well for treating acne and are very safe to use. To avoid side effects, it’s important to follow instructions and use them correctly.
There are four prescription retinoids used to treat acne. They come in different formulations and strengths:
Tretinoin (Retin-A)
Adapalene (Differin)
Tazarotene (Tazorac)
In 2016, the FDA approved adapalene 0.1% gel for over-the-counter (OTC) use. This is a lower-strength version of a prescription-only retinoid.
Isotretinoin (Accutane)
There’s one type of retinoid pill called isotretinoin. It’s only available with a prescription and requires close medical monitoring. Isotretinoin was first sold under the brand name Accutane and has been used to treat acne and other skin problems for decades.
Isotretinoin is approved by the FDA to treat severe cystic acne in people 12 years and older, often with great results. It’s available as a generic medication and under other brand names, like Absorica and Claravis.
Are retinoids safe to use for acne?
Yes, retinoids are safe to use for acne. They’re one the most effective treatments for all types of acne. This is because they prevent pimples from forming in various ways. Retinoids can help:
Promote the growth of healthy skin cells
Remove dead skin cells
Lower oil production
Lower inflammation
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When you first start using a retinoid, it’s common for your acne to get a little bit worse before it gets better. This is normal and it means the medication is working. Try to trust the process and stick with it.
Benefits of topical retinoids
Topical retinoids are one of the main treatments for acne in adolescents and adults. They come in different strengths and formulations (like creams, gels, and foams). This makes it easier to find the best topical retinoid for you.
Retinoid creams can also help lighten acne scars (the red or brown spots left on your skin after acne heals).
Benefits of isotretinoin pills
Isotretinoin works to treat severe acne when other treatments don’t work. After just one course of treatment (typically 4 to 5 months), 85% of people have permanent clearing of their acne.
Isotretinoin can also help prevent the permanent scars that can develop when severe cystic acne isn’t treated.
Risks and side effects of retinoid creams
Retinoid creams can cause some short-term skin side effects. You’re less likely to experience these if you use the medication correctly, so it pays to be cautious. Don’t apply too much at once. And start out slowly by using the cream every other day or a few times a week.
Common side effects of retinoid creams
Skin irritation is the most common side effect of topical retinoids. You might notice:
Redness
Peeling
Dryness
Itching
The stronger the retinoid, the more likely it is to cause irritation. Not everyone gets irritated skin. But some people, like those with sensitive skin, are more likely to get it. If this is the case for you, try using the cream less often and add in a moisturizer.
Sensitivity to the sun
Another common side effect of topical retinoids is increased sensitivity to the sun, especially when you first start using them. This means your skin may burn faster than you’re used to.
Because of this, it’s important to apply sunscreen with an SPF of at least 30 every day when using a retinoid cream.
Common side effects of Accutane
Isotretinoin (Accutane) can also cause side effects. Many of these are minor and go away when the medication is stopped. But some are more significant. Anyone taking isotretinoin has to be strictly monitored with regular blood tests and checkups. These help lower the risk of harmful side effects.
Some side effects depend on the dose. This means you’re more likely to experience them with higher doses of the medication.
Below are ten of the more common side effects of isotretinoin. If you’re taking Accutane and experience any side effects that are severe or don’t go away, notify your prescriber right away:
Dry skin, hair, and mucous membranes: People often notice skin irritation, chapped lips, and sore eyelids. Regular moisturization can help soothe dry skin and hair.
Increased sensitivity to the sun: Isotretinoin can also temporarily make your skin more sensitive to sunlight. Protect your skin by wearing protective clothing and using daily sunscreen with an SPF of 30 or higher.
Muscle and joint pain: Isotretinoin can cause pain and tenderness in your joints and muscles, which can lead to back pain. In rare situations, muscle tissue can become inflamed and start to break down, causing a serious condition called rhabdomyolysis.
Dry eyes and blurry vision: Isotretinoin can cause blurry vision or a slight change in vision. You may also have trouble seeing in the dark or wearing contacts because of dry eyes. Artificial tears can help with dry eyes.
Nosebleeds: Dry nasal passages can make nosebleeds more likely.
Headaches and tiredness: Isotretinoin can cause headaches and tiredness. In rare situations, it can cause increased pressure in your brain (more on this below).
Liver or pancreas inflammation: In rare cases, isotretinoin can cause liver or pancreas inflammation. Regular blood work helps monitor this. If you develop stomach or lower back pain, stop taking the medication and let your prescriber know right away. It’s also important to avoid alcohol while taking isotretinoin because it can increase your risk of liver inflammation.
Hormonal changes: Women taking isotretinoin can develop abnormal periods.
Raised blood sugar and cholesterol: Isotretinoin can also increase blood sugar, cholesterol, or triglycerides (a type of cholesterol). You’re unlikely to notice this, which is why regular blood work is important during treatment.
Skin infections: Isotretinoin increases your risk of skin infections because of dry skin. This appears as cuts that don’t heal or that ooze fluid. Regular use of moisturizer can lower this risk.
Serious risks with Accutane
Beyond the above side effects, isotretinoin has some more severe risks. Some of these — like birth defects — are well established. Others, like depression, have been reported but aren’t clearly proven.
In any case, these possible risks are serious and important to know about if you’re considering isotretinoin as a treatment for acne.
Severe birth defects
Isotretinoin is teratogenic, meaning that it causes severe malformations in a developing baby. If you’re taking isotretinoin and there’s a chance you could get pregnant during treatment, you’ll need to:
Register with the national program iPledge.
Get regular blood work and pregnancy tests throughout your treatment.
Use two forms of birth control during your treatment (if you’re sexually active).
High pressure in the brain
Rarely, isotretinoin can increase pressure in your brain. This is called idiopathic intracranial hypertension, and it can lead to blindness if not treated.
The risk is higher if isotretinoin is taken with certain medications (like tetracycline antibiotics). Be sure to tell your prescriber about any medications and supplements you’re taking before starting isotretinoin.
Get immediate medical attention if you notice any of these symptoms while taking isotretinoin:
A severe headache that won’t go away
A sudden change in vision
Nausea and vomiting
Dizziness
The link between Accutane, depression, and suicide
Some reports have linked isotretinoin use to mood changes, including depression and an increased risk of suicide. This has raised concern that using isotretinoin can lead to depression and suicide in people who use it.
This is a particularly tricky issue because research shows that acne itself can cause depression and anxiety. Because of this, it’s hard to know whether mood changes are caused by acne, isotretinoin, or something else.
Many different studies have looked at this question. One recent large study used data from more than 9,000 people taking isotretinoin. So far, these studies don’t show a definite link between isotretinoin use and depression or the risk of suicide. In fact, some studies show that improving acne with tretinoin can actually help improve symptoms of depression.
Here’s the key takeaway: The association between isotretinoin, depression, and suicide is far from certain. More research is needed to provide clarity. Dermatologists take any signs of depression or mood changes very seriously and closely monitor anyone taking isotretinoin.
The link between Accutane and inflammatory bowel disease
Inflammatory bowel disease (IBD) is a group of conditions that causes inflammation in the gut. These include conditions like ulcerative colitis and Crohn’s disease.
Some scientific studies have shown a possible relationship between IBD and isotretinoin. But other studies haven’t found this link, including a more recent study that combined the results of eight different studies.
Here’s the key takeaway: So far, studies don’t prove that isotretinoin causes (or doesn’t cause) IBD. More studies are needed. Talk with a healthcare professional about your symptoms if you’re considering isotretinoin and have IBD or related problems like diarrhea.
Who should not use retinol
Isotretinoin isn’t safe to take during pregnancy or while breastfeeding. The evidence on topical retinoids isn’t as clear. But in general, it’s best to avoid these as well.
If you have certain skin conditions, it may be harder to use retinol or other retinoids. In these cases, you may need to start with a lower dose or strength. Talk to your prescriber if you have:
How to use retinol to avoid severe side effects
The best way to avoid serious side effects with any type of retinoid is to use it as directed and pay attention to how you feel:
For isotretinoin: Get regular blood work and monitoring to see if you notice any potentially serious side effects, like persistent headaches or abdominal pain.
For topical retinols: Start with a lower-strength OTC formulation, such as 0.1%. Apply it every other night. Slowly increase use as needed. Be sure to moisturize your skin regularly. If you notice redness or flaking, you can decrease how often you’re using it.
Alternatives to retinoids
Depending on your situation, alternative treatments may be better options than isotretinoin. Your healthcare team can help you choose the best treatment plan for you.
Some other effective acne medications include:
Antibiotic creams (like clindamycin and dapsone) and pills (like tetracycline and doxycycline)
Hormonal treatments for women (like birth control pills and Aldactone)
Frequently asked questions
When used correctly, retinol isn’t bad for your skin in the long term. Talk to your dermatologist about which products to use and how best to use them.
Yes, when used properly and under a physician’s supervision, retinol is safe for teens. In fact, it’s one of the most effective treatments for teenage acne. However, teens should avoid using OTC retinol products for skin rejuvenation. These products may be too harsh for younger skin.
When used correctly, retinol isn’t bad for your skin in the long term. Talk to your dermatologist about which products to use and how best to use them.
Yes, when used properly and under a physician’s supervision, retinol is safe for teens. In fact, it’s one of the most effective treatments for teenage acne. However, teens should avoid using OTC retinol products for skin rejuvenation. These products may be too harsh for younger skin.
The bottom line
Retinol and other retinoids are common and effective treatments for all forms of acne. For most people, topical retinoids are enough, especially when combined with other treatments. The main side effect is skin irritation, which is easy to manage. For more severe acne, isotretinoin (an oral retinoid) can be a life-changing option. It’s associated with more serious side effects, like birth defects and liver inflammation. But with proper monitoring, it’s a very safe and effective option.
Why trust our experts?
References
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