Tretinoin for Acne: 5 Side Effects and How to Manage Them

Having acne can be frustrating at any age, but topical retinoids may be the answer. Tretinoin is a potent prescription retinoid that’s available as creams, gels, and lotions. You may know it by many names, such as Retin-A, Atralin, and Avita.

Although tretinoin has several benefits, it’s not without side effects. Skin irritation is a common complaint from treatment. This may vary between tretinoin products. But, remember, everyone’s skin is different. Your dermatologist can help you find the best option for you.

So, what tretinoin side effects are possible, and is there anything you can do to prevent them? Below, we cover what you should know about five tretinoin side effects.

Promotion disclosure

Manufacturer exclusive discount

Retin-A

Avg retail price

$27.99(Save 49.05%)

GoodRx discount

$14.26

See all discounts

How it works

Use GoodRx to find medications, pharmacies, and discounts.

GoodRx discounts can help you pay less for your prescription.

Bring your free coupon or savings card to the pharmacy.

1. Skin irritation

When you first start tretinoin, you may notice that your skin appears dry, flaky, or red. And if you have sensitive skin, these effects may appear stronger. Your acne may even get worse in the beginning. Don’t fret! This is normal and known as a skin purge or flare. Over time, both your acne and skin irritation should improve.  

Tretinoin-treated skin should be handled gently. Here are ways you can prevent or lessen skin irritation from tretinoin:

• Ask your dermatologist about starting with a lower-strength tretinoin product.

• Start by applying tretinoin 1 to 2 times per week to ease into use.

• Always clean your hands and face before applying tretinoin.

• Use a pea-size amount for your whole face and don’t layer the product.

• Moisturize well before and after using it.

• Avoid applying tretinoin at the same time as other topical medications.

• Steer clear of sensitive areas, cuts, or rashes.

• Keep tretinoin away from the skin around your eyes and mouth.

• Don’t pick or peel dry skin.

• Try not to rub or exfoliate harshly.

• Avoid applying makeup over irritated skin.

If skin irritation is still an issue, talk to your dermatologist about other tips for managing it during treatment.

2. Skin color changes

Tretinoin can change the color of your skin. For some people, this can be a desired effect of the medication. That’s because tretinoin is sometimes prescribed off-label to treat dark spots or melasma. In these cases, lightening the skin spots is the goal.

But other times, tretinoin may cause too much lightening (hypopigmentation) or darkening (hyperpigmentation) of your skin. For acne, it may be an unintended side effect of the medication.

Keep in mind: Not everyone will experience skin color changes from tretinoin. But if you notice any unwanted changes, notify your dermatologist. They may need to adjust your skin care regimen.

3. Sun sensitivity

The areas where you apply tretinoin can become more sensitive to the sun. That’s because tretinoin reduces the outer layer of the skin, which then allows sunlight in faster. This means you can get sunburned quicker and your skin can be more easily damaged. To combat this, sun protection is key while using tretinoin. Here are a few tips:

• Stay inside when sun exposure is the strongest (10 AM to 4 PM)

• Stick to shady areas when outside

• Apply tretinoin at night and wash it off in the morning  

• Wear sunscreen (with SPF 30 or more) daily

• Never use tanning beds or booths

• Make sure to use protective clothing, hats, and sunglasses

4. Harm to a fetus during pregnancy

Topical tretinoin’s effects during pregnancy haven’t been well studied. But, animal studies have shown that tretinoin causes harm to the fetus. And we don’t know if tretinoin use during nursing is safe, either.

Because of this, most experts would recommend against using tretinoin if you’re pregnant. And if you’re planning to become pregnant, you may be advised to stop tretinoin at least one month before you start trying to conceive. Pregnant women also shouldn’t touch or handle the tretinoin with their bare hands. And if you’re nursing, talk to your dermatologist about safer alternatives.

We don’t know if there’s an increased risk of birth defects from men who use tretinoin when conceiving a child. But generally, the exposure risk is low in this case.

5. Allergic reaction

Tretinoin products may cause an allergic reaction. The risk of a true allergy to the main ingredient (tretinoin) is low. It’s actually the inactive ingredients that are more likely to cause an allergic reaction. 

Because of this, it’s important to review all the ingredients of your tretinoin product with your dermatologist or pharmacist. This way you can check for any known allergies you may have to the medication components. Atralin, for example, contains fish protein (fish collagen hydrolyzates). If you have any allergies to fish, you shouldn’t take this version of tretinoin.  

If you do have an allergic reaction, you should wash the treated area immediately. You may need to treat the area with Benadryl (diphenhydramine) or a topical steroid. If your symptoms seem severe or worsen, call your provider for further guidance. 

Do not reattempt using tretinoin after an allergic reaction. Your dermatologist can discuss alternative options to treat your acne.

When should you contact your healthcare provider about tretinoin side effects?

Certain tretinoin side effects may be mild and managed easily with a few tweaks to your skincare routine. But there are situations when you should contact your dermatologist. They can provide ways to help reduce these effects. Ask for help if:

• Your side effects continue or are worsening

• Your side effects are severe

• You can’t manage your side effects on your own

• Your skin feels itchy and hot

• You’re worried you might have a skin infection

• Touching your skin feels painful 

• You develop hives or blisters

Why trust our experts?

Written by:

Niousha Nader, PharmD, BCCCP

Niousha Nader, PharmD, BCCCP is a critical care and geriatric specialist. She has over 12 years of hospital experience, which also includes pediatric, emergency, surgical, and oncologic pharmacy.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Our editorial standards

Meet our experts