4 Tretinoin Interactions to Watch Out For

Tretinoin (Retin-A) is a prescription-only retinoid. It’s FDA approved to treat acne, but it’s also commonly used off-label for anti-aging purposes. It’s especially popular for reducing the appearance of wrinkles. 

Tretinoin comes in creams, gels, and lotions that are applied to the skin. The medication works by encouraging new skin cells to grow (and removing dead skin cells at the same time). However, tretinoin can cause skin irritation and redness, especially when you first start using it. And it’s possible that some of your other skin care products could make these problems worse.

Here, we’ll look at four types of skin care products and medications that can lead to tretinoin interactions.

Good to know: It’s hard to keep track of what interacts with tretinoin. So before using this medication, give your prescriber a list of all the medications and products you use. This includes  anything that’s over-the-counter (OTC), including skin care products. Your prescriber can help you determine if you need to make any changes to your medication regimen. They may also recommend spacing out when you use products. For example, tretinoin is typically used at night. So they may recommend using other products in the morning to prevent irritation.

1. Other retinoids

Retinoids, including tretinoin, are chemicals related to vitamin A. Using more than one retinoid at a time can make skin irritation more likely. In addition to tretinoin, some common topical retinoids are adapalene (Differin, Epiduo) and tazarotene (Tazorac, Avage). And isotretinoin (Accutane) is an oral retinoid used to treat severe acne. This medication is only prescribed after topical products haven’t worked.

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Several retinoids are available OTC under the name retinol, which is a natural form of vitamin A. Retinols are generally less potent than retinoids like tretinoin. But even though the risk is lower, they can still be irritating to the skin. So combining retinols with tretinoin is usually not recommended. Retinols may be listed on skin care product labels under various names, such as:

• Retinol

• Retinyl propionate

• Retinyl esters

• Retinaldehyde (also called “retinal”)

If you’re not sure if an OTC product contains a retinol, ask your pharmacist to check. Additionally, you should ask your dermatologist before using any new product on your skin.

EXPERT PICKS: WHAT TO READ NEXT

• How to use retinoids: Applying retinoids correctly helps minimize skin irritation and dryness. 

• Choosing a retinoid product: Retinoid products come in different forms and doses. The best one for you depends on several factors, including your skin type.

• How to save: Tretinoin (Retin-A) is available by prescription only, and there are several ways to save.

2. Acne Medications

Beyond retinoids, other acne medications can cause skin dryness and irritation. Examples include:

• Benzoyl peroxide (BenzeFoam)

• Beta hydroxy acids, such as salicylic acid

• Alpha hydroxy acids, such as glycolic acid and lactic acid

• Erythromycin gel (Erygel)

Even though these medications can cause dryness, your dermatologist may still recommend combining one of them with tretinoin. For example, tretinoin and benzoyl peroxide are sometimes used together to treat acne. If your dermatologist recommends this approach, they will give you tips on how to minimize dryness and irritation. Or they may recommend a product that’s less likely to cause dryness, such as azelaic acid (Azelex).

It’s always best to check with your dermatologist before using any new acne products if you use tretinoin, even if the product is OTC.

3. Toners and astringents

Astringents and toners can also dry and irritate skin. These skin care products are typically used after you cleanse your face. They prepare your skin for your other skin care products, allowing them to work better. But ingredients in astringents and toners can cause dryness and irritation. Some examples are:

• Witch hazel

• Salicylic acid

• Glycolic acid

• Alcohol

• Fragrances

Instead of products that contain these ingredients, look for ones that include hydrating and soothing ingredients like glycerin, hyaluronic acid, or aloe vera. These ingredients can support your skin's health and reduce irritation from tretinoin.

4. Medications that increase sun sensitivity

Tretinoin may cause sun sensitivity (photosensitivity), especially when you first start using it. This is when the skin overreacts to sun exposure, and sunburns (including severe ones) become more likely. Combining tretinoin with other medications or products that cause photosensitivity can increase this risk. Some examples are:

• Tetracycline antibiotics, like doxycycline (Vibramycin, Doryx) and minocycline

• Fluoroquinolone antibiotics, like ciprofloxacin (Cipro) and levofloxacin 

• Sulfamethoxazole / trimethoprim (Bactrim, Bactrim DS)

• Nonsteroidal anti-inflammatory drugs (NSAIDs), like naproxen (Aleve, Naprosyn) and ibuprofen (Advil, Motrin)

• Thiazide diuretics, like hydrochlorothiazide (Microzide) and chlorthalidone

Make sure all members of your healthcare team know that you’re taking tretinoin so they can look for potential interactions. In some cases, they may determine the benefits of taking one of these medications with tretinoin outweigh the risks. To prevent sunburn when taking medications that increase sun sensitivity, wear protective clothing and a hat outdoors. Apply sunscreen every 2 hours, and avoid direct sunlight when you can.

What products are safe to use with tretinoin?

Several of the skin care products discussed above, like benzoyl peroxide, may be safe and even beneficial to use with tretinoin. You’ll just want to be more careful about moisturizing, protecting yourself from the sun, and applying your products correctly. For example, your prescriber may recommend applying tretinoin correctly only once or twice a week at first, then slowly progressing to daily use. You should only apply a thin layer of tretinoin each time and combine it with a daily moisturizer to prevent dryness.

In addition to the ones listed above, there are several skin care ingredients that are known to be safe to use with tretinoin. Examples include:

• Niacinamide: Niacinamide is found in a lot of skin care products, including acne and anti-aging products. It can boost collagen and reduce sun damage. It’s moisturizing and safe to use with tretinoin.

• Hyaluronic acid: Hyaluronic acid is another ingredient you’ll find in many skin care products. It helps your skin retain moisture and can be part of a healthy skin care routine.

• Vitamin C: Vitamin C is a powerful antioxidant that has many skin benefits, including brighter skin. It can be used with retinoid products, but they should be used at different times. For example, you can apply vitamin C in the morning and your retinoid (such as tretinoin) at night.

Why trust our experts?

Written by:

Alex Evans, PharmD, MBA

Alex Evans, PharmD, MBA, has been a pharmacist for 12 years. His first job was floating in a community chain pharmacy.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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.

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