Dermatology
Topical retinoids
Vitamin-A skin treatments for acne (e.g. adapalene, tretinoin) — Vitamin-A creams and gels that unblock pores and are a mainstay of acne treatment.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
Quick answer
What is Topical retinoids?
Topical retinoids are vitamin-A-derived creams and gels used mainly for acne. They clear and prevent the blocked pores that cause spots, and also improve skin texture.
- How it works: They speed up the turnover of skin cells lining the pores, stopping them clogging and helping existing blockages clear, which reduces both blackheads and inflamed spots.
- In practice: In practice topical retinoids are a cornerstone of acne treatment, working on the blocked pores that drive blackheads, whiteheads and spots, and often combined with a topical antibacterial such as benzoyl peroxide.
What it is
Topical retinoids are vitamin-A-derived creams and gels used mainly for acne. They clear and prevent the blocked pores that cause spots, and also improve skin texture. They are applied directly to the skin.
How it works
They speed up the turnover of skin cells lining the pores, stopping them clogging and helping existing blockages clear, which reduces both blackheads and inflamed spots. This same increase in cell turnover causes the early dryness and peeling, and makes skin more sensitive to the sun.
In practice
In practice topical retinoids are a cornerstone of acne treatment, working on the blocked pores that drive blackheads, whiteheads and spots, and often combined with a topical antibacterial such as benzoyl peroxide. Three practical points decide success and tolerability. First, they commonly cause an initial phase of dryness, redness, peeling and even a temporary flare in the first few weeks — warning people about this, starting gradually (a thin amount, every other night at first) and using a non-greasy moisturiser greatly improves adherence. Second, they increase sun sensitivity, so they are applied at night and daily sunscreen is advised. Third, oral and topical retinoids are linked to birth defects, so topical use is generally avoided in pregnancy and anyone who could become pregnant is counselled. Results build over two to three months, so persistence matters; stopping early because "it made my skin worse first" is the usual reason treatment fails.
Examples
Practical use
How to take it & use it well
- Apply a thin, pea-sized amount across the whole affected area at night, rather than dabbing it only on individual spots, as it works by preventing new blemishes forming.
- Wash and gently dry your skin first and wait until it is fully dry before applying, as putting it on damp skin can increase irritation.
- Start by using it less often, such as every other night, then build up as your skin gets used to it, since redness, dryness and peeling are common at first.
- Use a non-greasy moisturiser and a daily sun cream, as these treatments make the skin more sensitive to sunlight and can be drying.
- Be patient and keep going, as acne can seem to worsen in the first few weeks before it improves, and full benefit takes a couple of months.
- These creams and gels must not be used in pregnancy or when trying to conceive, so use reliable contraception and ask for advice if this applies to you.
Common uses
- Acne (blackheads, whiteheads and inflamed spots)
- Often combined with benzoyl peroxide or a topical antibiotic
- Some are used for skin texture/photoageing
Monitoring
- Acne response over 2–3 months
- Skin irritation and tolerability
- Pregnancy status/contraception where relevant
Weighing it up
Advantages & disadvantages
Advantages
- They are an effective treatment for many types of acne, especially blackheads and whiteheads, and help prevent new spots.
- They are applied to the skin, so very little is absorbed compared with treatments taken by mouth.
- Over time they can improve skin texture and reduce the marks left by acne.
- They can be combined with other acne treatments to tackle different aspects of the condition.
- They are well established and available in several strengths and forms to suit different skin.
Disadvantages
- They commonly cause dryness, redness, peeling and stinging, particularly in the first few weeks.
- Acne can appear to flare before it gets better, which can be discouraging.
- They make the skin more sensitive to sunlight, so sun protection is needed.
- They should not be used in pregnancy or when trying to conceive.
- They take time to work, so results are gradual rather than immediate.
Key safety principles
What to watch for
- Expect early dryness, redness and peeling (and sometimes a temporary flare) — start gradually and moisturise.
- Increase sun sensitivity — apply at night and use daily sunscreen.
- Avoid in pregnancy and if trying to conceive (retinoids are linked to birth defects).
Key interactions
What to avoid or check alongside
- Using harsh scrubs, strong soaps or other peeling agents at the same time can add to dryness and irritation.
- Applying other strong active skincare, such as certain acids, at the same time of day can overload and irritate the skin.
- Strong sun exposure and sunbeds increase the risk of burning and irritation while using these treatments.
- Combining them with other acne medicines should be guided by a pharmacist or prescriber so the skin is not over-treated.
- Waxing the treated area can damage sensitised skin, so it is best avoided.
Patient & carer advice
- Use a pea-sized amount at night, starting every other night, and moisturise to ease dryness
- It can make skin worse for a few weeks before it improves — keep going
- Wear sunscreen daily and do not use it if you are or might become pregnant
Answers
Topical retinoids: frequently asked questions
Why has my acne got worse since starting a retinoid?
It is common for acne to seem to flare in the first few weeks as the treatment brings blemishes to the surface. This usually settles, and the skin improves over a couple of months, so keep going unless the irritation becomes severe.
Can I use a retinoid cream while pregnant?
No, topical retinoids are not recommended in pregnancy or when trying to conceive. If you are pregnant, planning a pregnancy, or could become pregnant, speak to your GP or pharmacist about safer acne treatments.
How do I stop my skin getting so dry and red?
Start by using it only every other night and build up slowly, apply a thin layer to dry skin, and use a gentle moisturiser. Avoid harsh scrubs and other strong actives at the same time, as these add to irritation.
Should I put it only on my spots?
No, apply a thin layer across the whole affected area rather than spot-treating, because it works mainly by stopping new blemishes forming. Treating the full area helps prevent future breakouts.
Do I really need sun cream with this?
Yes, these treatments make your skin more sensitive to sunlight, so you burn more easily. Use a daily sun cream and avoid strong sun and sunbeds while you are using a retinoid.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
Related guides
Medicines in this class
Common topical retinoids by active ingredient
Individual, dose-free guides to specific medicines in this class:
Used for
Conditions this class is used to treat
See how this class fits into the wider treatment picture for each condition:
Browse by body system
Part of the skin, hair & nails
See all the conditions, medicine classes and active-ingredient guides for this body system in one place:
Need a custom medicines or prescribing resource?
We build evidence-led clinical references, calculators and decision aids for teams.