Topical Retinoids

What are the aims of this leaflet?

This patient information leaflet is designed to help you understand the types of retinoids used in skincare and dermatology, including over-the-counter products like retinol, and prescription topical treatments such as tretinoin.

It explains how retinoids work, what conditions they are commonly used to treat, and what to expect when starting treatment. It also outlines potential side effects, how to use retinoids safely, and what alternatives are available if they are not suitable for you.

If you and your clinician are discussing incorporating a retinoid into your treatment plan, this guide will help you make an informed decision and support these discussions.

What are Retinoids and how do they work?

Retinoids are vitamin A-derived ingredients used in skincare and dermatology. They act on the cells of the skin to help increase skin cell turnover, reduce acne, fade pigmentation, and improve fine lines and overall skin texture.

There are several types of retinoids, some of which are already in their active form, and some of which need to be converted into an active form by the skin. They vary in potency depending on how many steps it takes to convert them into their active form (retinoic acid).

Cosmetic / over-the-counter retinoids (generally milder):

• Retinyl esters (such as retinyl palmitate, retinyl acetate, retinyl linoleate): the weakest form, often included in cosmetic creams; require several conversion steps in the skin before becoming active.
• Retinol: stronger and widely available in non-prescription skincare; needs conversion in the skin before becoming active, so results develop slowly.
• Retinaldehyde (retinal): more potent than retinol, requiring fewer conversion steps, and may act more quickly.
• Granactive retinoid (hydroxypinacolone retinoate): a newer stabilised form that binds directly to retinoid receptors; designed to offer clinical benefits with less irritation than traditional forms.

Prescription-only retinoids (stronger and more effective, but with a higher risk of irritation):

• Adapalene: a synthetic retinoid commonly used for acne; usually better tolerated than tretinoin.
• Tretinoin (all-trans retinoic acid) the “gold standard” prescription retinoid for treatment of acne, pigmentation and photoageing, more potent than cosmetic forms and often associated with dryness and irritation, especially at the start.
• Tazarotene – a stronger prescription retinoid sometimes used for psoriasis and acne; usually reserved for more resistant cases.

Why might I use a topical retinoid?

Retinoids may be recommended to treat a variety of skin conditions, most commonly acne (including both inflammatory and comedonal types). They are also used to improve types of hyperpigmentation, such as melasma  and post-inflammatory dark marks, due to their effect on both skin cell shedding and melanocyte activity. They can also be used to address early signs of skin ageing, including fine lines, roughness, and loss of firmness.

Retinoids may also benefit individuals with dull or uneven skin texture, supporting a brighter and more even complexion over time. A consultation with a dermatologist or qualified clinician can help determine whether a retinoid is appropriate for your specific skin needs.

What are the benefits of retinoids?

Retinoids are not a “cure” in the traditional sense, but with consistent use, they can significantly improve many common skin concerns. They can help reduce the number and severity of breakouts, fade pigmentation, improve skin texture, and soften the appearance of fine lines. These effects develop gradually over several months and tend to be most noticeable with long-term use.

How should I use retinoids?

Treatment should be prescribed following a consultation with a healthcare professional, usually a dermatologist.

Topical retinoids (in creams or gels) are applied to cleansed skin in the evening. For most people, it is best to start by using the product every second or third night, and then gradually build up to nightly use as tolerated. A thin layer of moisturiser may be applied around 15 minutes beforehand to reduce the risk of irritation.

Initial improvements are often seen after 8 to 12 weeks, but more noticeable results typically take several months of consistent use. It is important to avoid using other active ingredients or exfoliating products – such as scrubs, chemical exfoliants, or mechanical exfoliators – while your skin adjusts, unless specifically advised by your clinician.

Retinoids are typically used as a long-term treatment to maintain and support skin health. Many people continue using retinoids for years to maintain the benefits.

What are the side effects of retinoids?

It is common to experience some mild side effects when starting a retinoid, especially during the first few weeks of treatment. These may include:

• Redness or irritation
• Dryness and flaking
• Tingling or mild stinging
• A temporary flare in breakouts (often called “purging”), as blocked pores begin to clear

The risk of side effects relates to the strength of the retinoid being used and the frequency of application. It is common to slowly increase the strength of the cream over time (such as treinoin 0.01% > 0.025% > 0.05%) and increase the frequency of application as your skin adjusts to treatment (called the retinisation period).

These effects are usually short-lived and tend to settle within four weeks as the skin adjusts. If these effects do not settle, your clinician may recommend reducing the strength or frequency of your retinoid.

Retinoids, including over-the-counter retinol, must not be used during pregnancy or breastfeeding.

Is there anything I should do or avoid whilst using retinoids?

A moisturiser can be used before application to help minimise dryness or irritation. Daily sun protection is essential, as retinoids increase the skin’s sensitivity to UV light. A broad-spectrum SPF 50 sunscreen should be applied every morning and reapplied throughout the day.

While adjusting to retinoids, it is best to keep your skincare routine simple. Use a gentle cleanser and non-comedogenic sunscreen in the morning, and apply a moisturiser followed by your retinoid in the evening. Avoid any other potentially irritating skincare products such as hydroxyacids; these can be cautiously reintroduced once your skin has adjusted after discussion with your doctor.

When should you not apply Retinoids?

Retinoids should not be used when trying to conceive, during pregnancy or when breastfeeding, as they may pose a risk to the developing baby. They should also be avoided by people with a known allergy to vitamin A derivatives.

People with very sensitive or eczema-prone skin may be more likely to experience irritation with topical retinoids. In many cases, these can still be used safely with medical advice and a personalised treatment plan.

You should also avoid procedures such as facial waxing, dermaplaning, chemical peels, or laser treatments on areas where you are using a topical retinoid, unless specifically approved by your clinician. Retinoids can make the skin more fragile and increase the risk of irritation, burns, or damage from these treatments. Always inform your practitioner that you are using a retinoid before undergoing any cosmetic or dermatological procedure.

Where can I get more information about Retinoids?

Prescription retinoids must be prescribed by a qualified healthcare professional. This is usually a dermatologist, although some GPs or prescribing pharmacists may be able to prescribe topical retinoids for acne, depending on local services.

A medical consultation is required before starting prescription retinoids. This allows your clinician to assess your skin type, medical history, and treatment goals, and to determine the most appropriate product and strength. It also ensures you receive the correct instructions for safe and effective use.

For more information, you can visit:

• NHS – Acne treatment guide
• info – https://patient.info/medicine/tretinoin-for-acne
• British Association of Dermatologists – https://patient.info/medicine/tretinoin-for-acne

This leaflet has been produced by the British Cosmetic Dermatology Group (BCDG).

Leaflet version: v1.0

Date of publication: October 2025

Planned review: October 2030