How tretinoin (Retin-A) works, choosing 0.025%, 0.05% or 0.1%, when antibiotics help, and why isotretinoin (Accutane) can’t be bought like other medicines.
How tretinoin works
Tretinoin (the active ingredient in Retin-A, and in brands sold outside the US such as Retino-A, Tretinex and Tretiheal) is a retinoid – a form of vitamin A applied to the skin. It speeds up skin cell turnover, unblocks pores and helps stop new spots forming. It's prescription-only in the US.
Choosing a strength
| Strength | Typically used |
|---|---|
| 0.025% | First prescription, or sensitive skin |
| 0.05% | After getting used to 0.025% |
| 0.1% | Acne that needs more than the lower strengths |
Your prescriber will start you on the strength that suits your skin and may increase it later.
Using tretinoin
- Apply a pea-sized amount for the whole face, once a day at bedtime, to clean, dry skin – wait 20 to 30 minutes after washing.
- Expect dryness, redness and peeling in the first few weeks; acne can briefly look worse before it improves. Results usually take 6 to 12 weeks.
- Use a moisturizer and sunscreen every day – tretinoin makes skin burn more easily.
- Don't use tretinoin if you are pregnant or planning a pregnancy, unless your doctor says so.
Antibiotics for acne
For inflamed acne, prescribers sometimes add an antibiotic such as doxycycline for a few months, usually together with a topical treatment.
Why isotretinoin (Accutane) is different
Isotretinoin capsules – sold as Absorica, Claravis and Amnesteem in the US, and as Accufine and other brands elsewhere – are very effective for severe acne but can cause severe birth defects. In the US they can only be prescribed and dispensed through the FDA's iPLEDGE program, which requires registered prescribers and pharmacies, pregnancy tests and monthly check-ins. That's why we don't sell isotretinoin, and why you should never buy it from a website that doesn't follow iPLEDGE. A dermatologist can tell you whether it's right for you.
We sell FDA-approved tretinoin cream in 0.025%, 0.05% and 0.1%, dispensed after our pharmacist verifies your prescription.