How to Get Started With Tretinoin
Thinking about switching from over-the-counter retinoids to prescription tretinoin? Here’s what you need to know about the key differences, benefits, and potential downsides to find out if making the jump is worth it for your skin.
Look, I get it. When it comes to skincare, it’s tempting to jump to the strongest, most potent version of any ingredient. And with prescription retinoids getting easier to obtain (I got mine from an online pharmacy after a simple video consult), it’s easy to wonder if you should skip all those over-the-counter (OTC) products and just go straight for the hard stuff.
When I made the decision to switch to prescription tretinoin earlier this year—after years of using OTC retinoid products—I was surprised by how…umm, tricky…the transition ended up being. Turns out, despite my status as a retinol veteran, my skin was still woefully underprepared for the real step-up in potency that comes with a switch to the prescription stuff. For the first time in my life, I ended up with a damaged skin barrier, uncontrollable breakouts, itchiness, redness—all at once. It took me months to recover from the damage.
But here’s the good news. There was light at the end of this nightmarish tunnel for me, because I was able to eventually claw my way out of retinoid purgatory by taking a safer, more skinimalist approach to my skincare. Lucky for you, I’m here to share all the mistakes I made, so you can decide if a prescription retinoid is right for your skin, and how to incorporate it safely into your skincare routine.
The Difference Between OTC and Prescription Retinoids
I’ve written a much more in-depth blog post about the different kinds of retinoids, and some good OTC product options for each, so do check that out if you’re totally new to this. But, in short, there are a few different kinds of retinoids that are currently popular and fairly easily available in most markets. They are:
Retinol (with an ‘o’):
The most common retinoid in OTC products, it has to first be converted to retinoic acid (the active form of vitamin A) through a two-step oxidation process before it can fully be absorbed by your skin.
Retinal (with an ‘a’)
Also known as retinaldehyhde, this increasingly popular OTC retinoid is a step closer to retinoic acid in terms of potency, requiring fewer conversions in the skin to become active. This makes it more effective than retinol, and potentially less irritating too.
Adapalene
Formerly prescription-only, adapalene is a synthetic retinoid that’s now available over-the-counter in many countries. Like other retinoids, it provides anti-aging benefits, but is much more widely used for its acne-fighting properties. It is already in an active form.
Tretinoin:
The gold standard of anti-aging, tretinoin is a prescription retinoid that is highly effective for treating acne, reducing hyperpigmentation, and improving skin texture. It requires no conversion in the skin to become active.
The main difference between them all? To put it simply, most OTC retinoids need to be converted to the active form of retinoic acid before they can be absorbed by our skin. A prescription retinoid like tretinoin, on the other hand, is already in the active form. That means it works faster, potentially goes deeper into your skin, and can, in theory, provide quicker, more dramatic results.
But, of course, there’s a catch. For most people, the prescription stuff is harsher, and far more irritating, especially at first. Some people with especially sensitive skin can never get used to the potency of a prescription strength retinoid, so it’s important to make sure your skin’s ready before making the switch.
When You Should Take the Step Up to a Prescription Retinoid
So, how do you know if the retinoid risk is worth the retinoid reward? Here are a few things I considered before stepping up to prescription strength:
1. Evaluate your skin’s needs
If you’re in your 20s with no signs of aging to speak of, you may not actually need a retinoid at all, let alone a prescription strength retinoid. If you have sensitive or dry skin, you may want to proceed very cautiously, and test out how your skin reacts to low concentrations of an OTC retinoid first.
Everyone’s skin has different needs and goals, and despite how effective an ingredient is, it may not be right for you.
2. Exhaust your OTC options first
If you definitely want to include a retinoid in your routine, start with OTC options first. Unless you’re on a derm-prescribed skincare routine, there’s no rush to take the jump up.
Tretinoin is something I worked my way up to only after using OTC retinol, retinal and adapalene first—and over a period of roughly 6 years. I started with the lower strength stuff, slowly building up my skin’s tolerance, making sure that I could use these products consistently without irritation. I only reached for a prescription when I felt like my results were plateauing.
3. Take Stock of the Rest of Your Routine
There aren’t a lot of actives that play nice with prescription retinoids, so be prepared to get rid of most other products—including AHAs, BHAs, and vitamin C—from your night-time skincare routine (and yes, please only use tretinoin at night!). If this isn’t something that works for your current skincare goals, I would reconsider if this is the right next step for you.
How to Get Started With Tretinoin (Without Destroying Your Skin)
If like me, you’ve thought through all the concerns above, and have decided that a prescription strength retinoid is the right next step in your skincare journey, then let’s get ready for the tricky part. Here are all the things I wish someone had told me when I first got started with tretinoin. The lessons learnt from the major mistakes made. How you start with a prescription retinoid will determine how your journey with it goes, so these are some things you can do to make the transition easier:
1. Start low and slow
Most derms will prescribe the lowest percentage of tretinoin for first-timers (usually 0.025%), and no matter how experienced you think you are, I encourage you not to go for anything stronger. I started at 0.025%, and even then, it went…badly.
Cap the frequency of usage to about 2-3 times a week at most in the beginning, even if you were previously using an OTC retinoid every night (yep, been there too). Gradually increase the frequency of usage IF YOU NEED IT. Today, after nearly a year of usage, I use my prescription retinoid on every alternate night.
2. Make sure your skin is completely dry before you go in
For me, applying tretinoin first thing after cleansing has worked best, and there’s a reason for that. Applying it on damp skin can cause it to absorb faster than your skin can handle, and intensify irritation in the process. I wait about 5-10 minutes after washing my face, so my skin is absolutely bone dry before I apply tretinoin. The one exception to this rule is if you have extremely sensitive, dry skin and you’re using the sandwich method, which involves applying a moisturizer as a buffer before your retinoid to slow down its absorption (yes, it’s confusing, I know). In that case, make sure you’re using a thick, occlusive moisturizer before your retinoid.
3. Apply the thinnest layer you possibly can
You may have heard people talk about applying a “pea-sized” amount, and they’re absolutely right. Retinoids are not like moisturizers that have to be slathered on, all you need is enough to cover your skin with a thin layer. Seriously, a little goes a long way with this stuff, so get some peas out of the freezer to measure how much you need if you have to.
4. The rest of your routine is just as important
So, you’ve applied your tretinoin, now what? Let me tell you, what you decide to follow it up with is just as important. I like to keep the rest of my routine very simple by focusing on hydrating and soothing ingredients which support skin barrier function. On my tretinoin nights, my routine goes something like this: tretinoin, followed by a hydrating toner and/or barrier serum, followed by a moisturizer and an eye cream (because my eye area’s too sensitive for tret). This is where Korean skincare, with its focus on hydration and barrier support has been a game changer for me.
Here a few of my favorite products to apply alongside tretinoin, but the main idea is to avoid any strong active ingredients that could potentially sensitize your skin, and opt for skin soothing ingredients instead :
Full disclosure: I do make a teeny little commission from these links, so consider supporting my blog if you found this article helpful
5. If all else fails, try the sandwich method
If you’ve tried all the steps above and are still experiencing discomfort, try the sandwich method. This involved sandwiching your tretinoin between 2 layers of moisturizer. One layer of moisturizer gets applied before your tretinoin and acts as a buffer between your skin, and the second layer gets applied as per usual after your tretinoin. This may slow down the efficacy of the retinoid, but is a good way to ease your skin into using it.
6. Sunscreen, the next morning, is non-negotiable
All retinoids make your skin especially sensitive, and tretinoin is the mother of all retinoids—so expect the mother of all sun sensitivity the day after you use it. For maximum protection, make sure you apply at least SPF30 religiously during the day (and re-apply it every 3-4 hours if you’re going to be outside).
Final Thoughts: Long-term Consistency Over Short-term Results (and Irritation)
I started this post by talking about how tempting it can be to rush headfirst into the world of prescription retinoids, and I’ll end this post with the same wisdom. Starting slow may not give you immediate, dramatic results, but it will give your skin the chance to acclimatize to this new and potent ingredient. That’s what you need to aim for.
Targetting the big results led me into a vicious start-stop cycle, where I’d use my prescription retinoid for a couple of weeks, and then have to take a break from it for a couple of months because of how bad the irritation got. Today, I can use it every alternate night, without the side effects, and it’s because I prioritized long-term consistency over short-term results. I hope this post helps you do the same.
About The Skinimalist
Hi, I’m Mal, a 30-something recovering skincare addict, and this is my blog. A space where I attempt to de-influence you from chasing trends and buying more skincare products you may not need.
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