Do you continue applying tretinoin (all-trans retinoic acid) when peeling occurs after initially starting treatment?

Managing Tretinoin-Induced Peeling During Initial Treatment

Yes, you should continue applying tretinoin when peeling occurs during the initial treatment phase, but with modified application techniques to minimize irritation while maintaining therapeutic benefits. 1, 2

Understanding Tretinoin-Induced Peeling

Tretinoin (all-trans retinoic acid) is a cornerstone topical therapy for acne treatment. The peeling effect is a normal part of the skin's adaptation process:

• Peeling, dryness, and mild irritation are expected side effects during the first 2-4 weeks of treatment 1
• These reactions represent your skin adjusting to the medication and typically subside within 2-4 weeks of continued use 2
• By 3-6 weeks, you may notice new blemishes (papules and pustules) - this is part of the purging process and not a reason to discontinue 2

Recommended Approach When Peeling Occurs

Step 1: Modify Application Technique

• Reduce frequency of application (every other night instead of nightly) 2
• Use the "short contact" method: apply for 30-60 minutes, then wash off
• Apply a smaller amount - a pea-sized quantity should cover the entire face 2
• Wait 20-30 minutes after washing face before applying tretinoin (skin must be completely dry) 2

Step 2: Enhance Skin Barrier Support

• Apply a non-comedogenic moisturizer every morning 2
• Consider applying moisturizer before tretinoin (buffer technique) to reduce irritation
• Avoid other potentially irritating products (exfoliants, alcohol-based toners)
• Use gentle cleansers only

Step 3: Continue Treatment with Patience

• Do not stop treatment at first signs of improvement 2
• Significant improvement typically requires 6-12 weeks of consistent therapy 2
• Once acne is under control, continue regular application as directed by your physician 2

Important Cautions

• Keep tretinoin away from corners of nose, mouth, eyes, and open wounds 2
• Some tretinoin formulations should be applied in the evening due to photosensitivity 1
• Use daily sunscreen to reduce risk of sunburn 1
• Avoid applying tretinoin with benzoyl peroxide simultaneously (unless using formulations specifically designed to be stable together) 1

When to Contact Your Doctor

• If irritation becomes excessively troublesome or severe 2
• If peeling and irritation do not subside after 4 weeks of adjusted use
• If you develop signs of allergic reaction (severe burning, swelling, blistering)

Remember that tretinoin works deep inside your skin and requires time to show results. Continuing treatment through the initial adjustment period is essential for achieving the best outcomes in acne management.