Retin-A (Tretinoin) 0.025% Usage Guidelines and Precautions

Application Instructions

Apply tretinoin 0.025% once daily at bedtime to clean, completely dry skin, waiting 20-30 minutes after washing to minimize irritation. 1

Cleanse and wait: Wash face with mild soap, dry gently, then wait 20-30 minutes for skin to be completely dry before application 1
Amount: Use approximately half an inch or less of cream for the entire face 1
Technique: Dab medication on forehead, chin, and both cheeks, then spread lightly over the entire affected area until invisible 1
Avoid sensitive areas: Keep away from corners of nose, mouth, eyes, and open wounds 1
For sensitive skin: Start with every-other-night application, then advance to nightly as tolerated 1

Minimize sun exposure during tretinoin use and avoid sunlamps entirely, as tretinoin significantly increases photosensitivity. 1

Use sunscreen products and protective clothing over treated areas when sun exposure cannot be avoided 1
Patients with sunburn should not use tretinoin until fully recovered 1
Those with occupational sun exposure or inherent sun sensitivity require particular caution 1

Expect 3-6 weeks before noticing improvement, with optimal results at 6-12 weeks of continuous therapy. 1

Initial 2-4 weeks may involve discomfort, peeling, or skin "blushing" as skin adjusts 1
New blemishes (papules and pustules) may appear at 3-6 weeks—this is expected and requires continuing treatment 1
Once acne is controlled, continue regular application until physician instructs otherwise 1
Do not increase frequency beyond once daily, as this will not accelerate results but will increase irritation 1

Avoid concomitant use with other potentially irritating topical products, particularly those containing sulfur, resorcinol, or salicylic acid. 1

Discontinue medicated or abrasive soaps, products with strong drying effects, and high-alcohol content products 1
"Rest" skin from other active preparations before starting tretinoin 1
Never apply tretinoin simultaneously with benzoyl peroxide, as oxidation will inactivate tretinoin 2
Avoid waxing for hair removal due to increased skin fragility 2

Tretinoin is pregnancy category C and should be used with caution in women of childbearing potential. 1

While topical tretinoin has lower systemic absorption than oral retinoids, pregnancy testing and contraception discussions are prudent 2
Systemic retinoids like acitretin require strict contraception for 3 years after treatment, but topical tretinoin does not carry this same requirement 2

If severe irritation occurs, reduce application frequency, discontinue temporarily, or stop use altogether depending on severity. 1

Apply moisturizer or non-comedogenic moisturizer with sunscreen every morning after washing 1
Tretinoin may cause severe local erythema and peeling at application sites 1
Use with utmost caution in patients with eczematous skin 1
Weather extremes (wind, cold) may increase irritation 1

Store tretinoin 0.025% cream below 80°F (27°C). 1

Over-application: Using more than recommended amount increases irritation without improving efficacy 1
Premature discontinuation: Stopping at first signs of irritation or before 6-12 weeks prevents seeing therapeutic benefit 1
Daytime application: Evening application is preferred due to photolability of some formulations 2
Combining with incompatible products: Simultaneous use with benzoyl peroxide or other irritants reduces efficacy and increases adverse effects 2, 1