Tretinoin (Altreno, Atralin, Avita, Retin-A) is used to treat acne. Tretinoin is also used to reduce fine wrinkles (Refissa and Renova), improve spotty discoloration (Renova) and treat rough feeling skin (Renova) alongside other skincare and sunlight avoidance programs.¹ Tretinoin belongs to a class of medications called retinoids and works by unclogging pores and promoting the peeling of affected skin areas.²

Tretinoin (Retin-A) is in a class of medications called retinoids. It works by promoting peeling of affected skin areas, unclogging pores and encouraging new cell growth.^{3, 4}

Tretinoin comes as a lotion (Altreno), cream (Avita, Refissa, Renova, Retin-A) and gel (Atralin, Avita, Retin-A) and is typically applied daily at bedtime. Follow the directions on your prescription label carefully and be sure to ask your doctor or pharmacist to explain anything you do not understand. Use tretinoin exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Tretinoin controls acne but does not prevent it. During the first seven to 10 days of treatment, your acne can temporarily worsen with red, scaling skin and an increase in acne sores. With continuous use, improvement can be seen in two to three weeks, although it can take more than six weeks for some people.

Tretinoin may reduce fine wrinkles, spotty discoloration and rough feeling skin but does not prevent them. These issues may take three to four months or up to six months to improve. If you stop using tretinoin, the improvement may gradually disappear.

Use only nonmedicated cosmetic items on clean skin. Do not use a topical product with a lot of alcohol, menthol, spices or lime, such as shaving lotions, cleansers and perfumes. These products can sting your skin, especially when you first use tretinoin.

Do not use any other topical medications, especially benzoyl peroxide, hair removers, salicylic acid (wart remover) and dandruff shampoos containing sulfur or resorcinol, unless your doctor directs you to do so. If you have recently used any of these topical medications, tell your doctor and ask if you should wait to use tretinoin.

Your doctor may tell you to use moisturizer to help with dryness.⁵

If you are to apply any form of tretinoin (Retin-A), follow these steps:⁶

1. Wash your hands and affected skin area thoroughly with mild, bland soap and water. Do not use a medicated or abrasive soap or soap that dries the skin. Wait 20 to 30 minutes for your skin to dry before applying tretinoin.

2. Use clean fingertips to apply the medication.

3. Use enough medication to cover the affected area with a thin layer.

4. Apply the medication to the affected skin area only. Do not apply on areas of sunburn. Do not let tretinoin get into your eyes, ears, mouth, corners along your nose or vaginal area.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient so you have this information readily available.

RedBox Rx prescribes brand-name Retin-A cream and generic tretinoin cream in 0.025%, 0.05% and 0.1% doses. The stronger the concentration of the active ingredient tretinoin in the cream, the faster and more visible the results. However, the stronger concentrations may come with more side effects.

Usually it takes two to three weeks to see improvements in acne with tretinoin (Retin-A) cream. Acne may get worse in the first week or so, before it gets better. Keep using tretinoin for at least three weeks to assess results for acne.

For fine lines, discoloration and skin texture, it can take three to six months to see visible results. Tretinoin cannot prevent skin aging but it can reduce signs. You must maintain regular, continued use to keep enjoying the anti-aging benefits of tretinoin.⁷

Before using tretinoin (Retin-A):⁸

• Tell your doctor and pharmacist if you are allergic to tretinoin, fish (if taking Altreno), any other medications, or any of the ingredients in tretinoin lotion, cream or gel. Ask your pharmacist for a list of the ingredients.

• Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements and herbal products you are taking or plan to take. Be sure to mention any of the following: certain antibiotics such as tetracyclines; antihistamines; diuretics (“water pills”); fluoroquinolones such as ciprofloxacin (Cipro), delafloxacin (Baxdela), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox) and ofloxacin; medications for mental illness and nausea; or sulfonamides such as co-trimoxazole (Bactrim, Septra), sulfadiazine, sulfamethizole (Urobiotic) and sulfisoxazole (Gantrisin). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• Tell your doctor if you have or have ever had eczema (a skin disease), actinic keratoses (scaly spots or patches on the top layer of the skin), skin cancer or other skin conditions.

• Tell your doctor if you are pregnant, plan to become pregnant or are breastfeeding. If you become pregnant while using tretinoin, call your doctor.

• Plan to avoid unnecessary or prolonged exposure to sunlight or ultraviolet light (tanning beds and sunlamps) and to wear protective clothing, sunglasses and sunscreen. Tretinoin may make your skin sensitive to sunlight or ultraviolet light.

• You should know that weather extremes, such as wind and cold, may be particularly irritating.

Apply the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not apply extra cream, lotion or gel to make up for a missed dose.⁹

Tretinoin (Retin-A) may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:¹⁰

• Warmth or slight stinging of the skin

• Lightening or darkening of the skin

• Red, scaling skin

• Increase in acne sores

• Swelling, blistering or crusting of the skin

• Dryness, pain, burning, stinging, peeling, redness or flaky skin at the treatment area

Some side effects can be serious. If you experience any of these symptoms call your doctor immediately:

• Itching

• Hives

• Pain or discomfort at the treatment area

Tretinoin may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

If you stop using tretinoin (Retin-A) cream, any results you experienced may disappear. Tretinoin cream works best when used consistently.¹¹

Name-brand Retin-A cream and generic tretinoin cream require a prescription and are not available over the counter.¹²

There are retinol products available over the counter that have similar properties in lesser strengths. It takes longer to see results and overall results tend to be less significant than with prescription tretinoin cream.

At RedBox Rx, name-brand Retin-A cream costs $40 to $60 per month and generic tretinoin cream costs $20 to $35 per month, depending on the quantity purchased. Our online consultation for acne or anti-aging costs only $25. RedBox Rx has one of the lowest prices of Retin-A and tretinoin cream available.

Yes, tretinoin (Retin-A) cream will expire. Most tubes will have an expiration date to help you know if the medication has expired.

Retin-A cream requires a prescription.¹³ Start an online doctor consult for acne or anti-aging with RedBox Rx to determine if Retin-A cream or generic tretinoin cream is right for you.

Dermatologists recommend using simple moisturizers with tretinoin (Retin-A) cream. Try finding a moisturizer that has ceramides, hyaluronic acid or humectants, but no other active ingredients. Ingredients like fragrance can irritate the skin when used with tretinoin cream.¹⁴

Keep this medication in the container it came in, tightly closed and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not allow the medication to freeze.¹⁵

Unneeded medications should be disposed of in special ways to ensure that pets, children and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location, out of their sight and reach. http://www.upandaway.org

If someone swallows tretinoin (Retin-A), call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Keep all appointments with your doctor.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Altinac®

• Altreno®

• Atralin®

• Avita®

• Refissa®

• Renova®

• Retin-A®

• Tretin X®

We offer a variety of prescription medication options for acne, including:

• Tretinoin cream (generic Retin-A®)

• Tretinoin gel (generic Retin-A®)

• Adapalene gel (generic Differin®)

• Tazarotene 0.1% cream (generic Tazorac®)

• Benzoyl peroxide

• Clindamycin phosphate solution (generic Cleocin T®)

• Metronidazole cream (generic MetroCream®)

• Metronidazole gel (generic MetroGel®)

• Spironolactone (generic Aldactone®)

We offer a variety of prescription medication options for anti-aging, including:

• Tretinoin cream (generic Retin-A®)

• Tretinoin gel (generic Retin-A®)

• Tazarotene 0.1% cream (generic Tazorac®)

• Adapalene gel (generic Differin®)

• Azelaic acid 15% gel (generic Finacea®)

• Hydroquinone 4% cream (for melasma, dark spots)

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15. Mayo Clinic