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Reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Tretinoin cream comes in a variety of concentrations, ranging from mild .005% cream to creams that contain as much as .1% tretinoin.
Like many other skincare medications, the type of tretinoin cream you choose to treat acne can have a significant effect on your results, as well as your risk of experiencing side effects.
Below, we’ve listed all of the different concentrations of tretinoin cream that are available in the United States. We’ve also explained which concentration is the optimal choice for treating and preventing acne.
We’ve also explained how tretinoin works as an acne treatment to prevent breakouts and keep your skin clear year round.
Acne vulgaris, or simply acne, is a common skin condition that develops when your hair follicles, or pores, become blocked with a mix of sebum, dead skin cells and other substances.
Just about everyone develops acne at some point in life. For some, it’s a condition that occurs in adolescence. For others, it’s a lifelong annoyance involving adult acne breakouts that can occur during a person’s 30s, 40s and even well into middle age.
Several different things all contribute to acne breakouts. One of these is sebum -- a natural type of oil that’s produced by your sebaceous glands.
When sebum builds up on the surface layer of your skin, it can seep into your pores, causing them to become clogged.
Another factor in acne is the buildup of dead skin cells that occurs over time. These cells, which are left behind by the epidermal turnover process, can mix with sebum to clog pores and cause acne to develop.
When bacteria begin to multiply inside a clogged pore, the acne can become infected, inflamed and painful.
Acne can vary hugely in severity, from small comedones to severe nodules and cysts that hurt your skin. Common types of acne include:
Inflammatory acne. These acne lesions are red, tender and occasionally painful due to the presence of bacteria. Think of a classic red, inflamed pimple. Papules and pustules are common types of inflammatory acne.
Nodular and cystic acne. These severe forms of acne develop when bacteria multiply inside acne lesions deep in your skin. Nodular and cystic acne are often challenging to treat and can leave behind acne scars.
Our guide to adult acne goes into more detail about how and why acne develops, as well as the steps that you can take to control acne breakouts.
Tretinoin is one of the most effective acne treatments available today. In fact, tretinoin and other topical acne treatments have been referred to in research as a “mainstay” of therapy for dealing with acne breakouts.
Retinoids like tretinoin work by accelerating the process through which your skin produces new cells, commonly referred to as epidermal turnover. Tretinoin also comes in a gel, which you can learn about the differences in both products from our tretinoin cream vs gel blog.
To understand how this prevents acne, we need to cover the basics of how your skin maintains and repairs itself, as well as the consequences this process can have on your skin’s texture and appearance.
Your skin has several functions. These include acting as a protective barrier against infectious pathogens, such as fungi and bacteria, as well as regulating your temperature, keeping water inside your body and shielding your organs from UV radiation and its effects.
Basically, your skin does more than just make you look good. Most of this work is done by the outer layer of your skin, which is called the epidermis.
In order to maintain itself, your epidermis constantly produces new cells to replace older, worn ones. These cells are formed in the basal layers of your skin. Over time, they gradually travel towards the surface, allowing your older skin cells to detach and shed into the environment.
This process is referred to as epidermal turnover. One way to think of it is as your skin’s way of applying a fresh coat of paint as each old layer gets worn down by the environment.
The length of the epidermal turnover process can vary based on your age and a range of other factors. For most people, the epidermis turns over once every 40 to 56 days.
So, what does this have to do with acne, and how is tretinoin involved? As we covered above, one of the biggest factors in the development of acne breakouts is the buildup of old skin cells on the surface layer of your skin.
By promoting skin cell turnover, tretinoin assists in the exfoliation of dead skin cells. This cuts down your risk of developing clogged pores that turn into comedones or other types of acne.
Beyond its ability to get rid of acne, tretinoin also has other skin benefits. It directly stimulates collagen production, which can make lines, wrinkles and other signs of facial aging lighter and less visible.
It can also improve photodamaged skin -- skin that’s rough, dry or unevenly pigmented due to exposure to sunlight.
We’ve discussed these non-acne benefits in more detail in our guide to using tretinoin to treat wrinkles and skin aging.
Tretinoin starts working as soon as it’s absorbed by your skin, but it usually takes a few months before you’ll be able to see any major improvements.
In most studies, tretinoin takes three to six months to produce noticeable improvements in acne severity. During this period, you might notice that your skin gradually gets better, or that you get fewer pimples or other types of acne.
Some people who use tretinoin for acne experience the tretinoin “purge” -- an increase in acne, skin irritation and other symptoms after starting treatment with tretinoin.
This is a temporary issue that usually passes after a few months. It’s important to hang in there and be patient after starting tretinoin.
It does work, but it may take a few months before you can see any real improvements in your skin.
In the U.S., tretinoin acne cream is available in several strengths, from .005%, to .025%, .05% and .1%.
The weakest tretinoin cream contains .005% tretinoin, or approximately 5% as much tretinoin as the strongest .1% cream.
You can also purchase .025% and .05% strength tretinoin creams, although not all brands offer tretinoin in these concentrations.
Tretinoin is a safe and effective medication for most people. However, like all medications, it has the potential to cause adverse effects. The tretinoin strength can also affect these side effects.
Most of these are mild and temporary, but there are a few that you should be aware of before using any product that contains tretinoin.
Potential side effects of tretinoin include:
A warmth or stinging sensation
Red, scaling or dry skin
A temporary increase in acne lesions
Lightening or darkening of your skin
Blisters, crusting and skin swelling
Pain, burning, redness or flakiness
Tretinoin may also cause more severe side effects, particularly if you have sensitive skin or skin that’s easily irritated by topical treatments.
Make sure to contact your healthcare provider if you experience severe irritation, hives, itching or pain after applying topical tretinoin.
One additional side effect of tretinoin that’s important to know is that it can increase your skin’s susceptibility to sunlight, causing you to become sunburned more easily.
If you use tretinoin, it’s important to take care in sunny weather. Use protective clothing to keep your face shielded from bright sunlight, apply sunscreen and avoid considerable sun exposure, even if it’s artificial sunlight, as much as possible.
Like with most skin medications, the stronger concentrations of tretinoin cream tend to have the most significant results.
In a 1991 study, researchers found that .05% tretinoin cream produced a larger improvement in wrinkling, post-inflammatory skin hyperpigmentation, skin laxity and thickness when compared to weaker .01% tretinoin creams and a non-therapeutic placebo.
Other studies have also produced similar findings -- that higher concentrations of tretinoin tend to produce more noticeable improvements in skin quality than lower-strength tretinoin creams.
In short, the more tretinoin a cream contains, the more likely it is to treat acne and improve skin clarity and quality.
However, this doesn’t always mean that a strong concentration of tretinoin is the best option for you.
Creams with a higher concentration of tretinoin tend to be the most effective at preventing acne and premature skin aging, but they’re also more likely to produce side effects.
For example, one 1995 study found that while .1% and .025% tretinoin produced similar results in overall improvement in photoaging of the face, the stronger form of tretinoin had “statistically significantly greater” side effects, including redness and skin peeling.
In short, creams and gels with a higher concentration of tretinoin are associated with a greater level of skin improvement, but they also tend to have a higher risk of causing irritation, peeling, redness and other common and uncommon side effects.
Because everyone’s skin is different, there’s no “best” concentration of tretinoin cream for the treatment of acne.
Most people that use tretinoin, whether for acne prevention or in an anti-aging cream, use a variety of different concentrations over the years before choosing the type of cream that best suits their skin.
In the United States, most healthcare providers start by prescribing patients .01% (low strength) tretinoin cream, which provides an optimal combination of effectiveness and tolerable side effects for most patients.
If this cream isn’t effective at treating your acne, your healthcare provider may recommend switching to a stronger tretinoin cream.
If side effects such as skin irritation, redness or peeling occur, your healthcare provider might recommend switching to a lower strength tretinoin cream, using the cream less frequently, or applying an alcohol-free face moisturizer in combination with the tretinoin cream to prevent dryness.
Finally, it’s important to remember that tretinoin often causes the most significant side effects during the first two to six weeks of use.
This means that even at the perfect concentration and dosage, there’s still some potential risk that you might experience irritation and other “purge” effects when you start treatment.
In the United States, tretinoin requires a prescription, meaning you’ll need to talk to a licensed healthcare provider before you can purchase and use it.
Once you have a prescription, you can purchase tretinoin from most pharmacies. It’s available under a variety of brand names, including Retin-A®.
Alternatively, you can get tretinoin online in products such as our Customized Acne Cream.
Designed specifically to treat stubborn acne and skin issues, it uses a tailored formula to stop acne through the power of science-based ingredients like tretinoin and niacinamide.
Tretinoin comes in numerous strengths, from mild .005% creams all the way up to the strongest .01% cream.
It’s best to start with a mild tretinoin formulation, then adjust your tretinoin cream or other treatment based on your acne severity and response.
Tired of dealing with acne? Our range of skin care products includes proven options for stopping acne breakouts, getting rid of fine lines and improving your skin’s texture, appearance and function.
You can also learn more about treating acne breakouts with tretinoin in our full guide to tretinoin for acne.
Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.