Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 5/22/2021
Acne medications can be a confusing maze of topicals, treatments, scrubs, moisturizers and astringents that seems impossible to navigate.
Maybe you understand the basics — hydration good, dryness bad — but once the conversations get into more complicated things like retinoids, acne treatment might feel a little overwhelming. We get it.
These things aren’t easy to understand, and there are potential issues you can create by misusing or overusing certain products.
Retinoids aren’t scary though, and used correctly they can help solve major skin issues for acne sufferers of all ages.
That doesn’t mean they’re without side effects, of course, but with proper usage, those side effect risks can be minimized.
To start this conversation though, let’s take a brief look at what acne is, and why it can make your skin feel less than lustrous.
Acne is, simply put, a bacterial infection in your pores resulting from an imbalance in several key elements.
There are ultimately four factors that can contribute to pimples: dead cells, hydration, oil production and bacteria themselves.
Blemishes occur when dead cells accumulate in your pores, triggering the production of excess sebum (oil) to help them slide out.
Between the extra oil and the dried out dead cells, your pore becomes a perfect breeding ground for acne bacteria. When this happens, they can thrive, causing inflammation and, well, pimples.
There are several different types of acne — learn more with our Guide to Types of Acne.
How this happens is less simple, because acne can occur for a variety of reasons. Diet and hydration issues, stress, the weather and genetics can all contribute to your chances of having acne issues.
But at the end of the day, a lot of it comes down to hormones.
Acne treatments can address either the cause of the acne or the symptoms themselves, but most of the effective solutions address one of those four elements of imbalance.
Sebum plays an important role in keeping oil and dirt away from your skin, but an excess can lead to problems of its own.
Excess sebum can be removed with products like blotting papers, or by the use of masks or astringents like witch hazel.
A healthcare professional might recommend products for more extreme cases, like benzoyl peroxide or salicylic acid.
The trick here is using products or treatments that don’t strip too much of your skin’s natural oils away, as that also can trigger an increase in sebum production that can be pretty disastrous for your skin.
Dryness can be addressed with moisturizers, as you probably guessed. Topical hyaluronic acid, for instance, has been shown to help your skin retain moisture.
And then of course there are lifestyle changes that might address stress, poor diet or dehydration.
So, it’s best to address these regardless of whether they’re the acne culprits. Drinking more water and avoiding a high sugar diet is just good for your health, too.
And then there are retinoids. Retinoids actually go by several names: retinol, retinoids, retin-A compounds or Vitamin A. They’re all very similar.
Essentially, they’re chemical exfoliants. In the topical application, retinoids do two things: help remove the dead, dried out layer of dead skin cells on top of your skin (which contribute to problems and can make you look wrinkly), and stimulate the production of collagen underneath the skin.
The joint result of this is that the layer of older, dead skin is removed, and the younger skin underneath gets a boost to grow.
That’s a benefit in and of itself, but when it comes to acne, this can be an effective treatment for helping your struggling pores shed those dried out cells and move along to the newer stuff.
There are over-the-counter options for this, but prescription options are available for the messier cases. One of the most frequently prescribed retinoids is tretinoin for acne.
While we’re all about the benefits of retinoids for your skin, it’s important to note that there are warnings you should heed for side effects.
Retinoids have a tendency to irritate skin, and they can exacerbate existing irritations, which means they’re not always the best solution when your acne is currently inflamed.
Of the known potential side effects of retinoids like tretinoin, you should be on the lookout for redness and peeling — a usually temporary side effect known affectionately as the Tretinoin Purge.
All of these problems can be compounded by sensitive skin, so it’s important to mention sensitive skin to your healthcare provider before starting a course of retinoid treatment.
There are ways to enhance and misuse retinoids respectively, so we’ve made a brief list of things you should know before starting a retinol regimen.
First, topical retinoids are best used in the evening. Tretinoin is a volatile chemical that’s known to break down when exposed to sunlight.
They’re also effective for anti-aging benefits when combined with vitamin C, which acts like an antioxidant for your skin, protecting it from free radicals and other stressors throughout the day.
Then there are antibiotics to take alongside your retinoids. Clindamycin is prescribed to treat infections of the lungs, skin and reproductive system, but is also used — among other common antibiotics like erythromycin — to inhibit the growth of bacteria that cause acne, while simultaneously reducing inflammation.
With regards to acne, clindamycin has been shown to slow down bacteria's growth and spread, and may prevent them entirely from multiplying.
Based on the advice of your healthcare provider, you may end up using one or all of these medications in tandem.
That advice will be individually tailored to your particular acne issues.
Topical retinoids are a proven safe and effective tool in combating acne, but they have their limits.
In addition to the known side effects, they also need to be used carefully and as instructed, and may cause conflicts with other medications and treatments.
And this is a big reason why the first step you take in taming your acne shouldn’t be a clean sweep of products from the cosmetic aisle, rather a chat with a healthcare provider (and check out the Hers customized acne cream).
They are uniquely suited to help diagnose the underlying cause of your acne, which may or may not eventually lead to effective retinoid use.