Tretinoin for Cystic Acne and Hormonal Acne

    Kristin Hall, FNP
    Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 7/22/2021

    Your bathroom shelf has seen cleansers, gels, moisturizers, pads, masks, oils, toners, creams, and who knows what else. But has any of it really helped your acne? 

    Searching for an acne treatment that works can be difficult, costly and sometimes worsen the problem you’re trying to remedy. 

    There comes a point where you have to suspend the over-the-counter skincare war and bring in a professional. 

    Prescription medications like tretinoin offer treatment for acne with the guidance of a healthcare professional or certified dermatologist, and sometimes that’s what’s needed to turn a corner on your acne problem.

    Acne 101

    According to Johns Hopkins Medicine, most people will be affected by acne at some point in their lives, but this doesn’t make it any easier to deal with.

    Oil, or sebum, is created in your sebaceous glands, and travels out of your hair follicles, or pores, to the surface of your skin where it keeps you moisturized. 

    But when this oil can’t escape your pores, this can cause acnes

    Generally, a layer of dead skin cells blocks your pore and traps the sebum, where it builds up and causes a pimple. Add to this trapped oil some bacteria, and you have the recipe for an inflamed acne lesion. 

    Repeat the process, and you have acne.

    Acne can be triggered by a variety of things. It’s certainly tied to hormone fluctuations, which explains why it first rears its ugly head during puberty. 

    In adult women, this means acne breakouts may be more common around menstruation, pregnancy or menopause.

    It can also show up when you start a new birth control pill or any number of medications. 

    Smoking, endocrine disorders, stress and genetics can also play a role in the development of acne in women.

    Moderate to severe acne can cause scarring, but can also impact your quality of life. Psychologically, it can even lead to depression and anxiety — but we’re sure you didn’t need to hear that from us.  

    What Is Tretinoin?

    Tretinoin is one of several different treatments available for acne. 

    The first line of defense among women with acne is generally their drug store, where you’ll find things containing benzoyl peroxide, which is designed to dry out the skin. 

    But when this proves ineffective, tretinoin is one of several acne medications available with a prescription. 

    Retinoids are a class of topical medications that work to reduce acne lesions, reduce dead skin cell shedding and block inflammation. 

    According to the American Osteopathic College of Dermatology, they were first introduced in 1971 and are chemically derived from vitamin A. 

    Other retinoids include retinol, adapalene, isotretinoin and tazarotene. You may recognize them under brand names such as Atralin, Avita, Refissa, Renova, Retin-A, Retin-A Micro, or Tretin-X.

    What Types of Acne Does Tretinoin Treat?

    Tretinoin is known to successfully treat several different types of acne vulgaris and the side effects that often come with it, such as acne scarring, blackheads, and whiteheads. 

    Many people use tretinoin to treat mild to moderate forms of stubborn acne that just won’t go away. 

    Other types of more severe acne that can be treated by tretinoin include cystic acne and hormonal acne

    As a sort of added bonus, retinoids can also combat the signs of sun damage or “photo-aging” of the skin which develops during tanning under sunlamps or prolonged sun exposure. 

    It is very important to note that this is not the same as preventing sun damage or sunburn. Tretinoin can actually increase your skin’s sensitivity to the sun, so it is extra important to still apply sunscreen. 

    Additionally, healthcare professionals sometimes prescribe tretinoin to treat other skin problems such as fine lines or wrinkles, and hyperpigmentation (dark skin spots).

    Tretinoin for Cystic Acne

    Cystic acne is a severe form of acne. While regular acne develops when a hair follicle becomes clogged with a mixture of oil and dead skin, cystic acne forms when a clogged hair follicle becomes infected with bacteria.

    When bacteria makes its way inside the follicle, it can cause inflammation. Infected pimples can become red, swollen and filled with pus. 

    They may become itchy, irritated and can be painful if accidentally bumped or touched.

    Worse yet, cystic acne can spread easily. If one infected pimple bursts, the bacteria can easily get stuck under your fingernails or trapped inside other hair follicles, causing a major outbreak elsewhere on your face or body that can affect your skin for months at a time.

    Just like regular pimples, cystic acne is most common in teenagers and people in their early- to mid-twenties. However, it can affect people of all ages, and in adults it’s called adult-onset acne.

    How Does Tretinoin Treat Cystic Acne

    While there aren’t any studies that specifically look at tretinoin as a treatment for cystic acne, tretinoin is widely used and thoroughly studied as a conventional acne treatment. 

    It’s also a widely prescribed medication by healthcare providers for treating cases of cystic acne.

    Because cystic acne is caused by a combination of acne and bacteria, most healthcare providers use two medications as part of a treatment program: a retinoid (such as tretinoin, or in cases of severe or persistent cystic acne, isotretinoin) in conjunction with an antibiotic to help reduce inflammation and kill bacteria.

    On its own, tretinoin does not kill bacteria, meaning that, while it’s effective in combination with an antibiotic, it’s usually not enough to completely treat cystic acne independently.

    Some common antibiotics used in combination with tretinoin to treat cystic acne are tetracycline antibiotics like doxycycline, minocycline and tetracycline

    Some healthcare providers also prescribe topical antibiotics like clindamycin and erythromycin, particularly for young people.

    On the whole, healthcare providers often recommend a combination of tretinoin (or a similar topical or oral retinoid) and an antibiotic. 

    For most people, antibiotics are prescribed for a short period of time to kill bacteria and clear up cystic acne, while tretinoin is usually prescribed for long-term acne treatment and prevention.

    Tretinoin for Hormonal Acne 

    While almost all acne is technically hormonal, the term “hormonal acne” usually refers to acne that occurs as a result of fluctuations in your body’s production of androgenic hormones.

    Androgens like testosterone stimulate your body’s production of sebum -- a natural oil that’s vital for keeping your skin hydrated and healthy. 

    When your body secretes too much sebum, excess sebum can collect inside your hair follicles, creating blocked pores that can develop into acne.

    Sebum isn’t the only component of hormonal acne. Another factor that can contribute to hormonal outbreaks is the presence of dead sk​​​​in cells on your skin, which can become stuck inside open pores.

    When dead skin cells combine with sebum inside a pore, the result is a blockage. Blocked pores can be partially open (a blackhead) or completely closed (a whitehead). 

    They can even become infected and inflamed, leading to the development of painful, uncomfortable acne lesions.

    While hormonal acne affects both men and women, it’s slightly more common in women. It usually becomes visible in the days immediately before and during your period, as this is when your body’s testosterone levels are at their highest.

    How Does Tretinoin Treat Hormonal Acne

    Retinoids like tretinoin work by speeding up your body’s skin cell turnover cycle. When you use tretinoin over the course of several months, your body produces new skin cells at a faster pace than it normally would, all while quickly exfoliating away old, dead skin cells. 

    This means you’re less likely to develop blocked pores as a result of dead skin cells while using tretinoin.

    So, is a 100% effective treatment for hormonal acne? Not quite. While tretinoin can remove one-half of the hormonal acne equation and significantly reduce acne outbreaks, it’s not proven to have any effects on your body’s sebum production. 

    If you have oily skin, you might need to use an additional treatment alongside tretinoin to get your body’s sebum production under control. 

    Depending on your acne, your healthcare provider may recommend combining tretinoin with birth control to lower androgen levels and slow sebum production on a hormonal level. 

    Or your healthcare provider might recommend combining tretinoin with antibiotics to target the bacteria that keep acne inflamed and lower your chances of developing infection or spreading your acne.

    Is Tretinoin An Effective Acne Treatment? 

    In general, retinoids such as tretinoin are the mainstays of acne treatment, and this is because they’re widely effective and popular for that reason. 

    Although popular, you may be wondering: What does tretinoin do for acne?

    According to research from the International Journal of Basic and Clinical Pharmacology, tretinoin is an effective topical acne treatment option, producing reductions in the number of both inflammatory and noninflammatory acne lesions, unclogging pores and even reducing discoloration and acne scars. 

    For more severe forms of acne, tretinoin may be combined with another treatment, such as birth control or antibiotics.

    Tretinoin and Hormonal Birth Control

    Dermatologists occasionally prescribe tretinoin (as well as more powerful, oral retinoids such as isotretinoin) alongside hormonal birth control pills such as YAZ, Ortho Tri-Cyclen and Estrostep.

    These birth control pills are all approved by the FDA as acne treatments, meaning they’ll be able to target acne outbreaks while providing contraceptive benefits.

    Birth control pills target acne at a hormonal level. Because combined oral contraceptives like the three pills listed above contain a combination of estrogen and a progesterone, they can reduce your body’s androgen levels.

    Lower androgen levels mean you’ll produce less sebum, reducing your chances of experiencing a hormonal acne outbreak.

    Used together, birth control and topical medications like tretinoin can act as a one-two punch for your acne. 

    While birth control pills work on a hormonal level to reduce breakouts, tretinoin works locally to speed up skin cell turnover and reduce the amount of dead skin cells on your face.

    Want to learn more about birth control and its benefits for acne? Our guide to birth control and acne explains how birth control pills can lower your androgen levels and prevent acne, as well as how they fit into acne prevention alongside retinoids and other medication.

    Tretinoin and Antibiotics

    For severe acne, tretinoin is often prescribed with antibiotics. Like hormonal birth control, using antibiotics with tretinoin allows you to target acne from two angles -- this time, by targeting the dead skin that can lead to acne, plus the bacteria that can cause acne to become inflamed.

    Some of the most common antibiotics for dealing with severe hormonal acne are doxycycline, erythromycin, minocycline and tetracycline.

    For less severe cases of hormonal acne, some dermatologists will recommend tretinoin with a topical antibiotic like clindamycin. 

    Hers Acne Cream contains tretinoin, clindamycin and niacinamide in combination for optimal acne prevention effects.

    Because no two cases of acne are the same, there’s no “best” medication protocol for dealing with acne. 

    Your dermatologist might recommend tretinoin on its own, tretinoin along with birth control, or even a completely different acne medication based on your needs.

    Tretinoin Side Effects: What You Should Know

    Tretinoin is available with a healthcare professional or certified dermatologist’s prescription. And while it’s effective in the treatment of acne, it does come with its own list of potential side effects. 

    One, in particular, is called the tretinoin purge.

    Many people experience skin irritation within the first few weeks or months of use, especially if they have sensitive skin

    This irritation may include dryness, itching and peeling, but is classified as “mild to moderate” and limited to the outermost layer of skin. 

    Once your skin gets used to the medication, this irritation usually subsides. Tretinoin can also cause UV sensitivity, so it’s important to avoid direct sunlight for extended amounts of time or wear sunscreen when using it.

    FAQs About Tretinoin

    What Else Does Tretinoin Treat? 

    Topical retinoids like tretinoin are also used as an anti-aging treatment, targeting fine lines, dark spots or hyperpigmentation. 

    In fact, many people only think to use retinoids, like tretinoin and retinol, for their anti-aging properties. 

    Luckily, tretinoin is effective for a whole host of skin conditions, from acne to anti-aging and beyond.

    However, tretinoin is not a good treatment option for certain skin conditions, especially dry skin, psoriasis and eczema. 

    For these conditions, seek professional advice from a dermatologist, who can prescribe an alternate medication for your symptoms.

    How Long Does it Take for Results to Appear When Using Topical Tretinoin?

    After you start applying tretinoin, you may actually experience worse skin in the short term. This is because tretinoin can be irritating, especially at first, to some skin types. 

    This is often called the tretinoin purge. However,  you should begin to see results in the acne-affected areas after a few weeks of treatment with tretinoin cream and should see the full benefit after 6-12 weeks. 

    If you see no improvement after 12 weeks, talk to your doctor or dermatologist.

    How Does Tretinoin Work for Acne?

    Tretinoin works by increasing cell turnover (the rate at which your body creates new skin cells) and boosts your skin’s production of collagen. 

    This promotes the reduction of acne, blemishes, fine lines and the appearance of aging.

    The Bottom Line: Does Tretinoin Help With Acne? 

    The research is clear — tretinoin works. Like most prescription medications, it may come with certain side effects that make your skin look worse before it looks better. 

    The important thing to keep in mind is, for the overwhelming majority of people, skin health will improve.

    Using tretinoin can help combat adult female acne and restore your quality of life while improving your skin.

    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.