Tretinoin Before and After: What to Realistically Expect

Quick answer: No source we checked gives a month-by-month tretinoin timeline, so this page doesn’t invent one. MedlinePlus says acne probably will get worse during the first 7 to 10 days of use. It says sores should improve in 2 to 3 weeks of regular use, and sometimes more than 6 weeks. The American Academy of Dermatology says that to see clearing you need to stick to your treatment plan. It takes at least 6 to 8 weeks before you start to see fewer breakouts.

This page covers what MedlinePlus, the AAD and published trials say you can expect from prescription tretinoin. It also covers how to judge your own progress fairly.

What does tretinoin do for acne?

MedlinePlus explains that tretinoin is a retinoid. It works by increasing production of new skin cells and unclogging pores. The AAD lists tretinoin among the prescription retinoids used to treat acne, and says a retinoid you apply to your skin can treat blackheads, whiteheads and some pimples.

The 2024 AAD acne guideline gives topical retinoids a strong recommendation, the same grade it gives benzoyl peroxide and oral doxycycline. That recommendation is for topical retinoids as a group. It doesn’t predict how fast your skin will change.

How long does tretinoin take to work on acne?

MedlinePlus says tretinoin works slowly to control acne. Its page gives two to three weeks, and sometimes more than six weeks, of regular use before sores improve. The AAD says that to see clearing, you need to stick to your treatment plan. It says it takes at least 6 to 8 weeks before you start to see fewer breakouts.

On its page about acne that won’t clear, the AAD says that if a treatment works for you, you should notice some improvement in 4 to 6 weeks. It can take two to three months or longer to see clearing. Its page on habits that worsen acne says complete clearing generally takes 3 to 4 months.

You may see “3 to 4 months or up to 6 months” quoted for tretinoin. In MedlinePlus, that range is about fine wrinkles, not acne. We found no tretinoin-specific acne timeline beyond the numbers above.

What did the tretinoin trials actually measure?

The two trials below each ran for 12 weeks. A 1998 trial was a 12-week study in patients with mild to moderate acne. A total of 271 patients were enrolled. The two 0.025% tretinoin creams showed comparable efficacy that was statistically significantly greater than that of the vehicle, which is the cream without tretinoin.

A 2019 post hoc analysis covered two Phase 3 trials in moderate or severe acne. Hispanic subjects aged 11 to 50 years (N=766) were randomized to tretinoin 0.05% lotion or vehicle. They used it once daily for 12 weeks. At week 12, the abstract reports a mean percent reduction of 60.1% for inflammatory lesion counts and 53.0% for noninflammatory counts. On vehicle, the reductions were 51.1% and 38.7%.

Look at the vehicle numbers too, because skin on the plain lotion improved as well. These are group averages from a study lotion, not a promise about your own skin or about generic tretinoin cream. The abstract reports treatment success in 19.6% of subjects by week 12, compared with 12.7% on vehicle. Success meant at least a 2-grade reduction in the Evaluator’s Global Severity Score and clear or almost clear skin.

What can the first 7 to 10 days look like?

MedlinePlus says your acne probably will get worse during the first 7 to 10 days, with red, scaling skin and an increase in acne sores. Its instruction is to continue to use it. The 2019 trial abstract also reports slight transient increases in scaling and burning over the first four weeks.

That description comes from the tretinoin page at MedlinePlus. Our article on the retinol purge covers the same idea for over-the-counter retinol. If a flare lasts, gets severe or worries you, message your prescriber instead of guessing.

What should your before and after photos show?

The AAD says it takes at least 6 to 8 weeks before you start to see fewer breakouts, so fewer breakouts are the change to look for first. Count new pimples rather than old marks. If you photograph your skin, use the same light, distance and angles each time so the pictures compare fairly.

Dark marks left after acne follow a different clock. The AAD says a retinoid can help lighten dark spots that develop after acne clears. Its page on dark spots in darker skin tones says to treat the acne first. Most dark spots will then fade on their own over time, but it may take a long time.

The same page says a spot that is a few shades darker than your natural skin color will usually fade within 6 to 12 months. If the color lies deep in your skin, fading can take years. It also says sunscreen can prevent new dark spots and patches, and can also help to clear existing ones. That page is written for darker skin tones, so ask your dermatologist how it applies to you.

Why can tretinoin make skin dry or irritated at first?

MedlinePlus lists dryness, itching, burning, stinging, peeling, swelling, redness, blistering or flaky skin at the treatment area as side effects. It says to tell your doctor if any of these are severe or do not go away. Call your doctor immediately if you notice itching, or a rash, or hives, or pain or discomfort at the treatment area.

The AAD says to tell your dermatologist if a retinoid irritated your skin before, because that happens to some people. It notes that irritated skin doesn’t typically mean that you have an allergy. To reduce irritation, your dermatologist may recommend a smaller amount of medication, or using the retinoid less often. They may also recommend moisturizer first, especially if your skin needs a stronger retinoid. The AAD says to make these changes only with your dermatologist’s help.

The AAD’s moisturizer page lists tretinoin among the treatments that tend to dry and irritate skin. It says a daily moisturizer can help your skin tolerate them. It also warns that when skin gets dry, your body makes more oil, which can clog pores. Look for moisturizers labeled oil-free, non-comedogenic or won’t clog pores.

MedlinePlus says to plan to avoid unnecessary or prolonged exposure to sunlight or ultraviolet light, including tanning beds and sunlamps. Wear protective clothing, sunglasses and sunscreen, especially over the treated areas. Weather extremes, such as wind and cold, may be particularly irritating to the treated areas.

How should you use tretinoin so the results are fair?

MedlinePlus says to use tretinoin daily at bedtime, exactly as directed. Do not use more or less of it, or use it more often than your doctor prescribed. Use enough to cover the affected area with a thin layer. Do not let it get into your eyes, ears, mouth, corners along your nose, or vaginal area. Also do not apply it to sunburned skin or skin affected by eczema.

For a missed dose, MedlinePlus says to apply it as soon as you remember. If it is almost time for the next dose, skip the missed dose. Do not apply extra cream, lotion or gel to make up for a missed dose.

The same page says not to use any other topical medications unless your doctor directs you to do so. It names benzoyl peroxide, hair removers, salicylic acid, and dandruff shampoos containing sulfur or resorcinol. It also says to use only non-medicated cosmetics. Do not use topical preparations with a lot of alcohol, menthol, spices or lime, such as shaving lotions, astringents and perfumes.

The AAD says that using only some of what your dermatologist prescribes could be the reason you still have acne. Follow the whole plan, and ask before you add or drop anything.

MedlinePlus also says to tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using tretinoin, call your doctor. Tell your doctor if you have or have ever had eczema, actinic keratoses, skin cancer or other skin conditions.

When is tretinoin not enough on its own?

The 2024 guideline gives oral isotretinoin a strong recommendation for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Ask your dermatologist how that recommendation applies to you.

Our Accutane vs tretinoin article explains the difference between the oral and topical medicines. If you’re deciding between an over-the-counter product and a prescription, read retinol vs tretinoin and retinol vs tretinoin for acne. For daily habits around any acne medicine, see skincare on acne medication.

How does a prescription work at The Goal Is Clear?

The how it works page says the quiz takes about two minutes and you upload two photos. A board-certified dermatologist reviews your case within 24 hours. The dermatologist writes the prescription, asks follow-up questions in your dashboard, or routes you to in-person care if your case is out of scope. A prescription is never guaranteed for any patient.

The pricing page lists the Acne Care path as topicals, antibiotics and more. Medication is billed separately by the pharmacy, as low as $0 for the prescription with insurance. You are refunded in full if your board-certified dermatologist does not prescribe. BNG Health Services, LLC operates the brand and is not the prescribing physician.

Common questions about tretinoin before and after

How long does tretinoin take to show results? No source we checked gives one date. MedlinePlus says sores should improve in 2 to 3 weeks, and sometimes more than 6 weeks, of regular use. The AAD says it takes at least 6 to 8 weeks before you start to see fewer breakouts. It also says it can take two to three months or longer to see clearing.

Does acne get worse before it gets better on tretinoin? MedlinePlus says your acne probably will get worse during the first 7 to 10 days, with red, scaling skin and an increase in acne sores. It says to continue to use it. Tell your prescriber if the redness or peeling is severe or does not go away.

Are online tretinoin before and after photos typical? The sources we checked don’t say. The 2019 abstract reports group averages over 12 weeks, and skin on vehicle improved too. Compare your own photos taken the same way over time.

Can tretinoin fade dark marks after acne? The AAD says a retinoid can help lighten dark spots after acne clears. Its page on dark spots in darker skin tones says most dark spots will then fade on their own over time, but it may take a long time. That page says a spot a few shades darker than your natural skin color will usually fade within 6 to 12 months. If the color lies deep in your skin, fading can take years. That page is written for darker skin tones, so ask your dermatologist how it applies to you.

What should you do if tretinoin dries or irritates your skin? Tell your prescriber about the dryness. The AAD says your dermatologist may recommend a smaller amount of medication, or using the retinoid less often, and that you should only make those changes with their help. MedlinePlus says to call your doctor immediately for itching, or a rash, or hives, or pain or discomfort at the treatment area.

What is a realistic takeaway for tretinoin results?

MedlinePlus says your acne probably will get worse during the first 7 to 10 days. The AAD says it takes at least 6 to 8 weeks before you start to see fewer breakouts. Track your own photos and follow your prescriber’s plan. MedlinePlus also says to protect treated skin from sunlight and ultraviolet light. If you’d like a board-certified dermatologist to look at your case, take the quiz, which takes about two minutes. The FAQ answers common questions about care and insurance.

This article is general information, not medical advice. A prescription is never guaranteed, and treatment decisions stay with the board-certified dermatologist who reviews your case. Retin-A® is a registered trademark of its respective owner, and tretinoin is the generic name. The Goal Is Clear is operated by BNG Health Services, LLC, which is not the prescribing physician; board-certified dermatologists prescribe.

Sources

• Reynolds et al., Guidelines of care for the management of acne vulgaris, J Am Acad Dermatol 2024
• Lucky et al., Double-blind, vehicle-controlled, multicenter comparison of two 0.025% tretinoin creams in patients with acne vulgaris, J Am Acad Dermatol 1998
• Cook-Bolden et al., Novel tretinoin 0.05% lotion for once-daily treatment of moderate-to-severe acne vulgaris in a Hispanic population, J Drugs Dermatol 2019
• American Academy of Dermatology, Acne: Diagnosis and treatment
• American Academy of Dermatology, Acne that won’t clear
• American Academy of Dermatology, 10 skin care habits that can worsen acne
• American Academy of Dermatology, Moisturizer: Why you may need it if you have acne
• American Academy of Dermatology, How to fade dark spots in darker skin tones
• MedlinePlus, Tretinoin topical