How Tretinoin Treats Hormonal Acne Breakouts

If you suffer from hormonal acne, you know how they seem to happen at the worst times and how difficult it is to treat. Many people turn to prescription alternatives like Trentonin to clear their skin.

While tretinoin is highly effectively in reducing hormonal acne breakouts it does not address the root cause of the hormonal imbalance. I learned this lesson the hard way when I took tretinoin for close to 6 months in my twenties. While it did help alleviate acne breakouts it did nothing to help the hormonal balances stemming from my diet.

In this article we’ll review the best process for applying tretinoin to acne prone skin in order to maximize its effectiveness, and minimize the potential side effects of dry, irritated skin.

After this we’ll provide comparison between tretinoin and several other common acne medications, along with our recommended alternatives.

While Tretinoin is not formulated to rebalance your hormones, it’s a great acne treatment option for reducing hormonal acne breakouts. Just make sure you consult with a certified dermatologist first for safe use and follow a low-inflammation diet and lifestyle for the best possible results. 

5 step process to maximize the effectiveness of tretinoin for hormonal acne

Tretinoin heals hormonal acne breakotus by binding with retinoid receptors in your skin. This gives your body the ability to produce new skin cells and get rid of the dead ones faster than usual by using tretinoin.  Unfortunately, this causes many people to have dry flaky, irritated skin.

Applying the cream to your skin helps unclog pores, reduce inflammation, stimulate collagen production, prevent collagen loss, and minimize pigmentation. This, in turn, helps clear up hormonal acne.

One study investigated the anti-inflammatory properties of Tretinoin. It concluded that the topical use of this cream, along with clindamycin, combines antibacterial, anti-inflammatory, and comedolytic properties for treating different stages of acne. 

Many people swear by Tretinoin because, apart from treating hormonal acne, it reduces the signs of aging from sun exposure, including:

  • Wrinkles and fine lines
  • Uneven skin texture and dull skin tone
  • Dark spots and acne scars
  • Hyperpigmentation 

Below we have a 5 step process that will increase the effectiveness of tretinoin usage and mitigate the potential adverse effects:

1. Prep Work

Before you begin treating your skin with tretinoin you need to schedule an appointment with a dermatologist and conduct a small patch test on your skin to ensure you do not have an adverse reaction to tretinoin.

Because tretinoin is such a powerful medication, it requires a prescription to get access to the cream. During your consultation, your dermatologist will analyze your skin to ensure your skin can handle the drug.

Even if your dermatologist suggests tretinoin you should still do a “patch test” on a small area of skin to ensure you do not have an adverse reaction. Generally speaking, a patch test should be about the size of a quarter. Assuming there is no adverse reaction on the patch with 24 hours of using the tretinoin cream you can begin using it as prescribed on the rest of your face.

2. Cleanse the skin

You should cleanse your skin with a non-comedogenic face wash before applying tretinoin cream to your face. This will help remove oil, dead skin cells, and other debris from the pores which allows the tretinoin to penetrate deeper into the skin and maximize its effectiveness in treating hormonal acne.

3. Pat the face dry

Pat your face dry with a clean towel immediately after washing your face. It’s important to pat the face dry because you do not want to aggravate your skin before applying tretinoin, which can also cause irritation.

Although it sounds easy to ignore you should make sure you use a new towel every time you pat your face dry. This ensures makeup, dirt, and oils from previous facial cleanses are not rubbed back into the skin.

4. Apply a thin layer of tretinoin on the skin

You are free to apply a thin layer of tretinoin to your skin once you have completed the above checklist. If you only have acne in a few areas, like the “t-zone”, you can just apply it to the specific areas. However, if breakouts are common everywhere on your face, you can apply a thin coating every, just make sure to stay away from your eyes, mouth, and nose.

Usually, your dermatologist will provide guidance on how frequently to apply tretinoin but for most people it is between 2-4 times per week.

5. Moisturize the skin

You should moisturize your skin with non pore clogging moisturizer once the tretinoin has absorbed into your skin (usually around 5 minutes).

Although tretinoin is highly effective for treating acne breakouts, it has the potential to significantly dry out and irritate the skin. A non-comedogenic moisturizer will help keep the skin hydrated, protect the skin barrier, and minimize the chances of irritation.

Tretinoin Cream vs. Gel

Tretinoin comes in several different forms, primarily a cream and gel base. Although both work for treating hormonal acne breakouts, there are a few key differences which we have notated below:

DifferencesTretinoin CreamTretinoin Gel
TextureThicker, more moisturizingLighter, more drying, alcohol-based
Best for Skin TypeDry or sensitive skinOily, combination, or acne-prone skin
Feel on SkinHeavier, potentially greasierAbsorbs quickly, feels lighter
IrritationGenerally less irritating; better for sensitive skinMore potentially irritating due to alcohol content
ApplicationEasier to spread evenly; may need less productDries quickly; requires fast, even spreading
SuitabilityBetter in drier climates or in colder weatherMore suitable for humid climates or warmer weather
ComedogenicitySome formulations might clog poresLess likely to clog pores
Preferred UseGood starting option for new tretinoin usersGood for those accustomed to tretinoin or with more oily skin
MoisturizingMore moisturizing; can alleviate some of the dryness associated with tretinoinLess moisturizing; can increase skin dryness

Will tretinoin improve hormonal levels?

No, tretinoin will not change hormonal levels at all. Although tretinoin is highly effective in treating hormonal acne it does nothing to address the root cause of a hormonal imbalance.

Because of this we highly recommend analyzing your diet, supplements, and other skincare products so you can address the root cause of your hormonal acne – your hormones.

Does tretinoin help acne scars?

Yes, tretinoin is highly effective in reducing the appearance of acne scars by speeding up skin cell turnover, which accelerates new skin cell growth wherever it is topically applied.

This is why many dermatologists recommend applying Tretinoin cream to prep the skin for chemical peel treatments aimed at removing acne scars.   

A three-and-a-half-month study involving 38 participants with acne scarring (9 males and 29 females) aged between 16 and 29 confirmed the benefits of using Tretinoin for acne scars. The results showed that 79% of the participants witnessed the flattening of their acne scars when they used the cream consistently. It was seen that the cream worked best on younger acne scars as well as indented icepick scars. 

In another study, 94% of the participants reported a reduction in their acne scars’ depth after using Tretinoin cream with an iontophoresis device twice a week for three months.

Is tretinoin safe for fungal acne?

No, tretinoin should not be used on skin with fungal acne. Fungal acne is resistant to retinoids and many types of antibiotics. In fact, prolonged retinoid use can actually worsen fungal acne symptoms by inflaming the hair follicles.

Although many people believe retinoids antimicrobial properties make them beneficial for fungal acne and yeast infections, you should check with a dermatologist to ensure you do not contract any unwanted side effects

Does Tretinoin require a prescription?

Yes, tretinoin requires a prescription for a dermatologist. It cannot be bought over the counter.

Tretinoin vs. retinol for hormonal acne

Although both tretinoin and retinol are vitamin A derivatives that are used to increase skin cell turn over and treat acne breakouts they have different strength levels, use cases, and side effects.

The difference lies in the formula’s strength – retinol is weaker than retinoids like tretinoin, which is why it can easily be obtained without a prescription. For tretinoin or products that contain tretinoin, you’ll need a prescription from a dermatologist and can expect greater effectiveness in return.

Below we have a comparison chart to highlight some of the key differences between tretinoin and retinol:

PotencyHigh (more potent)Moderate (less potent)
PrescriptionYes (prescription required)No (available over the counter)
Primary UseModerate to severe hormonal acneMild hormonal acne or maintenance
EfficacyFaster and more effective in acne treatmentSlower, gradual effectiveness in acne treatment
Side EffectsHigher chance of irritation, redness, peeling, and sensitivityGenerally milder side effects like slight irritation and dryness
Skin SensitivityMore likely to cause irritation, especially in sensitive skinLess irritating, suitable for sensitive skin
Onset of ResultsTypically shows results quickerTakes longer to see visible results
ApplicationUsually 2-3 times per week (as prescribed)Often used daily, depending on the product and skin tolerance
FunctionUnclogs pores, reduces inflammation, promotes cell turnoverGradually converts to retinoic acid in the skin, promoting cell turnover
Additional BenefitsAlso used for anti-aging, reducing wrinkles, and improving skin textureAlso offers anti-aging benefits; improves texture and tone but more slowly
SuitabilitySuitable for people needing aggressive acne treatmentGood starting retinoid for beginners or those with less severe acne

Tretinoin vs. Accutane for hormonal acne

Tretinoin and Accutane (isotretinoin) are both derivatives of Vitamin A used to treat acne, but they are quite different in terms of their form, application, side effects, and the severity of acne they are used to treat. Tretinoin is a topical application used to treat moderate hormonal acne breakouts, whereas as Accutane (Isotretinoin) is an oral medication generally reserved to several cases of hormonal acne. Below is a comparison chart that highlights key differences and similarities:

DifferenceTretinoinAccutane (Isotretinoin)
FormTopical cream or gelOral capsule
UseApplied directly to the skinTaken by mouth
Acne SeverityUsed for mild to moderate acne, particularly where topical treatment is deemed appropriatePrimarily used for severe cystic acne or acne that hasn’t responded to other treatments
Mechanism of ActionIncreases skin cell turnover, unclogs pores, and prevents formation of new acne lesionsReduces the size and output of the sebaceous glands, reduces skin inflammation
PrescriptionYes, prescription requiredYes, prescription required; also enrolled in a special program (i.e., iPledge in the USA) due to its high risk of severe side effects
Common Side EffectsDryness, redness, irritation, increased sensitivity to sunlightDry skin, chapped lips, nosebleeds, changes in blood lipids and liver enzymes, increased sensitivity to sunlight, and depression
Pregnancy WarningNot recommended during pregnancyStrictly contraindicated in pregnancy due to high risk of birth defects
Usage DurationCan be used long-term as per dermatologist’s adviceTypically used in a course lasting several months (often around 6 months); not usually used long-term
Onset of ActionImprovement often seen in weeks to monthsImprovement often seen after one or two months, with many patients achieving prolonged remission after a full course
MonitoringLess intensive monitoring requiredRequires regular blood tests and monitoring due to potential for serious side effects
EffectivenessHighly effective for many types of acne, particularly with long-term useExtremely effective, often considered a “last-resort” for stubborn, severe acne

Hormonal acne treatments that work well with tretinoin

The best hormonal acne treatment to use with tretinoin is to use an acne safe face wash twice per day, moisturize with a non pore clogging moisturizer, and follow a low-inflammation diet. Tretinoin will work to quickly reduce the appearance of acne and scarring, while the dietary and product changes will help address the root cause of your hormonal imbalance.

What are the side effects of using tretinoin?

Tretinoin can cause several side effects that are primarily related to skin irritation and discomfort, despite its effectiveness in treating acne breakouts, uneven skintones, and signs of aging. This is laregely due to tretinoin’s ability to accelerate skin cell turnover. Below we have a list of the most common side effects associated with tretinoin:

  • Itchiness 
  • Burning 
  • Dryness 
  • Peeling 
  • Redness
  • Sun sensitivity
  • Skin turning a lighter color at the application site
  • Skin feeling warm to the touch

In some cases, Tretinoin can also cause skin irritation or allergic reactions. It is crucial to talk to your doctor about any side effects you may experience while using this cream. Important: Do NOT use Tretinoin for hormonal acne if you’re pregnant or breastfeeding

Is tretinoin safe for pregnant women?

No, tretinoin is not safe for for pregnant or breastfeeding women to use. Tretinoin, along with pretty much all other vitamin A derivatives, has been shown to increase the chance of birth defects. Because of this the medical community highly discourages the use of any retinoid products while pregnant.

Tretinoin alternatives for hormonal acne

The best alternative to tretinoin is generally with non-comedogenic retinol skincare products combined with a low-inflammation diet.

Retinol products can be purchased over the counter, and offer similar benefits to tretinoin (although generally less powerful)

A low inflammation diet will help balance the hormones and ensure that the skin’s oil production is in a normal range.

By combining retinol and a healthy diet together you can get the longterm benefits of tretinoin usage without risking significant side effects.


Originally Published: October 30, 2023

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sam wood is GoodGlow's Chief Editor
Analyzed by Sam Wood

Hi, I’m Sam Wood, the chief editor, lead acne expert, and health coach at GoodGlow, as well as a best-selling author for one of the top acne books on Amazon. I struggled with acne for over 10 years, and began studying the effects of diet on skin quality while pursuing a degree in Nutrition Sciences at the University of Missouri. After shifting from mainstream skincare trends to in-depth research in medical journals, I experienced significant personal success in managing my acne. This inspired me to start GoodGlow, where I simplify complex scientific findings into easy-to-understand advice. With over 10 years in the field, I’ve helped more than 2,500 people achieve clearer skin through natural, holistic methods, and I’m dedicated to personally assisting those seeking guidance on their acne journey.

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