Salicylic acid, benzoyl peroxide, tea tree oil. If you’ve been dealing with acne since you were old enough to have a learner’s permit, then you too could rattle off the active ingredient of any given acne treatment in the drugstore aisle. And not to knock your favorite spot treatment, but if they actually worked for everyone, then we would all have clear skin and live happily ever after. But that’s not the case. If you’ve had breakouts for years and still aren’t seeing an improvement, then it might be time to call in the big guns—we’re talking retinol for acne.
Technically, it’s not just retinol but retinoids too. While both are derivatives of vitamin A, retinoid is the umbrella term for both prescription-strength retinoids and over-the-counter (and gentler) retinol. They work the same way, albeit on different levels—retinoids are stronger and work faster, whereas retinol is slower to work but gentler on your skin.
How does retinol help acne?
“Vitamin A derivatives help to clear acne, as they help to regulate skin cell turnover,” says Marisa Garshick, M.D., a dermatologist in New York City. Unlike salicylic acid, which exfoliates dead skin cells and dissolves clogs, and benzoyl peroxide, which kills acne-causing bacteria, retinoids work from the inside out. The retinoic acid seeps into the cell and binds to nuclear receptors, which oversee big-picture functions like cellular metabolism, proliferation, inflammation, and cell death—ultimately telling these receptors to kickstart their turnover process, stat.
Not only does increased skin-cell turnover remove a key factor of what causes acne—namely, dead skin cells—but there’s another benefit, says Deanne Mraz Robinson, M.D., a dermatologist in Westport, Connecticut. “Keeping dead skin cells on the move can help to keep pores clear and open so other topical acne medications can penetrate effectively,” she says. “Retinols are usually only part of a more comprehensive treatment plan for acne.”
How to use retinol products
You should only combine retinoids with benzoyl peroxide and salicylic acid using extreme caution. “The combination of a retinoid and benzoyl peroxide is a mainstay of acne therapy, although the combo can also be dry and irritating,” says Karen Hammerman, M.D., of Schweiger Dermatology Group in Garden City, New York. However, certain concentrations of benzoyl peroxide could deactivate retinoids, while salicylic acid can reduce their efficacy. “To avoid this, we recommend using the benzoyl peroxide or salicylic acid in the daytime and the retinoid at night,” she says.
Also: Before you experiment with a retinol for acne, consider seeing a dermatologist to make sure you know exactly what you’re dealing with. "Sometimes papulopustular rosacea is mistaken for acne—and while the condition is categorized by acne-like lesions, a retinol may further exacerbate the flare-up,” says Robinson.
Do retinoids work for every type of acne?
Anyone who experiences breakouts knows there are many different types of acne. The good news is that retinoids work on all of them. Born with oily skin, big pores, and a predisposition for breakouts? Retinoids can work. “It’s keratolytic, meaning it dissolves away dead skin layers,” says Hammerman. “By doing that, you are allowing new skin layers to come through smoother and softer.” If you’re plagued by blackheads and whiteheads, retinoids essentially “bust out” the keratin clogging those pores. As for inflamed red bumps and pustules, “the retinol exfoliates the dead skin, allowing for other acne topicals to penetrate your skin more effectively,” she says.
What retinol dosage or products are right for my acne?
First, factor in your skin type. “Sensitive skin will benefit from a retinol, while more resilient skin may be able to tolerate a retinoid,” says Robinson. Also: Not all retinol is created equal, and if you buy an over-the-counter version, it may be formulated with counteractive ingredients. “They are often targeted more to anti-aging benefits and may combine Vitamin A with oils to benefit aging skin—but those oils could clog the pores of an acne patient,” she warns.
Topical retinoids also come in various strengths depending on the formulation, the lowest being 0.025% and the highest being 0.3% (which is only available as a prescription). Most over-the-counter retinols hover in the 0.05% to 0.1% range. Again, you’ll want to keep your skin’s sensitivity in mind.
Can you get prescription-strength retinoids without a doctor?
Prescription-strength retinoids come in a few different forms—there’s tretinoin, isotretinoin, and adapalene, among others. “For those with more mild acne or with sensitive skin, adapalene is an effective option, while those with more cystic, inflammatory acne that leads to scarring may benefit from an oral form of vitamin A called isotretinoin,” says Garshick. (You might know isotretinoin by the brand name Accutane.) Differin is currently the only prescription-strength adapalene you can buy over the counter. “The formula is noncomedogenic, fragrance-free, and contains 0.1% percent adapalene to help heal current acne while preventing future breakouts,“ Robinson says. You can also get tretinoin without a doctor visit via Curology, where providers may prescribe it virtually based on photos.
Side effects of using retinol
Whether you’re going for a retinoid or retinol, start slowly. “Begin with every three nights and work your way up to nightly use,” says Robinson. As your skin is adjusting to it, you may experience some flaking or dryness—that’s normal. Buffering—or layering a retinol product between two layers of moisturizer—can also help minimize retinol burn. “Benefits will be seen in about four to six weeks of consistent, nightly use,” she says.
You might also get more breakouts once you start using retinoids. Keep calm and stick with it. “It’s common to see acne get worse before it gets better, as the retinoids can cause a mass ‘purge,’” says Robinson. Basically, as skin cell turnover increases, new clogs rise to the top. Unfortunately, your only recourse is to wait it out. “This improves once the comedones are expelled and the retinoid has had a chance to normalize the turnover of skin cells in the follicle,” says Hammerman.
Keep using retinoids after your acne has cleared up
Retinoids can do good even after your skin is breakout-free. “Retinoids also work to stimulate collagen production, which can help improve the appearance of scarring related to acne as well,” says Garshick. And more collagen is always a good thing, particularly if you’re one of the estimated 15% percent of women who are dealing with adult acne, according to the American Academy of Dermatology.
The best retinoids and retinol for acne
We’ve got a full list of the best retinol serums and creams—complete with editor reviews—but if you’re looking for a good place to start, these retinol products are it.
Deanna Pai is a beauty writer in New York City. Follow her on Instagram @deannapai.
