How can I use a retinoid without irritating my skin?

Retinoids can sound like the skincare ingredient everyone should be using. They are recommended for acne, blocked pores, uneven texture and some signs of sun related skin ageing. Then you try one and your skin becomes dry, flaky, red or sore.

That does not necessarily mean retinoids are wrong for your skin. The product may be too strong, you may be using it too often or something else in your routine may be adding to the irritation.

Retinoids work gradually. The aim is to find a routine your skin can tolerate for long enough to benefit, rather than trying to use the strongest product as quickly as possible.

Which type of retinoid am I using?

Retinoids are substances related to vitamin A that affect how skin cells grow and behave. In acne, they help prevent dead skin cells from blocking hair follicles, reducing blackheads, whiteheads and inflamed spots over time.

Some topical retinoids can also improve uneven texture and the appearance of fine lines caused by sun related skin ageing. The evidence, strength and intended use vary considerably between products.

Prescription topical retinoids include medicines such as adapalene and tretinoin. Retinol and retinal are weaker forms commonly found in cosmetic products marketed for ageing concerns.

A prescription retinoid is not interchangeable with a cosmetic retinol serum. Follow the instructions for the exact product you have, particularly if it has been prescribed as part of an acne treatment.

Oral isotretinoin is also a retinoid, but it is a completely different treatment with specific risks and monitoring requirements. The advice in this article relates only to products applied to the skin.

How should I introduce a retinoid?

Start slowly and follow the directions supplied with your product or given by your clinician. Applying it more frequently than recommended will not make it work faster, but it can make irritation much more likely.

For acne treatments, NICE advises that irritation may be reduced by beginning with an application every other day or using the treatment for a short period before washing it off. You can then progress to standard use if your skin tolerates it. Discuss short contact use with a clinician or pharmacist first because it will not suit every product.

For cosmetic retinol, starting once or twice a week may be appropriate, depending on the strength and product instructions.

Unless told otherwise:

• Apply the retinoid in the evening
• Cleanse gently and allow your skin to dry
• Use about a pea sized amount for the whole face
• Spread it in a thin layer rather than applying it thickly
• Avoid the eyelids, lips and corners of the nose
• Wash your hands after applying it

If you are using a prescribed retinoid for acne, it is usually applied thinly across the whole acne prone area rather than only to individual spots.

Moisturiser can make treatment easier to tolerate. You can apply it after the retinoid or, if your skin is particularly sensitive, use moisturiser before and after it. This may reduce dryness and stinging.

If the corners of your nose or mouth become irritated easily, applying a small amount of plain moisturiser or barrier balm to these areas before the retinoid may help protect them.

Do not apply a retinoid to broken, sunburnt or actively inflamed skin unless a clinician has specifically advised you to do so.

How long will it take to see a difference?

Retinoids do not usually transform the skin within a few nights.

With acne, some improvement may become noticeable after six to eight weeks. NICE recommends reviewing first line acne treatment after about 12 weeks, which is a more realistic point for judging the response.

Changes in texture, uneven tone or fine lines develop gradually and may take several months. Cosmetic products also vary in strength, formulation and supporting evidence, so results cannot be guaranteed.

Early dryness does not mean the retinoid is working more effectively. Mild flaking may settle as your skin adjusts, but ongoing soreness or inflammation can make the treatment harder to continue and may leave darker marks in some skin tones.

If your skin becomes uncomfortable, reduce the frequency and focus on gentle cleansing and moisturising. Do not increase the amount to compensate for using it less often.

Is my skin purging or becoming irritated?

Some people notice that their acne appears worse during the first few weeks of treatment. This is often called purging, although it is not a precise medical diagnosis and not every early breakout is caused by the skin adjusting.

A temporary flare is more plausible when spots appear in the same areas where you usually develop acne. It should begin to settle as treatment continues.

Signs of irritation include:

• Persistent burning or stinging
• Marked redness
• Raw or painful skin
• Cracking or bleeding
• Swelling
• Blisters
• Eczema like patches
• Irritation around the eyes, mouth or neck

Redness may be less obvious on brown or black skin, so pay attention to soreness, warmth, tightness, swelling and changes in texture as well as colour.

Do not try to push through severe irritation. Stop using the product and allow the skin to recover. If the reaction is painful, persistent or worsening, ask a pharmacist, GP or dermatologist for advice.

What should I use alongside a retinoid?

A simple routine is usually easier for the skin to tolerate:

• A gentle cleanser
• A suitable moisturiser
• The retinoid
• Broad spectrum sunscreen during the day

Avoid introducing strong exfoliating acids, facial scrubs, peeling treatments or several new acne products at the same time. If irritation develops, it will otherwise be difficult to know which product caused it.

Benzoyl peroxide can be used alongside some topical retinoids and is included in established acne treatments. Some products combine adapalene and benzoyl peroxide in the same formulation.

If you have separate products, do not create your own schedule without checking the instructions. Some combinations may need to be applied at different times, while others have been designed for use together. A clinician or pharmacist can advise you.

Once acne improves, a topical retinoid may sometimes be continued as maintenance treatment to help prevent blocked pores and new breakouts. Follow the plan given by your clinician, particularly if antibiotics formed part of your initial treatment.

Daily sun protection is important. Irritated or peeling skin can be more vulnerable to sunlight, while ultraviolet exposure contributes to uneven pigmentation and skin ageing.

Use a broad spectrum sunscreen with an SPF of at least 30 on exposed skin. Reapply it during prolonged outdoor exposure, particularly after sweating, swimming or wiping your face.

If one sunscreen stings, feels too heavy or appears to worsen breakouts, try a different formulation rather than abandoning sun protection.

Can I use a retinoid during pregnancy or breastfeeding?

Do not use topical retinoids during pregnancy or when planning a pregnancy. This applies to prescription retinoids and cosmetic products containing retinol or other vitamin A derivatives.

If you become pregnant while using a topical retinoid, stop using it and contact your GP, pharmacist or prescribing clinician for advice.

Breastfeeding guidance depends on the exact retinoid and formulation. Some adapalene products may be used during breastfeeding with appropriate precautions, while other prescription combinations should not be used.

Ask a clinician or pharmacist to check your particular product. If its use is considered appropriate, it should not be applied to the chest or anywhere the baby could touch or lick. Wash your hands after application.

Do not assume that an over the counter retinol is automatically safe during pregnancy or breastfeeding because it is weaker than a prescription treatment.

When should I stop using a retinoid or ask for help?

Speak to a pharmacist, GP or dermatologist if:

• Irritation does not settle after reducing or stopping the product
• Your skin becomes very painful, swollen, blistered or crusted
• Acne remains painful or is causing scars
• Your skin is developing persistent dark or light marks
• You have eczema, rosacea or very sensitive skin
• You are unsure how to combine the retinoid with other treatments
• You have used an acne treatment consistently for about 12 weeks without improvement

Seek urgent medical help if you develop swelling of the lips, mouth or throat, difficulty breathing or another sign of a serious allergic reaction.

Sometimes the answer is a lower strength, a different formulation or less frequent use. In other cases, a retinoid may not be the best option for your skin.

A small amount used consistently is more useful than a strong product that repeatedly leaves your skin sore. Retinoids reward patience. Give the treatment time to work, protect your skin barrier and slow down when your skin tells you it is struggling.

About the author

Dr Adam Friedmann is a multi-award-winning Consultant Dermatologist and Director at ProDerm UK, with clinics in London’s Harley Street, Cheltenham, Birmingham and Bristol. With over two decades of clinical experience, he specialises in the diagnosis and treatment of skin, hair and nail conditions.

He has expertise in general dermatology, moles and skin lesions, skin cancer, acne, alopecia, psoriasis, eczema, rosacea and complex dermatological diagnoses. Dr Friedmann is committed to evidence-based, patient-centred care, offering safe, effective and personalised treatment for adults and children.