Why first-time tretinoin use is on the rise
The first week he started tretinoin, Jordyn Alexander-Johnson ended up with a chemical burn. “I wasn’t using any moisturizer,” he says. Big mistake. Using tretinoin — a form of vitamin A that’s known for its effectiveness in treating acne and reducing signs of aging — is drying and requires that you almost bathe in moisturizer after. And then roll around in sunscreen.
After a two-week break, the 30-year-old Dallas resident tried again, this time with the elaborate skincare routine that tretinoin demands. He had previously completed two rounds of Accutane after years of dealing with skin problems in high school and wanted to try a topical treatment to keep his skin clear.
“It’s really hot and humid here, so using all these products can make you look like you’re sweating a lot,” he laughs, adding that less face time with people during the pandemic has helped make this manageable. “I’m working from home right now, so that’s probably why I’m doing so well with tretinoin.”
After cities across the world went into lockdown in 2020, people like Alexander-Johnson took advantage of the prolonged time spent indoors to try out stronger skincare products and treatments that they had previously been wary of due to the possibility of a bad reaction. Prominent among these has been the rise in the number of people using tretinoin for the first time. Tretinoin is a strong retinoid with potential side effects that can rival its efficacy. It’s sold under various brand names across the world in cream, gel, or ointment form. In some countries like the United States, purchasing tretinoin products requires a prescription while in others, like India or Vietnam, it’s available over the counter.
Because tretinoin stimulates cell turnover, essentially replacing older skin with newer skin, at a rate few other ingredients can match, tretinoin usage most often results in a dreaded “purge” — a kind of adjustment period lasting anywhere from a couple of weeks to months where users’ skin gets worse before it gets better.
The intensity of the purging differs for everyone. A lucky few can get away with just a couple of dry patches. Others deal with prolonged periods of peeling, flaking, inflammation, major breakouts, and other kinds of skin irritation. For people already dealing with skin issues, a marked disimprovement can be demoralizing, causing many people to abandon tretinoin — which requires consistent, long-term use to see results — barely a few weeks in. As Adelaide Yamoah, a newbie user from Canada, says: “Tretinoin is an emotional roller coaster.”
But spending months indoors during shutdowns, the side effects can be easier to handle.
Online skincare communities, where tretinoin is already a wildly popular topic, have seen a stream of questions from new tretinoin users since early 2020. A user on Reddit’s tretinoin forum around that time said they were “waiting for the lockdown order just so I can start tret [and] hope that the worst of the purge begins while we’re in lockdown.”
Another reason for tretinoin’s pandemic popularity — besides the available time at home to try it — may be the amount of time people are spending on social media as an outlet.
Tretinoin usage most often results in a dreaded “purge” — a kind of adjustment period lasting anywhere from a couple of weeks to months where users’ skin gets worse before it gets better.
“There’s a mania around skincare,” says Chicago resident and first-time tretinoin user Cait Rappel, 33. “It’s a downright obsession, and I’m kind of ashamed of myself for buying into it.” The no-makeup selfie trend, she says, further ramped up the pressure to have perfect, unblemished skin at all times.
Beginning tretinoin “was a mess,” says Mumbai resident Sanika Tipre of her tretinoin debut. She says it was social media that drew her to start tretinoin despite being only 25 with no major skin issues. “There were a lot of articles, IG posts, and videos made by people, even professionals like dermatologists and aestheticians, who recommended tretinoin as the best in the market for anti-aging,” she says. “Browsing through Reddit, I would always see posts of people with perfect skin at golden hour, and as much as I told myself that I should not let social media dictate my decisions … I wanted to try out the craze.”
She imagined herself emerging from the chrysalis of the lockdown like “a butterfly, with smooth glowing skin.” She used the A-Ret 0.05{409126f2c1f09c9e510a010c163a4bce2c3ccfc4019bdf864d6cb2d5d8752f38} cream by Medpharma, purchased over the counter during a previous trip to Dubai. “The first two weeks were a lot of dry skin and peeling,” she says. “No matter how much I moisturized, I would have skin flake every single night.”
Almost four months later though, her skin had not stopped purging. Tipre finally approached a dermatologist.
“After I consulted with her, she told me that the frequency of my usage was too much and that I should stop tretinoin immediately,” she says. She’s now trying a gentler retinoid with fewer side effects, and her skin is doing much better. “I’ve definitely learned my lessons,” Tipre says.
“[Tretinoin] can be very drying and irritating if your skin isn’t used to it, so you need to take care not to apply too much, not to apply too frequently, and to make sure you use a very gentle cleanser and moisturizer to support your skin as it adjusts,” says Michelle Wong, PhD, a chemist who runs the popular skincare platform Lab Muffin, in an email interview. “It’s easy to get overenthusiastic and apply too much at first.”
Mumbai-based dermatologist Dr. Rashmi Shetty, MBBS, agrees. “For example, [while using tretinoin], don’t use a face wash with benzoyl peroxide or salicylic acid in it,” she advises. Provided it is used under a doctor’s guidance, tretinoin is an established and safe treatment modality, she says.
After a two-week break to let his burned skin heal, and lots of careful note-taking from forums, Alexander-Johnson put together a proper skincare routine. Nine months later, with his skin having seen massive improvement, his confidence has soared too. “It was when I started taking selfies that I noticed,” he says. “I’m not a selfie person.”
It’s a small win in a dark time, but for Alexander-Johnson, it’s still meaningful.
