The sources give different time frames for different conditions. For acne, the Retin-A label states that therapeutic results should be noticed after 2 to 3 weeks but more than 6 weeks of therapy may be required before definite beneficial effects are seen. For fine facial wrinkles, the Renova (tretinoin cream) 0.02% label states that up to 6 months of therapy may be required before the effects are seen. These are statements from labels, not predictions for any one person.
Time frames by condition
The Retin-A label says it is indicated for topical application in the treatment of acne vulgaris. The Renova 0.02% label says it is indicated as an adjunctive agent for the mitigation (palliation) of fine facial wrinkles in patients who use comprehensive skin care and sunlight avoidance programs.
| Question | What the source says |
|---|---|
| Acne: what does the Retin-A label say? | Therapeutic results should be noticed after 2 to 3 weeks, but more than 6 weeks of therapy may be required before definite beneficial effects are seen. |
| Fine wrinkles: what does the Renova 0.02% label say? | Mitigation of fine facial wrinkling may occur gradually over the course of therapy. Up to 6 months of therapy may be required before the effects are seen. |
| Fine wrinkles: what does the Renova 0.02% label say the product does not do? | It does not eliminate wrinkles, repair sun-damaged skin, reverse photoaging, or restore more youthful or younger skin. |
The label for Refissa tretinoin cream (emollient) 0.05% states that with discontinuation of therapy a majority of patients will lose most mitigating effects on fine wrinkles, mottled hyperpigmentation, and tactile roughness of facial skin.
The first weeks: worsening and irritation
The Retin-A cream and gel label says that during the early weeks of therapy an apparent exacerbation of inflammatory lesions may occur, that this is due to the action of the medication on deep, previously unseen lesions, and that it should not be considered a reason to discontinue therapy. The Retin-A Micro (tretinoin) gel microsphere label, a gel and not a cream, states that during the early weeks an apparent exacerbation of inflammatory acne vulgaris lesions may occur, and that if the product is tolerated, initial worsening should not be considered a reason to discontinue therapy.
For photodamage, a Cochrane review reports that erythema, scaling/dryness, burning/stinging and irritation may be experienced initially.
Irritation has limits that the labels also describe. The Retin-A cream and gel label says the skin of certain sensitive individuals may become excessively red, edematous, blistered, or crusted, and that if these effects occur the medication should either be discontinued until the integrity of the skin is restored or adjusted to a level the patient can tolerate. For Retin-A Micro 0.1% gel microsphere, the label reports that during the 12-week treatment period no more than 3% of treated subjects had scores indicative of severe cutaneous irritation, and 6% (14/224) discontinued treatment due to cutaneous irritation.
What a 6-month follow-up reported
The Veterans Affairs Topical Tretinoin Chemoprevention Trial used 0.1% cream or vehicle control cream once daily, then twice daily as tolerated, with instructions to step down to once daily or less if twice daily was not tolerated. At the 6-month follow-up, the tretinoin group more commonly reported one or more side-effects than the control group (61% vs. 42%). Burning was the most common side-effect (39% tretinoin vs. 17% control). The tretinoin group was less likely to apply cream twice daily at 6 months (29% vs. 43%).
That trial tested whether tretinoin could reduce keratinocyte carcinoma, so these figures do not come from an acne or wrinkle trial. A systematic review of acne treatment adherence reported that reasons for nonadherence included cost, side effects, perceived treatment ineffectiveness or symptom resolution.
What this does not tell you
The time frames are statements in labels. They are not measurements for one person, and they differ by condition and by product. The passages used here do not say when irritation settles for any individual.
The percentages above come from the Veterans Affairs trial of 0.1% cream and from the label of a 0.1% gel microsphere. They are not results for other strengths or formulations. The FDA states that compounded drugs are not FDA-approved, meaning FDA does not verify the safety, effectiveness or quality of compounded drugs before they are marketed, so label time frames should not be read as a promise for a compounded cream. A licensed provider decides on treatment and follow-up.