Tretinoin for Acne in the UK
What tretinoin is, which tretinoin products are licensed in the UK, how it compares with adapalene, and how to use a retinoid safely.
Part of our acne health guides.
Key fact: Tretinoin is a retinoid that unblocks pores and treats acne. In the UK, no cream or gel containing tretinoin on its own is currently licensed for acne. The licensed options combine it with an antibiotic, such as Treclin (tretinoin with clindamycin), and adapalene (Differin, Epiduo) is the licensed retinoid most often used instead.
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See acne treatments →What tretinoin is
Tretinoin is a retinoid, a medicine related to vitamin A. Applied to the skin, it speeds up how skin cells turn over and stops them clogging pores, so fewer blackheads, whiteheads and spots form. It is also known by older brand names such as Retin-A. It is different from isotretinoin, which is a tablet for severe acne prescribed only by dermatologists; see isotretinoin explained.
Tretinoin in the UK
Tretinoin-only creams and gels (such as Retin-A) were withdrawn from the UK market. The tretinoin products currently licensed for acne in the UK combine it with an antibiotic:
- Treclin: tretinoin 0.025% with clindamycin 1%, a once-daily gel that NICE lists as a first-choice acne treatment
- Aknemycin Plus: tretinoin with erythromycin, a solution
Tretinoin on its own can only be supplied in the UK as an unlicensed medicine (an imported product or a "special"), which means it hasn't been assessed for that use by the UK regulator. Access Doctor doesn't supply unlicensed tretinoin. For most people, a licensed retinoid such as adapalene does the same job.
Tretinoin or adapalene?
| Tretinoin | Adapalene | |
|---|---|---|
| What it is | A retinoid | A retinoid-like medicine |
| Licensed UK products | Treclin (with clindamycin); Aknemycin Plus (with erythromycin) | Differin (on its own); Epiduo (with benzoyl peroxide) |
| Irritation | Dryness and peeling are common at first | Usually a little gentler |
| Can be used long term to keep skin clear? | Treclin: 12 weeks, then review, because it contains an antibiotic | Yes |
| With an antibiotic tablet? | Not Treclin (it already contains an antibiotic) | Yes (Epiduo is NICE's choice) |
| Pregnancy | Must not be used | Must not be used |
NICE treats tretinoin with clindamycin and adapalene with benzoyl peroxide as equal first choices. If you were looking for tretinoin to keep skin clear long term, adapalene is the usual licensed choice; see acne creams and gels compared.
Treclin: tretinoin with clindamycin
Treclin treats blackheads, whiteheads and inflamed spots in one gel. It is applied once a day at bedtime for up to 12 weeks, then reviewed. Because it contains an antibiotic, it isn't used with antibiotic tablets, and once skin is clear, a gel without an antibiotic, such as adapalene, is usually used to keep it clear. Women who could get pregnant must use effective contraception while using it and for 1 month after stopping.
How to use a retinoid
1
At night, on dry skin
Wash with a gentle cleanser, pat dry and wait until your skin is completely dry.
2
A pea-sized amount for the face
Dot it on the forehead, cheeks and chin and spread thinly. Avoid the eyes, lips and corners of the nose.
3
Start slowly
Every other night for the first couple of weeks if your skin is sensitive, then nightly.
4
Moisturise and protect
A plain moisturiser and daily SPF 30 or higher. Avoid sunbeds and harsh scrubs or acids.
Dryness, redness and a short-lived flare of spots are common in the first few weeks; see acne treatment side effects.
Pregnancy and other cautions
Not in pregnancy: tretinoin and adapalene must not be used if you are pregnant or planning a pregnancy. If you could get pregnant, use effective contraception. If you find you're pregnant, stop and contact your GP.
Don't use a retinoid on broken, sunburnt or eczema-affected skin, and tell your prescriber if you have rosacea or perioral dermatitis, which retinoids can make worse.
Frequently asked questions
Can you get tretinoin cream in the UK?
Tretinoin-only creams and gels are not currently licensed for acne in the UK. The licensed tretinoin products combine it with an antibiotic: Treclin (with clindamycin) and Aknemycin Plus (with erythromycin). Tretinoin on its own can only be supplied as an unlicensed medicine. Adapalene (Differin, Epiduo) is the licensed retinoid most often used instead.
Is tretinoin the same as Treclin?
No. Treclin contains tretinoin 0.025% together with the antibiotic clindamycin 1%. It is a licensed UK acne gel used once a day for up to 12 weeks, then reviewed. Because it contains an antibiotic, it isn't used with antibiotic tablets.
Is adapalene as good as tretinoin?
For acne, NICE treats adapalene with benzoyl peroxide (Epiduo) and tretinoin with clindamycin (Treclin) as equal first choices. Adapalene is usually a little gentler on the skin and is the licensed retinoid in the UK that can be used on its own and long term to keep acne away.
Is tretinoin the same as isotretinoin?
No. Tretinoin is applied to the skin. Isotretinoin is a tablet for severe or scarring acne that can only be prescribed by, or under the supervision of, a consultant dermatologist. Both are retinoids, and neither can be used in pregnancy.
Can I use tretinoin while pregnant?
No. Tretinoin and other retinoids, including adapalene, must not be used during pregnancy or if you're planning a pregnancy. If you find you're pregnant while using one, stop and contact your GP.
Why does my skin get worse when I start a retinoid?
Dryness, redness, peeling and a short-lived increase in spots are common in the first few weeks, as the retinoid speeds up skin turnover. It usually settles. Starting every other night and using a plain moisturiser helps; if irritation is severe or doesn't settle, speak to your prescriber.
Not sure which treatment suits you?
Complete a short online consultation about your skin and any treatments you have tried. A GPhC-registered pharmacist prescriber recommends a treatment and, if it is suitable, we dispatch it from our UK pharmacy. For adults 18 and over.
Start Acne Consultation →References
- National Institute for Health and Care Excellence. Acne vulgaris: management (NG198). nice.org.uk/guidance/ng198
- Treclin 1%/0.025% w/w Gel: summary of product characteristics. medicines.org.uk/emc/product/5371
- Electronic medicines compendium: products containing tretinoin. medicines.org.uk/emc/ingredient/947
- NICE Clinical Knowledge Summaries. Acne vulgaris. cks.nice.org.uk/topics/acne-vulgaris
Medical disclaimer: This page is for information only and isn't a substitute for medical advice. Most of the treatments mentioned are prescription-only, so a clinical consultation is needed before they can be supplied. Many acne treatments must not be used in pregnancy. Always follow your prescriber's advice and the leaflet. In a medical emergency, call 999.