Retinoids such as retinol, tretinoin, adapalene and tazarotene can cause retinol side effects like a rash, irritation, redness, and skin sensitivity.
There are many different types of retinoids at different percentages and strengths. The stronger retinoids are more likely to cause retinoid dermatitis.
You can avoid a retinol rash and other side effects by using the correct retinoid for your Baumann Skin Type® and following my dermatologist instructions on how to use retinoids properly.
Retinoids can cause some inflammation of the skin and increase blood flow to the skin when beginning a retinoid. This results in skin redness, tenderness or peeling in some people.
If you do not see any of these side effects, then either you are on the right retinoid for your skin type and using a good retinol skin care routine or the retinol you are using is not very strong. There are many ineffective retinoids on the market.
Your side effect risk depends upon your Baumann Skin Type. Sensitive skin types are more prone to inflammation, skin stinging, and other reactions and are much more likely to have side effects from retinol.
Knowing your Baumann Skin Type® and corresponding skin care routine recommendations is the best way to avoid retinoid side effects.
Negative effects of retinoids
There are a few common side effects associated with retinoids.
Retinoids are in a family of Vitamin A compounds that includes retinol. All of them can cause the same retinoid rash as a side effect of using too much too soon.
This rash is called retinoid dermatitis which means inflamed skin caused by retinoids. It is temporary but makes your skin sting and feel uncomfortable.
Don't worry- retinol dermatitis will go away in 3-7 days. Follow the instructions at this link.
Retinol cannot "ruin" your skin. All of the negative effects of retinoid are temporary and retinoids are safe (except in pregnancy).
However, retinoid dermatitis and irritation from retinoids makes many people believe they have a retinol allergy. The negative effects are actually not due to allergy, but are caused when too large of a dose is used.
Common and Expected Side Effects
Retinoid side effects are very common- especially the first 2 weeks after beginning a retinoid. They usually begin 3-4 days after applying the retinoid.
Retinoids should cause some inflammation of the skin and increase blood flow to the skin when first starting a new retinoid.
This results in skin pinkness or mild scaling. This is how you know a retinoid is working.
However, you do not want to over do it because then you will get a retinol reaction usually called a retinol rash or retinoid dermatitis. If you use the retinol consistency and correctly, these retinoid side effects will go away.
The side effects of retinoids are bothersome, but it is worth it to push through and adapt to them because retinoids have been proven to control acne, reduce dark spots, and reverse skin aging! Click here learn more about retinoid science.
Most Common Side Effects
Retinoid side effects are very common. I see them often in patients who have not been told by other doctors how to use them properly in a custom skin care routine. They are much less common when used correctly- in fact thy can be completed avoided with the right skin care routine.
The 10 most common symptoms of retinoid rash and unwanted side effects of retinol are:
- redness (erythema)
- stinging or burning
- scaling or peeling due to increased desquamation
- dry skin
- rough skin
- painful burned skin
- skin sensitivity
- purging (acne breakout)
These common side effects of retinoids occur when too much gets into the skin. Many different factors determine how much retinol gets into the skin.
Allergy to retinol
When you begin retinoids, or use them incorrectly, you may get a retinoid rash or skin irritation that feels like an allergy.
This is not a true skin allergy to retinol. Dermatologists call this retinoid dermatitis.
It is not an immune system mediated allergy, rather it is an irritant reaction.
This means that you should be able to tolerate the retinoid if you lower the amount of retinoid that gets in the skin.
What to do for a retinol allergy?
Retinol allergy is very rare. The redness, burning, stinging, rash and red face from retinol is an irritate reaction- not a true allergy.
Stop using the retinoid and wait 4 days until skin is calm. Reintroducing the retinoid very slowly should allow you to tolerate it. Follow these instructions.
We know that after experiencing unpleasant side effects from retinol, it is hard to make yourself restart- but- the benefits of retinoids for acne, wrinkles and dark spots on the skin makes it worth it to try again.
Why Does Retinol Burn Skin?
Retinol irritates skin when too much gets into the skin and turns on genes that lead to inflammation.
Negative effects happen when they are used incorrectly and are most likely to occur when they are:
How to Minimize Side Effects from Topical Retinoids:
There are many different types of retinoids at different percentages and strengths. The stronger retinoids are more likely to cause adverse reactions.
You can minimize side effects by using the right type of moisturizer, applying moisturizer before the retinoid, using anti-inflammatory ingredients and avoiding hyaluronic acid, oils with oleic acid, and exfoliants.
Certain Baumann Skin Types are more likely to react to retinoids, so it is a good idea to get a personalized skin care routine and follow the instructions exactly- especially when beginning retinol for the first time.
Sensitive skin types are more prone to inflammation and are much more likely to have side effects from retinol.
Rosacea types should not start retinoids until they have completed at least one month of a hydrating anti-inflammatory skin care routine.
Know your Baumann Skin Type® and review our dermatologist - recommended skin care routine advice to avoid retinoid side effects.
What if I do not have any side effects when I begin retinol? Does that mean it is not working?
If you are not having any side effects to a new retinoid, then you are either:
- Following our custom skin care routine advice (Yay!)
- Using a good retinol skin care routine that is helping you tolerate the retinoid (cleansers and moisturizers are very important!)
- You have a resistant Baumann Skin Type that rarely reacts to products but the retinol is still beneficial for you.
- Using a retinoid that has the weak forms of retinoid that do not work such as retinyl palmitate, retinaldehyde
- Applying the retinoid on top of your moisturizer or oil
- Using a retinoid that is too weak for your skin type
How to Treat a Retinol Rash or Retinol Irritation
- Soothing cleanser (not foaming)
- Calming cream or oil
Avoid these products and ingredients when you have a retinol rash:
Use oil or cream-based cleansers without strong foaming detergents (a light weak foam is OK.) . Do not use soap! Choose cleansers with anti-inflammatory ingredients.
These are the cleansers I tell my patients to use when thy have a retinol rash:
- Zerafite Soothing and Calming Moisturizer- Repairs the skin barrier. Contains niacinamide and argan oil. Best for soothing cream for a retinol rash.
- Derma Made Nia-genic Lotion.-Contains soothing niacinamide and peptides. Best for combination skin or normal skin.
- SkinCeuticals Phyto Corrective Gel- Contains cucumber extract. Best for oily skin types.
Products to soothe retinol side effects in dry skin:
Products to soothe retinol side effects in oily skin:
These oils can be used on top of your barrier repair moisturizer to help slug the soothing ingredients into the skin.
Hydrocortisone or steroids for a retinol burn
We do not recommend steroids like hydrocortisone because they can cause rebound irritation when stopped.
Steroids on the face can also cause a perioral dermatitis rash around the mouth. Instead choose a soothing barrier repair moisturizer or an anti-inflammatory oil with soothing ingredients like argan oil, green tea, and centella asiatica.
What to do for a retinol burn on the neck?
Neck skin is more sensitive to retinol than facial skin and is more likely to develop side effects.
If you get a retinol burn on the neck, stop using the retinol immediately. Apply a soothing oil or soothing barrier repair moisturizer.
Do not wear and clothing that rubs the neck area. Avoid scratchy fabric like wool. Wear a shirt that covers the neck area and void sun exposure. Do not use any exfoliants. The neck burn should improve in 4- 7 days.
How to restart retinol after recovering from retinol irritation
If you are having side effects from retinol or prescription Retin A or retinoids, stop for 4 days and restart following these 4 steps to restart your retinoid:
- Use lower dose of retinoid (a 2x or 0.025% retinol (not prescription) is the lowest strength retinoid
- Use the retinoid less often
- Use the retinoid on top of your moisturizer
- Use the retinoid with the correct skin care products
You can find more specific instructions at this link.
How To Prevent Retinol Side Effects
Besides choosing the best retinoid and using it properly, here are some other tips to avoid retinol burns and rashes. Remember that side effects are increased or decreased according to the type of cleanser and moisturizer you choose to use with the retinoid.
Dermatologist advice on how to prevent retinoid side effects:
- Avoid over exfoliation
- Don’t use exfoliants like facial scrubs, hydroxy acids, or facial brushes
- Be careful kissing someone with a rough beard or prickly facial hair
- Rough clothing like wool can irritate retinol treated skin
- Stop using retinol for 4 days before getting hair removal with wax
- Use cooler wax- it is the heat that is the problem
- Choose laser but tell them you are on a retinoid
- Consider threading
- If you get facials or peels, tell your aesthetician that you are on retinol
- Chemical peels can burn skin if you are using retinol
- Do not get a peel if you have flaking or redness from retinol
- Stop retinol 3 days before dermaplaning
- Stop using retinol 2 days before going to a dry environment
- Stop 2 nights before an airline flight over 6 hours
- Use a barrier repair moisturizer on the flight
- Use a barrier repair moisturizer for 1-3 days in the dry climate if you have been using retinol until your skin adjusts to the climate then resume your normal skin care routine
- Never begin exfoliants at the same time as beginning retinol
- Begin one first for two weeks, then add the other one
- Too many exfoliants leads to over exfoliation
When not to use retinol?
Even if you are accustomed to retinol, there are times when you should not use retinol. Lifestyle changes, activities, and changes in your environment can increase the risk of reactions. For example, if it is really cold and you are going skiing, or if you plan to wear scratchy wool sweaters, or you will be on long international flights and your skin will get dehydrated, or you will be exposed to hotel sheets with lots of detergents.
Do not use retinol in these situations:
- When pregnant
- When travelling from humid climate to dry climate
- After dermaplaning (stop for 4 days)
- After a chemical peel (stop for 4 days)
- On the surgical scar after surgery (until skin is epithelialized which means skin completely closed and light pink. This takes 7-14 days.) Although retinoids speed healing when used before surgery, they slow healing when used after surgery so wait until completely healed to restart.
- Before getting hair removal with hot wax (stop 3- 4 days prior)
- 2 days before threading for hair removal
- Before going skiing or being exposed to very cold temperatures. (stop 3-4 days)
- Before having significant sun exposure like going fishing for hours (retinoids can protect you from sun damage but if you anticipate being in sun for long hours, having a build up of dead skin on the surface of the skin will help protect you- so best not to use exfoliants before significant sun exposure of 2 hours or more)
- If you have active flushing rosacea and skin feels warm and hurts
- If your skin burns or stings
- If you will be exposed to irritating substances like pesticides, detergents or strong chemicals.
Skin Care Routine to Minimize Side Effects
Retinol often causes side effects when you begin using it. Beginning retinoids properly, using the correct retinol cream, and using retinoids with a customized skin care routine can all help prevent side effects.
Its always best to shop for products and follow directions for your Baumann Skin Type. Let me help you build a skin care routine that minimizes the risk of retinoid dermatitis!
How to treat a retinol rash naturally?
If you want a natural option to treat a retinol burn, try aloe directly from an aloe plant or chamomile tea bags that have been steeped in warm water and cooled. A natural cucumber mask can also soothe skin. Naturals oils with the fatty acid linoleic acid are also soothing. Examples are argan oil, evening primrose oil, safflower oil, and Sunflower oil.
How long does a retinol burn last?
If you follow our instructions, a retinoid rash should last 1- 4 days before clearing. It should get a little better every day.
How to heal a retinol burn fast?
Apply a soothing oil and cover with an occlusive barrier repair moisturizer.
Does a retinol burn go away?
A retinol burn is not permanent. It will go away eventually on it's own but you can use soothing skin care to clear it faster.
Does retinol have long term side effects?
There are no long term side effects from retinol unless you tan your skin when you have retinoid dermatitis and end up with hyperpigmentation.
Best references and medical publications on retinoid side effects:
- Baumann L. Ch. 45 Retinoids in Baumann's Cosmetic Dermatology, 3rd Ed. (McGraw Hill 2022)
- Baumann, L. S. (2014). Cosmeceuticals and cosmetic ingredients. McGraw Hill Professional.
- Baumann L. Ch. 35 Skin Care Regimen Design in Baumann's Cosmetic Dermatology, 3rd Ed. (McGraw Hill 2022)
- Baumann, L. (2018). How to use oral and topical cosmeceuticals to prevent and treat skin aging. Facial Plastic Surgery Clinics, 26(4), 407-413.
- Baumann, L. S. Improving compliance with cosmeceutical-prescription combinations.
- Baumann, L. (2018). How to use oral and topical cosmeceuticals to prevent and treat skin aging. Facial Plastic Surgery Clinics, 26(4), 407-413.
- Grunebaum, L. D., & Baumann, L. S. (2014). Nonprescription topical treatments for skin rejuvenation. Facial plastic surgery, 30(01), 003-011.
- MacGregor, J. L., & Maibach, H. I. (2002). The specificity of retinoid-induced irritation and its role in clinical efficacy. Exogenous Dermatology, 1(2), 68-73.
- Zheng, Y., Che, D., Peng, B., Hao, Y., Zhang, X., He, L., & Geng, S. (2019). All‐trans‐retinoic acid activated mast cells via Mas‐related G‐protein‐coupled receptor‐X2 in retinoid dermatitis. Contact Dermatitis, 81(3), 184-193.