Retinol vs tretinoin: what the experts who reviewed both say

Tretinoin is the stronger of the two, and the experts we track back it more firmly. It has a Guru Score of nearly 90% from more than 25 experts, and not one of them said no. Retinol sits at about 70%. Retinol is the gentler, over-the-counter way into the same family, and the experts who hold back on it point to packaging, how tricky it can be for beginners and sensitive skin, and stronger retinoids that might do more.

Below is what separates the two, how the experts who reviewed both rated them, why retinol scores lower, and which one they point beginners, sensitive skin and acne towards.

What is the difference between retinol and tretinoin?

Strength, mostly. Both belong to the retinoid family, the vitamin A ingredients dermatologists rate for fine lines, dark spots and breakouts. Tretinoin is retinoic acid itself, the form that actually does the work in your skin. Retinol has to be converted first, into retinaldehyde and then into retinoic acid (a 2006 review of retinoids).

That extra step is why retinol is gentler and slower. The same review puts retinol at about 20 times less potent than tretinoin. In a study that tested the two side by side, four weeks of retinol caused the same kinds of changes in skin as retinoic acid, though they tended to be smaller (Kong and colleagues, 2016).

The other big difference is how you get them. Tretinoin is a prescription medicine in the US (FDA label) and the UK (NHS). Retinol is sold over the counter, in everything from drugstore creams to luxury serums.

Which do the experts rate higher, retinol or tretinoin?

Tretinoin, clearly. It has a Guru Score of nearly 90% from more than 25 experts. A handful gave it a mixed verdict and none said no. Retinol has a Guru Score of about 70% from a smaller group of around a dozen.

The fairest test is the experts who have reviewed both, because they are weighing the two against each other. A dozen of them have. Every one said yes to tretinoin. Most of them said yes to retinol too, the rest were mixed on it, and not one rated retinol above tretinoin.

Every verdict, with a link to the moment each expert gave it, is in our tretinoin guide and retinol guide.

Why do the experts back tretinoin so strongly?

Because it has the most proof behind it. The cosmetic chemist behind Lab Muffin Beauty Science puts it simply: “Most of the evidence we have on retinoids are based on tretinoin, so we know that it works for all the standard retinoid things like acne, pigment, and wrinkles.”

Dr Dray, a dermatologist, points to a study that followed people using 0.05% tretinoin every day for two years, and says it showed that “long-term use of topical 0.05% tretinoin daily was not only safe, but was effective for improving the visible signs of moderate to severe sun damage.”

The experts do not pretend it is gentle. Cassandra Bankson, a medical esthetician, says it “can make you peel” and “can make you burn”, “but it also works really freaking well”, and that it is “for seasoned skin intellectuals.”

Why does retinol score lower?

It is weaker, for a start, and the experts who hold back on it have more specific reasons. Even Dr Dray, a dermatologist who rates it, says it takes time: “Retinol definitely is not a scam. However, it doesn't yield instant results. Takes time. It takes patience.”

Several of the reservations are about the bottle rather than the ingredient. Retinol breaks down in light and air (the 2006 review), and Dr. Vanita Rattan warns against retinol in a dropper bottle: “You actually don't know how effective it is, how much of it's been oxidized.” Mad About Skin objects to brands that do not print the strength on the bottle, since that is how you match a retinol to your skin.

Others would point you to a different retinoid altogether. The Budget Dermatologist tells people to buy adapalene 0.1% gel instead of a retinol serum. And Dr. Aanchal MD, a dermatologist, finds retinol tricky for beginners and for dry, sensitive skin, and suggests a sandwich: moisturizer, a thin layer of retinol, then moisturizer again.

Should you start with retinol or tretinoin?

That depends on your skin and what you want from it, and a dermatologist is the person to settle it. What the experts say gives a fair starting point, though.

For beginners and sensitive skin, several of them point to an over-the-counter retinol first. Dr. Daniel Sugai, a dermatologist, puts it this way: “If you're a beginner, if you have sensitive skin, if you have rosacea, you might want to stick with an over-the-counter retinol.” Lab Muffin Beauty Science calls Kiehl's Micro-Dose serum “enough to have an effect but it's not enough to cause any issues.”

For people who have used retinol for a while and want more, the next step up is the prescription. Doctorly, a pair of dermatologists, put it plainly about one drugstore retinol: “You're not going to get the same efficacy that you would get from a tretinoin.” Dr. Shereene Idriss suggests a stronger over-the-counter retinol for people who are “not quite ready for [...] a prescription retinoid but want more from the retinol.”

For acne, the strongest evidence sits with the prescription retinoids. Topical retinoids are strongly recommended in the American Academy of Dermatology acne guidelines, and tretinoin is approved for acne. If you want an acne retinoid without a prescription, adapalene is sold over the counter in the US.

How do you start retinol or tretinoin without irritation?

The same way for both: slowly. The American Academy of Dermatology suggests starting every other night and building up. Dr. Mamina, a dermatologist, suggests a pea-sized amount for the whole face and says to “start low and slow.”

The first few weeks are the hardest. Dryness, peeling and redness are common early on with tretinoin (FDA label), and retinol can do the same more mildly. With tretinoin, a higher strength irritates more without clearly working better (Griffiths and colleagues, 1995), so a stronger tube is not a shortcut.

Give it time, too. Dr. Daniel Sugai says acne takes about 2 to 3 months to respond, and dark spots and collagen at least 4 to 6. Use either one at night, since light breaks both down (2006 review), and wear sunscreen in the morning (AAD).

Can you use retinol or tretinoin while pregnant?

No. Tretinoin's label says it should not be used in pregnancy (FDA label), and the American Academy of Dermatology advises against retinoids during pregnancy. Anyone who is pregnant or trying to be may want to talk to their doctor before starting either one.