Tretinoin vs tazarotene: what the experts say

The experts we track side with tretinoin. Every expert in our tazarotene guide also appears in our tretinoin guide, and all of them said yes to tretinoin, while only two said yes to tazarotene. The trials are closer than that verdict suggests: head to head, tazarotene mostly matched or beat the tretinoin it was tested against, most often a lower strength of it. What holds it back, the doubters say, is irritation, so the dermatologists among them start patients on tretinoin, and tazarotene is the alternative some people end up doing better on.

Below is how the two differ, how the experts who reviewed both rated them, what the trials found for ageing skin and for acne, and what to know before starting either one.

What is the difference between tretinoin and tazarotene?

Both are prescription retinoids, the vitamin A family dermatologists rate for acne and for signs of ageing. Tretinoin is retinoic acid itself, the active form that over-the-counter retinol has to be converted into, which makes it stronger and more irritating than retinol (Mukherjee and colleagues). Tazarotene is a lab-made retinoid that DermNet groups with the third generation, which act more selectively on the retinoid receptors in skin cells than tretinoin does.

The experts describe that difference too. Doctorly, a channel run by two dermatologists, describe tretinoin as “a little bit more balanced in the receptors that it binds to,” and Mad About Skin says that “Tazarotene works in a more targeted way on specific receptors.” The tazarotene label is more modest about what that means: it says the clinical significance of those receptor findings is unknown (FDA label).

In practice they do overlapping jobs. Tretinoin is approved in the US for acne, and a separate tretinoin cream helps soften fine facial wrinkles alongside sun protection (FDA, FDA). Tazarotene is approved for acne and plaque psoriasis, and a 0.1% cream is approved as an add-on for fine wrinkles and dark spots on sun-damaged faces, for people who also protect their skin from the sun (FDA label).

Which do the experts rate higher, tretinoin or tazarotene?

Tretinoin, clearly. It has a Guru Score above 90% from more than 25 experts, with nobody saying no. Tazarotene has a Guru Score of about 40%, from a handful of experts.

Every expert in our tazarotene guide also appears in our tretinoin guide, which lets us compare them side by side, and all of them said yes to tretinoin. On tazarotene they split. Dr Dray, a dermatologist, and Mad About Skin said yes. Dr. Sam Ellis, a dermatologist, was mixed. Doctorly and Lab Muffin Beauty Science, a cosmetic chemist, said no. Nobody rated tazarotene above tretinoin.

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

Is tazarotene or tretinoin better for wrinkles and sun damage?

On the trials, tazarotene holds its own, with one catch. In a 24 week trial in 349 people, 67% on 0.1% tazarotene cream and 55% on 0.05% tretinoin cream counted as a treatment success, against 22% on a plain cream (Kang and colleagues, 2001). A second trial in 173 people found that the differences which reached significance all favoured tazarotene, mostly in how quickly skin improved (Lowe and colleagues). The catch is that both trials put 0.1% tazarotene against 0.05% tretinoin, a middle strength, so they do not settle which is the stronger drug.

Dr Dray reads the evidence that way: “Overall, the data suggests that tazarotene and [tretinoin] are both equally effective. The decision between them really isn't about which one is stronger or more potent.” She adds that with tazarotene “You may see results faster than with tretinoin, with some improvement appearing as early as two weeks.”

Tretinoin's own record is longer. Its trials on ageing skin go back decades (Weiss and colleagues, 1988), and Lab Muffin Beauty Science points out that “Most of the evidence we have on retinoids are based on tretinoin.” Dr. Sam Ellis says it “deserves its good reputation.”

Is tazarotene or tretinoin better for acne?

Both are approved acne treatments, and in most of the head-to-head acne trials tazarotene came out ahead. In 12 week trials, 0.1% tazarotene gel cleared blackheads and whiteheads better than 0.025% tretinoin gel and did about as well on inflamed spots (Webster and colleagues), and it beat 0.1% tretinoin microsponge gel on overall improvement, 67% against 49% (Leyden and colleagues). Not every comparison went its way: a lower 0.05% tazarotene cream did about as well as a 0.04% tretinoin gel, with tretinoin faster on several measures (Kircik).

Doctorly point to a head-to-head study too, saying tazarotene “was significantly more effective than [tretinoin] in treating acne when you compare them head to head.” Even so, they rated tazarotene no, for the reason in the next section.

Which is gentler, tretinoin or tazarotene?

Tretinoin, for most people, according to the experts who rated tazarotene lower. Doctorly say: “Tazarotene is more irritating in general than tretinoin. When I start a patient on it, I usually get more complaints of flaking, purging, and irritation starting on tazarotene than I do with tretinoin.” Dr. Sam Ellis explains: “it's very effective, but often times it is more poorly tolerated. For that reason, it is the general practice of dermatologists to start patients on tretinoin first.”

The early trials did not show this as clearly. Two acne trials called the two comparable on tolerability (Webster and colleagues, Leyden and colleagues), while a sun damage trial found more burning with tazarotene in the first week (Lowe and colleagues). Lab Muffin Beauty Science sums up the arc: “It's kind of sad to read through the studies in date order and just sort of see all the hope just slowly fade.”

Neither is gentle. The tazarotene cream label reports that across its sun damage trials 40% of people peeled and 34% had redness, with new reports peaking at week 2 (FDA label). The tretinoin leaflet says dryness, peeling and redness are common in the first weeks and usually settle within two to four weeks (FDA). Both make skin more prone to sunburn (FDA, FDA label), and Doctorly put it plainly: “Photo protection and sun protection is paramount when using tazarotene.”

Some people do better on tazarotene, though. Dr. Sam Ellis says there is “a subset of patients who tolerate tazarotene more successfully,” and that “You start it the exact same way you start tretinoin.” Mad About Skin, who could never get on top of the peeling from tretinoin, found “Tazarotene to be much less sensitizing than Tretinoin.” Doctorly describe switching people who have stopped seeing progress after years on tretinoin, and say “they're generally pretty happy.”

Do you need a prescription for tretinoin or tazarotene?

Yes, for both. In the US both are prescription medicines (FDA, FDA). In the UK tretinoin is prescription only too, and the NHS lists it among the acne treatments a GP or specialist can prescribe.

Tazarotene is harder to find outside the US. A pharmacist-reviewed Patient.info leaflet says the only UK-licensed product, a gel, was discontinued in 2021, and that at its 2024 review no tazarotene skin preparations were available in the UK. If you are outside the US, a GP or dermatologist can tell you what is available to you.

Can you use tretinoin or tazarotene while pregnant?

The labels advise against both. Tretinoin's US label says it should not be used in pregnancy (FDA label), and its UK label lists pregnancy and planning a pregnancy as reasons not to use it (UK label). Tazarotene's US labels go further: they list pregnancy as a contraindication and ask for a negative pregnancy test before starting and effective contraception during treatment (FDA label). Anyone who is pregnant or trying to be may want to talk to their doctor before using either one.