Tretinoin vs. Isotretinoin: What’s the Difference?

Tretinoin and isotretinoin are similar-looking generic names for two different medications. Both medications are used to treat acne, and they both belong to a group of medications called retinoids. Retinoids are medications that are derived from vitamin A.

Despite their similar names, tretinoin and isotretinoin medications are not interchangeable when it comes to treating acne. They are used in different ways and for different reasons.

This article discusses the differences and similarities between tretinoin and isotretinoin. It also covers how you use them and why your healthcare provider may prescribe them.

Are Tretinoin and Isotretinoin the Same?

No, tretinoin and isotretinoin are different medications used to treat different types and severities of acne.

Tretinoin is a topical (applied to the skin) medication derived from vitamin A. Tretinoin is commonly used to treat mild to moderate acne, like blackheads and whiteheads. It may also be used to address signs of aging, such as age spots, sun damage, and wrinkles, and to improve the skin's overall texture.

Isotretinoin is an oral (taken by mouth) medication. It is also derived from vitamin A, but it is not prescribed for anti-aging purposes. Isotretinoin is used to treat severe acne, such as cystic acne or acne nodules. It works systematically by shrinking oil glands and limiting sebum (skin oil) production all over the body, making it the preferred medication for people with widespread acne.

There are some similarities between the two medications. Both tretinoin and isotretinoin are:

• Prescription-only: In most countries, including the United States, you will need a prescription to get tretinoin or isotretinoin.
• Used to treat acne: Both medications are prescribed as acne treatments, however, they are primarily indicated for different types and severities of acne.
• Derived from vitamin A: Research shows that increasing vitamin A levels can significantly improve inflammatory and non-inflammatory acne. All retinoids are derived from this vitamin.
• Known to cause cause side effects: A common side effect of both medications is skin irritation, often called "retinoid burn." Both medications also make your skin more sensitive to the sun, so you will need to take special care to protect yourself from sun exposure.
• Teratogenic: These medications should not be used by pregnant people. The use of retinoids in pregnancy has been linked to severe birth defects of the face, skull, cardiovascular, nervous system, and thymus (an organ that plays a critical role in the immune system).

What Are the Differences Between Tretinon and Isotretinon?

Tretinoin is used to treat mild-to-moderate acne along with signs of aging and hyperpigmentation. It is available by prescription as a gel, cream, or ointment.

Isotretinoin is prescribed for severe acne. It does not improve signs of aging or hyperpigmentation. It is available by prescription as a capsule or tablet.

What Is Tretinoin?

Tretionin is used topically, meaning that you put it directly on the skin. Usually, you apply tretinoin once or twice a day. Topical tretinoin medications come in cream, ointment, and gel, ranging in strength from .025% to .1%, the latter of which is most potent.

Benefits

Tretinoin clears acne by:

• Encouraging the skin to self-exfoliate by speeding up the rate at which skin cells turn over (die and regenerate)
• Unclogging pores, clearing blackheads and inflamed pimples
• Preventing breakouts after acne is cleared
• Reducing inflammation
• Reducing excess sebum (skin oil) production

The benefits of tretinoin for reversing and preventing signs of aging have been proven in numerous studies. Tretinoin reduces signs of aging by:

• Brightening the skin: Tretinoin speeds up the skin's natural exfoliation process, a process that slows down with age leading to dull, sallow skin.
• Preventing collagen loss to preserve skin elasticity: Collagen production also decreases with age, but tretinoin can slow this process.
• Reducing and preventing wrinkles: It does so by slowing down the destruction of collagen caused by enzymes known as matrixins (matrix metalloproteinases)
• Evening skin tone: It reduces hyperpigmentation to make skin tone more even.

Studies show that the anti-aging effects of tretinoin can be seen within four to six weeks of starting treatment.

Side Effects

The typical side effects of tretinoin include mild to moderate irritation in the form of:

• Dry skin
• Peeling
• Redness
• Burning

Side effects typically occur within the first few weeks of treatment then subside. Additionally, topical tretinoin will make your skin more sensitive to sunlight. While using this medication, it's important to apply sunscreen to treated skin areas daily.

Brand Names

Tretinoin is the active ingredient in medications prescribed to treat mild pimples to moderate acne and blackheads. Brand-name drugs containing tretinoin include:

• Retin-A
• Retin-A Micro
• Renova
• Tretin-X
• Ziana

What Is Isotretinoin?

Isotretinoin is an oral medication, so rather than apply it to your skin, it's swallowed as a pill. It's most often prescribed for severe forms of acne. Isotretinoin is also used to treat milder cases that are stubborn and have not responded to other types of acne medication. It may also be prescribed in cases when acne is leaving behind scars.

Benefits

Isotretinoin is the only treatment capable of putting acne into permanent remission. It does this by:

• Reducing the size of sebaceous glands, preventing them from getting clogged
• Limiting the production of sebum
• Prevents abnormal skin cell buildup (keratinization), which contributes to pores getting clogged and inflamed

Side Effects

Isotretinoin is a very beneficial treatment for certain people, but it isn't right for everyone. It can cause side effects, some of which are potentially serious.

Possible side effects of isotretinoin include:

• Dry skin
• Severely chapped lips
• Dry, irritated eyes
• Dry mouth
• Sun-sensitive skin
• Worsening acne (temporary)
• Night blindness
• Thinning hair
• Muscle or joint pain
• Rash
• Stomach problems
• Unhealthy cholesterol levels

Although uncommon, life-threatening side effects of isotretinoin have been reported, including liver damage, and increasing pressure on the brain which can lead to permanent loss of eyesight, and in very rare cases, death.

Your healthcare provider will monitor your skin and health during the entire time you're using isotretinoin.

Isotretinoin can't be used by people who are pregnant because it causes severe birth defects. The drug also increases the risk of miscarriage and premature birth.

People taking isotretinoin who can get pregnant must first register with a program called iPledge Program. The goal of this program is to prevent fetal exposure to isotretinoin.

The requirements include using two methods of contraception or practicing complete abstinence during treatment. You must also have negative pregnancy tests each month (for people of childbearing potential) and see a healthcare provider monthly. You also agree to have regular blood tests as needed.

Brand Names

Until 2009, isotretinoin was available in the United States by the brand name Accutane. Accutane was discontinued due to numerous lawsuits claiming the medication causes severe side effects like inflammatory bowel disease (IBD).

Researchers have found no evidence of a link between isotretinoin and IBD, although there is some evidence that isotretinoin may come with a slightly increased risk of ulcerative colitis.

In addition to generic isotretinoin, other brands of isotretinoin remain available, such as:

• Absorica
• Amnesteem
• Claravis
• Myorisan
• Zenatane

Isotretinoin clears up acne, and in the majority of cases, it doesn't return even after you stop using it. It's the closest thing to an actual cure for acne. In very specific cases, a low dose of isotretinoin may be prescribed long-term.

Tretinoin vs. Isotretinoin: Which Should You Use?

Although they have very similar-looking names, isotretinoin and tretinoin are very different medications. Since both are available by prescription only, you will need to consult with a dermatologist before choosing one.

If your primary skin concern is aging, a topical tretinoin is ideal for you. Bring your concerns to your dermatologist. The provider will help you choose the right strength of tretinoin for your skin.

If your primary skin concern is acne, your provider will consider:

• The severity of your acne: Isotretinoin may be better for you if your acne is moderate to severe, does not respond to other acne treatments, causes scars, or is causing psychological distress. If your acne is milder or comes and goes, your provider may recommend tretinoin.
• The type of acne you have: If you have mild to moderate comedonal acne, like blackheads or whiteheads, tretinoin is a good option. If your acne is cystic or nodular and inflammatory, your provider may recommend isotretinoin.
• Whether your acne is widespread: If you have severe acne in multiple areas of your body, such as your face and upper back, isotretinoin is recommended. If your face is the only area with acne, tretinoin may be for you.
• If you are pregnant or could become pregnant: In this case, your provider will likely recommend a treatment option that is safe for pregnant people, such as topical benzoyl peroxide, azelaic acid, or salicylic acid.

You won't have to decide any of this on your own. Your dermatologist will help you decide if either is the right treatment option for you.

Summary

Tretinoin and isotretinoin are both acne treatments derived from vitamin A. They may have similar names, but they're prescribed for different reasons and used in different ways.

Tretinoin is a topical medication that's used to treat mild to moderate acne. It speeds up the life cycle of skin cells, which helps to keep pores clear. It may also be used to treat wrinkles and sun damage.

Isotretinoin is an oral medication prescribed for severe acne or cases that may cause scars. It's used for a specified amount of time. In most cases, it keeps your skin clear even after you stop using it. It can potentially cause serious side effects as well as severe birth defects. While using it, you're required to use two forms of birth control.