How well does Retin-A work for cystic acne?

Tags:man age 25-34 pores acne cystic acne

I've always had large, red, painful breakouts, from my adolescence to this day. My dermatologist says it's definitely a case of cystic acne due to my pores getting clogged all the time for some reason. It's probably genetic because my dad had it too when he was young. Anyway, I've read a lot about Retin-A but I'm not sure if it's going to work for me. Nothing ever works for my deep breakouts. I kind of lost all my faith in these treatments. Should I give Retin-A a try? What do you think? Has it worked for very bad acne cases like mine in the past?


M, 30, Virginia


  • Retin-A can be a helpful tool when treating serious cases of acne. However, it is unlikely to be an ideal solution for severe cases of cystic acne.
  • An over-the-counter tretinoin topical cream (a form of Retin-A) is generally the first step towards an effective acne solution.
  • Unlike Retin-A and other common treatments, tretinoin topical cream does not require regular blood monitoring tests as only small quantities of the medication are absorbed into the bloodstream.
  • If tretinoin topical cream is unhelpful on its own, you may need to combine the medication with another acne solution like clindamycin to maximize its effects. Should this not prove effective against your acne, it may be time to speak to your dermatologist about Retin-A.
  • As determined by your dermatologist, your Retin-A treatment may also be combined with other medications for a tailored acne solution.

The consensus is based on 3 doctor replies to this question. For more details, scroll down to read them.

Retin-A can be an effective acne treatment so it won’t hurt you to try it out, but since you have cystic acne you’ll probably find you need a more comprehensive strategy.

If you’re truly desiring a singular approach, although it may be ineffective, you may want to try an over-the-counter tretinoin topical (a form of Retin-A) first. An example of this is the recently released Differin OTC (which is adapalene 0.1%).

Unlike other treatments, tretinoin topical does not require monitoring blood tests because only small quantities of the medication are absorbed internally by the skin. However, in the United States, the only over-the-counter retinoid available for this purpose is Differin 0.1%.

However, tretinoin topicals will not eliminate all of your blemishes, whether they are adult acne, hormonal acne or cystic acne. Tretinoin, a type of retinoid topical, is a comedolytic agent. This means it actually helps to unclog pores that have been blocked by excess oil and dry skin. An additional benefit of tretinoin is its ability to be an anti-ager by slowing and preventing photo-aging, and improving the appearance of dark marks and sun spots (typically in lower doses than those needed for acne treatment). Versions of tretinoin topical that make use of microsphere technology are absorbed more slowly, better for the skin cells, and have fewer side effects.

Should this be ineffective additional approaches can be employed; namely, Retin-A combined with other treatments.

In some cases a combination of tretinoin topical and clindamycin (a topical antibiotic) with or without additional benzoyl peroxide may be most effective. The tretinoin unclogs the blocked pores and the clindamycin destroys the acne bacteria. Combining these two treatments can be more effective than just following one, but doing so also increases the potential side effects. Both treatments make the skin more sensitive to the sun. As a result, if you decide to use both treatments at once it’s even more important that you apply sunscreen on a daily basis.

For pigmentary disorders, like melasma, or irregular pigmentation, like post-inflammatory hyperpigmentation (aka dark marks) and actinic lentigines, retinoids also help to improve their appearance. It’s ability to treat acne is just the tip of the iceberg for retinoids.

Ultimately, the most effective way to tackle cystic acne, inflammatory acne, and blemishes is to follow a structured skin care routine. I recommend that you speak with a board-certified dermatologist to learn which products are best suited to your specific needs.

In order to determine the right approach to tackle your cystic acne you’ll need to schedule an appointment with a board-certified dermatologist. Your dermatologist will conduct a detailed examination to determine your skin type (oily skin, sensitive skin, dry skin, etc.), the cause of your cystic pimples, and the best long term solution for your unique situation.

If you have severe cystic acne it’s likely that you’ll need a combination of topical and oral retinoids to combat it, plus you’ll probably need an oral or topical antibiotic to prevent infection. Once the acne has subsided, a chemical peel with salicylic acid may be a good option for you. Consult with your dermatologist to learn more.

Retin-A can be used to treat severe acne, including cystic acne. However, on its own Retin-A is unlikely to fully eradicate large cystic acne.

Prescription-strength Retin-A has been available for decades, and now a type of Retin-A called tretinoin is available without a prescription. Tretinoin Retin-A cream is an effective way to open clogged pores, small bumps and small cysts. It tends to be slightly more effective on fair-skinned individuals than darker-skinned individuals.

However, neither topical tretinoin or Retin-A will eliminate 100% of your blemishes, but closer to half of your blackheads, whiteheads and pimples will be taken care of through these treatments. Combining tretinoin topical with benzoyl peroxide and other skincare treatments may be a more effective way to achieve clear skin.

If you do decide to try Retin-A or tretinoin topical it’s important that you faithfully apply sunscreen whenever you go outdoors, as these treatments make the skin considerably more sensitive to sun exposure.