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Tretinoin and retinoids- toxicity and safety

March 24, 2013 Reviewed by Marta 103 Comments

When Junko told us about her trip to an eye doctor resulting in a stern warning to stop using a tretinoin cream (commonly prescribed by dermatologists for the treatment of acne, age spots and wrinkles) on the grounds that it is a toxin, it gave us all a scary jolt.  I have been doing as much research as possible and this post is a little long as I’ve tried to be thorough. So for those who want to cut to the car chase, tretinoin is indeed a toxin, a possible side effect is blurred vision and Junko should absolutely give up all non-dietary forms of vitamin A until her symptoms clear up.

Now for the detail. (Please note that I am continuing to add and update this post as I come across additional research).

Vitamin A and its natural and synthetic analogs are referred to as retinoids. There are several forms of retinoids: retinal (aldehyde); retinoic acid, which is also known as tretinoin (acid); and retinol (alcohol). Vitamin A is acquired through the diet and is ingested through animal sources as retinyl esters and through plant sources as carotenoids, and converted to retinol. Retinoids control normal cell growth, cell differentiation, and cell death during embryonic development and in certain tissues later in life.  These effects on the cells are controlled by receptors on the nucleus of each cell (nuclear receptors).

The toxicity of retinoids and, in particular, tretinoin is well known – and has been understood by scientists for well over a decade. Research (which I go into below) has extensively been conducted on cancer patients (mostly oral doses of tretinoin) and pregnant animals, looking at topical dosage effects. It is important to note that the absorption of tretinoin is systemic. The condition caused by vitamin A toxicity is called hypervitaminosis A (source). It is caused by overconsumption of preformed vitamin A, not carotenoids. Tretinoin (Retin-A) "because of the potential for systemic absorption of topical tretinoin" is not recommended during pregnancy (source).

Retinoids are relatively new types of anti-cancer drugs. Tretinoin is given orally in capsule form to patients – typically when other forms of treatment have failed. This option of last resort is because of, as the US Institutes of Health points out, the side effects of toxicity.

It is not at all a stretch of the imagination to associate an eye condition with tretinoin reactions. First, as the Linus Pauling Institute explains, the eyes are geared towards taking in, storing and processing vitamin A. Inadequate retinol available to the retina results in impaired dark adaptation, known as "night blindness." Neurologic symptoms include headache, drowsiness, blurred vision (source).

A study on three topical retinoids, reported that “despite their differing capacities to stimulate skin repair and cell growth, all of the agents were cytotoxic for fibroblasts and epithelial cells over the same range of concentrations (0.6 – 3  10-5 M). A fairly recent 6-year trial on over 1,000 veterans set out to discover if tretinoin could be used to treat skin cancer. It was stopped six months before the scheduled end because of a high number of deaths in the tretinoin group. The concentration used was 0.1%. "We report the halting of the VATTC Trial intervention 6 months before its scheduled end date because mortality in the tretinoin-treated group was higher than in the vehicle control group, and our evaluation of this potentially causal association between tretinoin therapy and increased mortality," the study authors wrote.

Meanwhile, pregnant women shouldn’t go anywhere near tretinoin or other retinoids. Used topically, it is “a potent teratogen following exposure in early pregnancy” (source) (a teratogen is an agent that can disturb the development of an embryo or fetus). A 1997 study on rabbits, using 10 times the amount humans would typically use of the tretinoin cream, Renova. The rate of abortion was increased significantly compared with the control group. Dosage-dependent increases in incidence and severity of skin reactions occurred in groups administered the vehicle and the two dosages of tretinoin. Similar results occurred in another study with a dose of 10 mg/kg daily.

Management of vitamin A toxicity includes ensuring that all vitamin A products are discontinued, including multivitamins and topical creams. Consumption of large amounts of dietary carotenoids will not contribute to vitamin A toxicity since efficiency of absorption decreases with dosage, and conversion to the vitamin is not rapid enough to contribute to toxic levels (source).

The following Tretinoin side effects are common (occurring in greater than 30%) for patients taking Tretinoin:

Typical retinoid toxicity include symptoms that are similar to those found in patients taking high doses of vitamin A: Headache, fever, dry skin, dry mucous membranes (mouth and nose), bone pain, nausea and vomiting, rash, mouth sores, itching, sweating, eyesight changes. Plus: Flu-like symptoms, bleeding problems, infections, swelling of feet or ankles, pain (bone and joint pain, chest discomfort), abdominal pain.

The following are less common Tretinoin side effects (occurring in 10-29%) for patients receiving Tretinoin: Weight increase, heart rate irregularities (arrhythmias - see heart problems), flushing, poor appetite, weight loss, earache or feeling of fullness in the ears, diarrhea, dizziness, constipation, numbness and tingling in hands and feet, anxiety, heartburn, low blood pressure, insomnia, depression, high blood pressure, confusion (source).

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  • August 28, 2017

    by Elpida

    I was using a tiny amount of Tretinoin on my face for approximately two months. I began getting joint pain in my hands and wrists but I did not connect it to the Tretinoin. Last month I began to see double, especially at a distance. My doctor thought I had a stroke and did a brain MRI, a brain MRA and ultra sounds of my arteries. Everything was normal. The neuro Ophthalmologist thought I may have had 6th nerve Palsy in my right eye, but he wasn't sure. Then I began to resesarch Tretinoin. I found many people who had joint pain from using it and also some who reported double vision. Only three days after I stopped using it, my joint pain went away and so did my double vision.

  • August 9, 2017

    by Mirra

    0.05 retin A cream gave my mom vision problems. She had watery eyes with retina problems. Kept seeing dots and silvery light. On stopping the symptoms reduced immediately

  • July 10, 2017

    by Marsha

    So happy that I just came across this article. My dermatologist put me in doxycycline and tretinoin about 4 months ago. 1 month and 2 weeks in I developed a migraine that just won't go away. I stopped the doxycycline because I thought that was the problem. It's been about a month and half maybe since I stopped the doxy. No improvements. I'm using the tretinoin as Dr recommended 2x a day. I'm super dizzy and my knees and legs are killing me. I've still been trying to narrow down what in my life has changed in the last couple of months. I also have MS so everyone just assumed that's what is going on. But it doesn't feel like my normal MS issues at all. I was talking to my friend the other night and I put her on hold so I could wash my face so I had the 20 minutes before the tretinoin. I went back to her and she asked me, "did you notice it's been ever since you started this stuff with your face that you started feeling awful?" I said yeah but it was the doxycycline, it takes a while to get out of your system. Anyway shorten this up a bit, I feel AWFUL. So, I deceived maybe it could be....I have seen so much positive and negative. I'm going to stop using it but how long before I start to feel like a human again??? It has definitely effected be in the sense that I have a hard time walking. Almost like it has made my MS more pronounced. Sound normal?
    Thanks

  • March 8, 2017

    by Sue

    I am slightly shocked by the realisation that the retinol (over the counter) cream I have bee using has given me quite bad side-effects. I have been using a small amount every night on my face. I had a severe dizzy attack a couple of weeks ago, and suffered on and off for about a week, and remained in a 'spaced-out' state. I tried to go through everything that might be causing it - and finally researched the cream I was putting on my face. I stopped it immediately and felt better the following morning after not applying it the night before. I had been having difficulty focusing to read, and my tinnitus was very bad; both these symptoms have improved and my tinnitus is back to what it normally is. I am pretty horrified by this. I am sensitive to things I take or put on me, but this has slightly shaken me.

  • February 23, 2017

    by grace

    I also had been using Tretinoin 1% . for about 2 weeks. Even though I was using a pea size amount
    I began to feel headaches after a few days, then dizziness, confusion and nausea. There was no
    physical or psychological reason for this. Shortly after I stopped applying it altogether, I was back
    to feeling well again. Why it affects a minority of people and not others , makes me wonder why!

  • October 3, 2016

    by Naomi

    I don't think anyone has answered this question so I would really appreciate it if someone could. Could 1% retinol, not retin -A, cause the blurry vision. The product I'm using states it converts to 0.025% retinoic acid on the skin.

  • October 2, 2016

    by Nikki

    Hello everyone,

    I have to start off by saying that I cannnot emphasize enough how much relief, even if short lived, this article has brought me. I am a 31 year old male and in desperate need of all of your help. I am happily married with two beautiful little girls. I have always had bad facial skin and I recently started using three products: Tretinoin 0.05% gel, clindamycin phosphate 1% foam and an over the counter 10% benzoyl peroxide face/body wash. I started them about three and a half weeks ago. Initially, I was using it sporadically, maybe every other day or every two days. This sporadic use was for no other reason than a super busy work schedule and my forgetting to apply it before bed after a long day at work. While my job requires long hours and is stressful, I have always managed well and even have awards to prove it. I'd also like to add that I have absolutely no psychiatric history. Nothing.

    So here is where it gets a bit tricky and basically where my life has been flipped upside down. My job, which happens to be in the medical field, occasionally requires me to switch over to nights. It is the hardest part of my job, but everyone has to do it. They are long 16-18 hour shifts back to back for 5 days in a row, followed by a short two day break and another 5 days in a row. All of my colleagues hate it and everyone agrees it is the hardest part of our current year. We have to do it a total of 4-5 times this year, but then we're done for the next two years. I have already completed two weeks of it earlier this year in July. Well, I was up for another two weeks of nights about 3 weeks ago (1/2 a week after starting the medication). I was concerned that it would interrupt my use of the topical medications, so I made sure I consistently applied the tretinoin every day before going to bed after a long night shift. My skin began to show great improvement. It was wonderful. However, toward the end of my first week of nights (two and a half weeks ago), I began to notice I was having mild chest pain and anxiety at work. My wife and I attributed it to the lack of sleep since I was averaging about three and a half hours of sleep between shifts. We did not think too much of it at first. However, by the time I hit the second week it was happening regularly. It was not only at work now, but I started to experience it on my drive to work. It was pretty bad. It felt like adrenaline, but without my heart necessarily racing. I felt it shooting down my arm, too. Worst of all, it began to affect my emotions. I was very emotional. I would have episodes of crying and overwhelmed with guilt of not being home with my daughters. My wife and I again attributed it to being over worked and sleep deprived. It did not make sense to me though, because I had already completed two weeks of nights back in July that were extremely difficult (harder than this time around) and I never developed these types of symptoms. However, I gave it the benefit of the doubt and figured since it was starting on my drive to work and while at work that perhaps it did have something to do with being overworked during nights and maybe I was developing some sort of aversion to night call. Then it got worse. I ended up having a full-on panic attack at work and locked myself in the bathroom so no one would see me crying my eyes out. I literally wanted to run away and never come back. The thing is, it was basically unprovoked. The night was slow and there wasn't too much going on. I called a friend in desperation who wanted me to go to the Emergency Room, but I knew my career would be over if I left my shift. I don't know how, but I managed to finish the shift. After that day, I began to continue having symptoms almost all day long. On my way to work, at work, on my way home, at home. It was affecting my sleep and filling me with more anxiety because I couldn't take advantage of the short amount of sleep I was already being limited to. Again, I attributed this to being on nights, even though I had to try hard to convince myself of this since it did not make sense given my work history. Keep in mind that I was applying tretinoin daily throughout this entire experience. Finally, when nights came to an end a little over a week ago, I expected all of these symptoms to be turned off like a light switch. Boy was I wrong. They have burdened me beyond anything I can describe. I am overwhelmed with anxiety, panic and depression every day. Completely unprovoked. It has become difficult to enjoy time with my family and I am losing interest in participating in events because I know I cannot enjoy them feeling this way. Now being back on day shifts, I continue to have constant unending anxiety and depression. It is absolutely unbearable. Along with these symptoms, however, I have also lost 10 pounds over the last three weeks, which I have attributed to the extreme anxiety that prevents me from having an appetite. Additional symptoms have also included constant dry mouth, irritable stomach, occasional but rare dizziness and headaches.

    I started to become overwhelmed with fear that I have developed an anxiety disorder that has caused depression and would have to live with it for the rest of my life. Until a couple days ago, I started to think about anything new in my life that could be causing this. It finally dawned on me that those three products were the only new things that I had introduced into my life and I had started them right around the onset of symptoms. I had not really thought about it before since it was a topical cream and seemed very unlikely to me that it could cause systemic symptoms. I finally pieced it all together and looked up the side effects, which seemed to be minor and superficial in nature with the topical product. However, the more I dug, the more stories I came across of people experiencing similar symptoms.

    I have stopped using all three products 48 hours ago. I am hoping to receive some support from people who discovered the same thing and were able to fully recover. I am overwhelmed with fear that this is something I will have to deal with the rest of my life. I am hoping I have discovered the culprit and after speaking to a medical profession, she agreed with me that it is very likely the source considering I am experiencing other systemic side effects such as the dry mouth, headaches and dizziness. Those of you that experienced anxiety and/or depression while on this medication and got off of it, how long did it take you to notice improvement? What about to fully recover? I know it has less to do with the product half life and moreso to do with how much vitamin A was built up so these periods of recovery could vary, but any feedback would be extremely helpful during this time in my life. I spend my day helping people, it is unusual for me to reach out like this. I am hoping for helpful responses. Thank you everyone for reading this extraordinary long post!

  • September 17, 2016

    by Leslie

    Hi, I have been using retin a .025 for about a week. Starting last night and throughout today, I am seeing double. Absolutely the cream has not touched my eyes, but I'm wondering if I'm getting too close to them. I never use anything larger than a pea-size dollop.

    Has anyone experienced this? If so, please tell me it goes away. Also, I am very reluctant to discontinue use, so am hoping its Temporary like the peeling and redness.

    Thank you.

  • September 11, 2016

    by Marta

    Hi Ana, we have another article about vitamin A and retinol safety in general: https://www.truthinaging.com/review/vitamin-a-is-it-safe

  • September 10, 2016

    by Anna

    So should all retinol containing products including retinyl palmitate and retinal be 100% avoided? What about in acne vulgaris or rosacea?

  • May 15, 2016

    by Uma

    I used Retin A (Tretinoin gel 0.5%) for anti ageing purposes. During the six weeks I was on it, I noticed my vision wasn’t as sharp as normal and my eyes were watery. I also suffered with headaches. Like Josh I've also felt low and antisocial. Until I read this, it never occurred to me that there may be a connection with Retin A, but now I’m not so sure. I was very careful and followed instructions only applying a pea size amount just once a week initially and nowhere near my eyes. At first my skin responded well, but when I increased application to twice a week a month later it became blotchy, spotty, red and irritated. I’ve now stopped using it but I’m left with enlarged pores, capillaries where there were none before and deeper wrinkles! I’ve read skin often gets worse before getting better where Retin A is concerned, but online forums and webpages show that Retin A which is a drug after all does have side effects and can damage skin. http://www.medhelp.org/posts/Dermatology/NEVER-USE-TRETINOIN--RETIN-A--MY-WORST-NIGHTMARE/show/1396217 and http://www.drugs.com/sfx/tretinoin-side-effects.html

  • May 6, 2016

    by Josh

    I am a 45 year old male that started taking retin A for wrinkles . I just started using tretinoin and wound up feeling really funny and achey in my bones and joints. I also feel unsociable slightly depressed and no motivation or excitement for life. I stopped taking Retin-A about a week ago and thought I'd start up again with the same symptoms coming back. Now I'm going to completely get rid of it it's not worth it.

  • March 10, 2016

    by Kyla

    I have been using the 0.1% gel and been experiencing heart problems as of recently. I started using the gel in the beginning of February and started experiencing a rapid heart rate and chest pain. I'm going to discontinue use of the gel and hope my heart returns back to normal

  • February 19, 2016

    by Barbara

    This article is beyond alarmist.
    http://medshadow.org/medshadow_blog/retin-a-safety/

  • February 16, 2016

    by Marta

    Hi Laura, this article already states that the doses in the studies were much higher than would typically used.

  • February 16, 2016

    by Laura

    This article is unbelievably irresponsible, made more so by the fact that many people have pointed out inaccuracies which you have failed to correct. Most notably the error where you confuse TOPICAL tretinoin with ORAL tretinoin's effects on an embryo. The third rat study linked to that showed effects of topical tretinoin on pregnant rats - the amount they put on these rats would be about 700ml (23 fl. oz) worth on a 150 pound person daily. Your typical tube of tretinoin is 30ml and it takes months and months to go through. This would be like using 23 tubes of tretinoin cream per day.

    I don't doubt that tretinoin has side effects for many people, but please add a disclaimer that you're not a medical professional and at the very least correct the glaring errors in your article.

  • February 5, 2016

    by Kimberley

    Ramona, have you noticed any improvement in you hair now that you've stopped using Tretinoin? I've been cycling through using various retinoids for adult acne for the past year and have had horrible hair shedding since late Nov 2015. My blood tests/hormone levels too came back normal, but my vitamin A level was not tested. I'm going back to the doc and stopped using my Epiduo gel about a week ago. I just hope I haven't permanently damaged my hair!!!

  • February 2, 2016

    by annette

    Having been using 0.05 steiva cream for 1 month. Have decided to stop the use of this cream
    I have experienced facial sweats (dripping) constant nausea and swelling of my under arm glands. I have never experienced peeling of the skin however i have noticed my facial skin has become thicker. I dont recommend this product. I will rather have adult acne than a destroyed liver or cancer.

  • January 20, 2016

    by Ramona

    I have been intermittently using Tretinoin cream .1% for 2 years, and it is the only thing I can point to for my drastic change in hair texture, quantity, and shedding pattern. All of my hormonal tests have been normal, but my liver Vit A test was out of range Toxic. My skin looked great most of the time, albeit, sometimes oddly yellow and too dry, but my hair was looking terrible most of the time. It was a trade off. The shedding was all over, but the most obvious and concentrated part was at the top of my scalp on the right side (rear right side) of my head. I stopped the cream in Dec of 2015, and will continue to monitor and report back to any women interested in the details. Beware, ladies!

  • December 14, 2015

    by Francsca

    FACT SHEET WITH WARNING... pretty bad...
    https://www.caymanchem.com/msdss/11017m.pdf

  • December 4, 2015

    by Flo

    I am happy i found this site, i am writing this comments as i have suffered these very bad symptoms of tretinoin. a friend asked me to use this cream because i was suffering from face skin discoloring, (it works so well on discoloring but when you stop, in a month the discolor will return even worst) the first time i used it, i thought i was going to have heart attack, i was so afraid, but to cut the whole story short i had all of the the symptoms this site mentioned. thank God i found out on time that it was this cream. please i really want to beg people to be very careful about this product. i was told by a friend that told me he know atless about three people that died from tretinoin. please friends be careful.

  • November 7, 2015

    by Christelle

    I have neurological issues and have to be careful about what I use on my skin as it goes directly into bloodstream and can cause problems. Several weeks ago, my dermatologist gave me a few samples of Renova (Tretinoid 0.2%) to treat white heads and I didn't think of checking neurotoxicity first. After a week or so, I had severe insomnia, dizzy spells, tingling in my face, abdominal pain, chest pain, etc. I reported it to my dermatologist, who said she wasn't aware of any issues but told me that she had been suffering from insomnia since she started using retinoid and tretinoid herself some 20 years ago. She thought (and still thinks) it's a coincidence. I don't think so...

  • November 6, 2015

    by Bettty

    Just had a colonoscopy. found to have a very small polyp that is positive for preadenoma carcinoma. 11 years without a polyp. Trying to figure out what is new in my life and it is retinol. Wondering if it could be the culprit.

  • October 28, 2015

    by Jamie

    YES I completely agree. Went through Accutane, 8 years ago and now if I use any cream with retinol I become confused and depressed within a few days... Irrational. Difficult to think it's from a simple cream on the face but it is evident. I'll just enjoy my face as it is.

  • October 26, 2015

    by Hilary

    I was using tretinoin 0.05% for about a year. Right around the time I started to get to the point where I could use it everyday I began to get these dizzy spells and headaches. At that time I had NO IDEA about the side effects of this stuff. I went to ENTs, urgent care, opthemologists, and a neurologist over the course of many months trying to find out why I was so dizzy all the time. I was put on prednizone, topamax, effexor, and elavil- non of which ever really worked. I was diagnosed with migraines which just didn't seem right to me. I went on a restrictive migraine diet and felt awful from all the different drugs I was being prescribed. I finally decided I couldn't live like that so I stopped the medication and looked into what could be causing the symptoms. That's when I found this site. I immediately stopped retin-a and literally with in a few days I was feeling fine. No headaches no dizziness and I didn't even need the glasses I was prescribed. It has been 6 months since I stopped retin a and I have not had any dizzy spells or headaches. This stuff is so dangerous.

  • October 2, 2015

    by Cheryl

    Thank you for sharing this information. I was looking for answers for my sister who currently has a bad rash. I googled the vitamins she takes and saw this link. I was curious to read because I use Retin-A (have been for 20 years) & experience many symptoms you described. The worse ones are vertigo/balance issues, gum issues and dry eyes. I also used Accutane about 20 years ago for 8 months. Knowing what I know now, I would have never went on that, what a horrible drug! But I didn't have the internet to search. I also take a multi vitamin with Vitamin A in it. I am going to discontinue the Retin-A & multivitamin until it's out of my system. Hoping I get some relief soon.

  • September 24, 2015

    by Ann

    I have been aware of this problem for years!!! We need to get this info out to the general public fast! Whenever I have tried any products with retinoids, I have experienced headaches, chest tightness, abdominal pain, insomnia, etc. within just a few days of using. I was prescribed Retin-A due to acne problems but went off quickly due to side effects. I've tried less potent over the counter creams with retinol and still get the same effects. It's toxic, and it's systemic meaning it is absorbed and stored in the body and builds up causing a multitude of serious problems. Some may be permanent. It should be taken off the market!

  • August 23, 2015

    by Robin

    I went through two years of living hell from using retin a. Fevers, dizziness and my mouth and throat were so dry, my uvula would become infected and swell. The side of my face would swell as well as my gums. My ears would swell shut. Left arm hurt daily and my feet and hands would go numb. CAT scan showed significant swelling in the lymphnodes on the left side of my face. Four specialists and twenty thousand dollars later, I was sent to the head onocologist at a major hospital. He did a full body pet scan to rule out lymphoma. He did every blood test you could order. He told me to stop the retin a. Two months later, I am symptom free. He told me that retin a is so very toxic to some people that it does permanent damage.

  • March 9, 2015

    by Dottie Marsh

    I have been using tretinoin for over 4 years. Using 0.1% for the last year. I have Sjogren's Syndrome and have been experiencing blurred vision, dizziness, depression, digestive problems and many of the other side effects listed above and from other individuals using Retin A. My skin suddenly begin to turn red and to be very dry no matter what I used for moisture. I stopped the tretinoin for a week now and my skin is getting better, my eyes, I feel, are getting a little better. I've had Sjogrens for 15 years. I believe the use of any type of retinoid may not be best for me and I've been doing more harm than good. So, now I'll just take care of my skin as best as possible without any form of Retin A. So glad to find information on the internet here and on other sites where individuals are having similar problems and have given websites to verify that Retin A could be damaging especially to someone who has an autoimmune disorder.

  • February 26, 2015

    by mimi

    I literaly started using tretinoin 0.05% on my face and 0.1% on parts of my body affected by acne and hyperpigmentation, only after 3 weeks into my treatment i started experiencing some of these side effects but did not associate them to my tretinoin (retinA) until reading this. i was really worried and concerned because i am not unhealthy or some whose pron to sickness or illness.
    I started have heart palpitations, fever, dry skin, dry mucous, nausea, sweating, flushing, dizzy spells, anxiety, fluctuation in moods and mini panic attracts.
    At first i thought it was a passing flu and sort advice, asked to check anything new in my daily regime and the only thing was the tretinoin and vitamin C tablets.
    My first instinct was that the possible combination could be causing these reactions but after reading about the effects of tretinoin (retinA) on other sites i never saw any correlations and dismissed it. BUT AFTER READING YOUR ARTICLE ON THE EFFECTS OF TRETINOIN AND IDENTIFYING WITH SOME OF THEM I AM SHOCKED!!!!!
    THIS HAS BEEN A REAL EYE OPENER FOR ME AND I HAVE DISCONTINUED MY VITAMIN C TABLETS WHILE ON TRETINOIN!I NO LONG SUFFER FROM ANY OF THESE SIDE EFFECTS AND I'M BACK TO GOOD HEATH BUT THIS IS SOUND INFORMATION GOING INTO TRETINOIN TO REALLY MONITOR WHAT OTHER PRODUCTS I INTRODUCE INTO MY BODY WHILE ON SUCH A SENSITIVE TREATMENT AS TRETINOIN (RETIN-A)

    THANK YOU SO MUCH!!

  • December 30, 2014

    by Kathy

    I am sure tretinoin, if you use it excessively in high doses, can be toxic - same as taking too many vitamin A supplements. I have noticed, however, that this product often is used by perimenopausal and menopausal women and that the "side effects" mentioned above resemble common symptoms of "the change." My suspicion is that many of the so-called side effects, other than the vision problems, are related to hormonal changes rather than the tretinoin itself. The menopausal transition usually begins long before periods end (often as early as age 35) and the symptoms can be much more sudden, extreme, and devastating than women are led to expect. Menopause is not just a few hot flashes - it is a relatively sudden and extreme change in your body chemistry based on a complex and poorly understood combination of hormonal interactions that have been functioning for decades. Common symptoms include dryness of all body parts, joint pain (sometimes severe), headaches, nausea, flushing and sweating (i.e., hot flashes), vertigo/dizziness, anxiety, and depression to name a few. Look up the symptoms of tamoxifen treatment in young breast cancer patients and you basically have the symptoms of menopause - no walk in the park. A lot more women need to be working on treating their menopausal symptoms a lot earlier instead of sitting in denial, looking for other explanations (which doctors and the media are happy to feed you) until they are overwhelmed by "unexplained" symptoms that seriously interfere with their functioning and quality of life.

  • December 30, 2014

    by Linda

    Hm, I've been using Retin A for years, like, probably ten years or more, and have never had any issues at all, no side effects whatsoever. I've been to two dermatologists, and neither has mentioned any side effects either. I'll have to look into this topic more.

  • December 9, 2014

    by Leigh

    Used Retin-A for many, many years, quit for a few, then started up again about two years ago. I am sure I am now experiencing Vit A toxicity. I have never felt so ill. Have discontinued it as well as my multivitamin. As soon as the excess Vit A is eliminated from my system, I will obtain my Vit A from natural sources, but even at that, I will be certain not to overload my system with even "healthy" Vit A. Moderation and variety in diet are two absolutely essential requirements for good health.

    I have experienced nearly all of the symptoms mentioned in Marta's article which follow.

    The following Tretinoin side effects are common (occurring in greater than 30%) for patients taking Tretinoin:

    Typical retinoid toxicity include symptoms that are similar to those found in patients taking high doses of vitamin A: Headache, fever, dry skin, dry mucous membranes (mouth and nose), bone pain, nausea and vomiting, rash, mouth sores, itching, sweating, eyesight changes. Plus: Flu-like symptoms, bleeding problems, infections, swelling of feet or ankles, pain (bone and joint pain, chest discomfort), abdominal pain.

    The following are less common Tretinoin side effects (occurring in 10-29%) for patients receiving Tretinoin: Weight increase, heart rate irregularities (arrhythmias - see heart problems), flushing, poor appetite, weight loss, earache or feeling of fullness in the ears, diarrhea, dizziness, constipation, numbness and tingling in hands and feet, anxiety, heartburn, low blood pressure, insomnia, depression, high blood pressure, confusion

  • November 20, 2014

    by Lori

    Wow. I was googling "retin a and depression" because I could SWEAR that whenever I use topical retin a I feel anxious, agitated and depressed for a day or more. (However, I was assured it wasn't the retin a if applied topical. "That can't happen"). What has been more recently happening is severe pain in both my7 eyes, and blurry vision. When I wake up in the morning I am shocked to have searing pain when I first open my eyes, or move them side to side. It never occurred to me that it could be the trentoin I have been using again now that summer is over and I once again have skin damage. As I sit here typing I am really feeling the eye pain. So, Trentoin is history for me... as are all other skin creams etc until I figure this all out. If anyone has any more specific info on topical trentoin, I would really appreciate it.

  • August 27, 2014

    by Abz

    I experienced severe headache after a couple of days using retin a. I stopped using it for 6 months and back on, had the same symptoms . I think Retin a is not for every one despite it benefits

  • August 4, 2014

    by Lee

    I started using Retin A last year. I used it every other night or so sometimes waiting several days between using it. I have had recurrent subjunctival hemorrages in my eyes. This is when a blood vessel bursts and fills the white of your eye with blood. It is scary looking and takes a couple weeks to heal. I'd say I've had at least 6 of these in the last year. Is this related to using Retin A?
    I also have an eye twitch in the same eye. My ophthalmologist tells me this is stress related. Thanks for your thoughts on this.

  • July 10, 2014

    by Marie

    I use Retin-A, have for over 20 years, but off and on. The last 10 years, I deal with chronic dry eye syndrome and it is horrible. I use restasis and god know what is in that. I also now have ear/head pressure pain and also have bilateral peripheral vestibulopathy (dysfunction in inner ear balance system). I do believe Retin-A could be the cause. I stopped using it for awhile and started up 2 years ago and noticed my eyes were worse and vertigo /pain came on. I believe this information posted is straight on. Do your research and decide. I am done with Retin-A. Sucks because I am 48 and do not look it. I get carded all the time.

  • June 13, 2014

    by Patricia

    Where is the disclaimer which mentions you are not a medical professional and therefore not to be relied upon for any such medical advice?

  • June 1, 2014

    by ida

    thank you for this info! I started having vertigo and left ear pressure since I started using the gel for my face. I never would have thought a pea-sized gel on my face would cause this side-effect. Thank you for the information

  • October 28, 2013

    by ira iyl

    I used tretinoin .05% for abt 3-4 weeks and developed headaches and pulsatile tinnitus. After online research came to know the cause. And secondly it dried out my skin so much, i developed more wrinkles. Inspite of using a sunblock everyday. Don't think it suits everyone.

  • October 1, 2013

    by Joanne

    I am 52. My dermatologist prescribed Tretinoin cream 0.1% and I used it for over 8 years.
    I did get flawless skin also experienced above mentioned side effects.
    My derma never warned of effects of prolonged use. This makes me so mad!

  • July 31, 2013

    by Jane

    I have used Retin-A for over 30 years ( not around my eyes) without any side effects. I have gone to numerous plastic surgery seminars in Calif. and all the Dr.'s recommended using Retin-A. I use the 0.5% and am in my 80's and it has saved my skin, even after a bad sunburn in my 20's. I use it every evening with a night creme over it.

  • July 11, 2013

    by yolanda

    I have used the gel for five years and my last vision appt revealed that my optic nerves were swollen. I was referred to a neurologist who asked if I was using acene medication and asked me was I using tretinoion. I answered yes, and was instructed to immediately stop using gel. I have been placed on meds to get rid of swelling since the tretinouin caused my spinal fluid to have a high level of pressure. So um yea, the topical gel CAN CAUSE THE SIDE EFFECTS NOTED BY PERSON WHO WROTE ARTICLE. But find out for yourselves.

  • July 7, 2013

    by Jerry

    tretinoin is in a alcohol base, it is in a metal squeeze tube and has a hard plastic screw on cap and is packaged for interglactic space voyages, ha ha. use it.

    The veteran patient study was later re canted by the study administrator as invaid. I don't remember why he invalidated it but MY simple math shows that his adverse effect numbers and, per cent, were the total for a six year period but these geniuses did not divide the total over the six year study by six to get the yearly number/percent. There total divided by six is equal or less than the CDC"s yearly numbers for deaths or problems for people in their age group for the diseases listed in the V A study.

    Also the participants were aged from 65 to 75 years old and would naturally have higher death or disease related issues.

    In closing, my main point, is if you ever begin to read something on line the has (citation) in it stop reading it.

  • June 12, 2013

    by Kat

    I have been using prescription Tretinoin (0.05%) on and off for more than 20 years (I am 50) and have only been pleased. It always clears up my acne, reduces my eczema, and I think has minimized my wrinkling since my skin is pretty good for my age. It does increase flushing a bit (especially when your drinking alcohol - lol), but nothing serious in my case. It increases sun sensitivity, so you need to use it with sunscreen. I agree this post is alarmist. I am a medical/science writer (for government, not industry) and understand research pubs fairly well. I think the writer of this vlog and some of the commenters do not. Please talk your doctor. This med requires a prescription in any case. Btw - I personally think that vitamin A supplements, at the right dose, actually are beneficial in healthy people as they age. Your body's ability to absorb vitamins from food declines with age, so supplements often are necessary. I used to take a vitamin A supplement and found that my night vision improved substantially. I have to drive a lot so this was fantastic. Effective vitamin A supplements are hard to find in the U.S., however. Oil of Olay used to produce a good one. Don't know what happened because I can't find it in the store anymore.

  • June 3, 2013

    by anna

    I agree that this post is alarmist and written by someone with no understanding of the source material. She writes that:

    Used topically, it [tretinoin] is “a potent teratogen following exposure in early pregnancy” (source) .

    This is a wildly inaccurate mis-statement. Look at the source article. You have mis-read it. That statement refers to ORAL tretinoin, taken systemically (usually at doses near 45 mg to induce cancer remission). The article goes on to state that:

    "When used topically, the teratogenic risk of tretinoin had been thought to be close to 0 (13). According to one source, no cases of toxicity had been reported after nearly 20 years of use (13). In support of this, it has been estimated that even if maximal absorption (approximately 33%) occurred from a 1-g daily application of a 0.1% preparation, this would only result in about one-seventh of the vitamin A activity received from a typical prenatal vitamin supplement (14)."

    For the record, the half-life of tretinoin is .5-2 hours (i.e., very short) and absorption rates without an occlusion are typically 1.1 to 2%. No increase in systemic (endogenous) retinoid concentrations (i.e., no increase in blood concentration) is acheived through topical use.

  • May 31, 2013

    by Alice

    10 years of severe headaches, pulsatile tinnitus, cracked lips, osteoporosis and joint pain - finally traced to chronic vitamin A toxicity. Sources - 15 years of daily retin-a use (face and neck) plus a daily vitamin supplement. Excessive vitamin A (retinoic form) builds up in the body and it is dangerous. And yes, topical application does get into the bloodstream. It's not worth it.

  • March 24, 2013

    by Jaclyn Huelbig

    Why are people canceling appointments with qualified medical professionals because of an alarmist, dated blog written by someone who didn't fully understand the source material? Perhaps you can raise the issue of vitamin toxicity as a concern with the doctor? Even from the "anecdata" on this blog points to the 0.1% concentration as the only area for concern. A more level headed approach would be to talk to the doctor about the best regimen to maximize results while minimizing side effects.

  • March 21, 2013

    by Nell Wages

    (I don't think my first comment posted either) I have a consultation with a dermatologist next week specifically to ask about Retin-A treatment. Now I feel like I should just cancel the whole thing!

    Even though I'm 52, I've never really had a skin care *routine* so I'm new to all these creams and serums, etc. I don't know where to start when it comes to dealing with lip lines and wrinkles. I thought Retin-A *was* the place to start!

  • March 21, 2013

    by heather

    Hi Marta,
    it doesn't seem like my first comment was posted.. ive been using Tretinoin about 2 months for mild ache and after reading this article ive decided its just not worth it. about how long do you think it will take to be completely out of my system?

  • March 21, 2013

    by Gaynell Wages

    Oh, wow, I've got a consultation with a dermatologist next week. Now I'm thinking of cancelling due to this alarming information!!

    I was going to see her specifically to discuss Retin-A options. Well, darn, I don't know what to do now.

  • March 21, 2013

    by Heather

    im sorry... also im kinda nervous because I normally don't take meds and I haven't just been experiencing bad headaches but also dry and sensitive skin, and fatigue. do you think I need to follow up with the doctor for testing?

  • February 6, 2013

    by Kimberly

    Due to excessive drying of my skin from strong retinoid products, I use them only as a spot treatment 2 to 3 times per week on problem areas such as deep wrinkles. This way, I do not have any annoying side effects, and still manage to see a decrease in wrinkle depth in those areas. Perhaps those of you who love retinoids as I do, but are concerned with harmful, dangerous side effects, can still use them on your problem areas without possible toxicity. I use the 0.05% night formula from SkinCeuticals. and have no side effects. Of course, I avoid my eye area and neck where my skin is most sensitive. I hope this helps. Thanks for the informative discussion guys and gals! :)

  • January 1, 2013

    by Alex

    This article is horribly misleading, and its author failed to do her research.

    When tretinoin is administered ORALLY, there are side effects.

    However, when it is administered TOPICALLY, there are no systemic side effects. NONE. The systemic absorption of topically applied tretinoin is so low that plasma concentrations of tretinoin do not rise above base levels (http://www.ncbi.nlm.nih.gov/pubmed/10701701).

    So if you are experiencing blurred vision, joint problems, and god knows what else from using topically applied tretinoin, then guess what? You're imagining it!

  • December 18, 2012

    by Danny

    You should go and get your liver checked out as sometimes yellowing if the face and body and the whites of the eyes . I know dozens of people who have used a retinoid for decades and have never had any problem . I've used Avene Retrinal and its a wondeful product as the retinaldehyde is a lovely ingredient . You will find it in osmosis skin care and the wonderful Sircuit skin care both of these are mostly free of chemicals etc . Vitamin A is one if the only medically recognised products that helps with ageing of the skin but what is interesting is that pregnant women are told not to use any vitamin A products either topically or orally . It must have the ability to get into the body and that's scary . I'd get a blood test to check your liver enzymes etc .

  • December 17, 2012

    by ajk

    hi!
    I have read your post from time to time.
    When I'm in a deep search for some answers on skin care I always seem to find myself at your site when I can't find the answers elsewhere. So thank you, it's much appreciated.
    I wanted to share my story...
    I had been using OTC retinol creams and then Avene retrinol it's form is retinaldehyde) for almost 10 years. No problems. Actually it kept my great skin, great.
    At the 10 year mark (almost 3 years ago now) I decided to stop as I had already stopped using products with any parabens, phthalates, etc many years prior and it was my last unhealthy product.
    Ironically months after I had stopped using I went raw vegan and of course upped my intake of beta carotene rich veggies. A lot coming from green juices. Not any carrot juice since I'm not a big fan. Well I started turning yellow, hands, feet and around the folds of my face. Got my beta carotene blood serum levels checked and I was through the roof. BUT my vitamin A levels where in normal range.
    Ok-- so I lower the greens. I did and it happened once again and I had to stop any green juices of any kind for several weeks to bring my levels down. Recently I wanted to take a high quality whole food based multi and within 10 days I could see the slight tinge of yellow on my face.
    My question is can topical creams with retinaldehyde used for several years build up beta carotene in the liver and if so how do you bring down the levels to prevent carotenemia.
    This all could be coincidental though I feel there may be some connection.
    Thanks so much!

  • November 28, 2012

    by Scott

    Just came across your post. Please go to www.prescriptiondrug-info.com and type in Accutane. I started the thread with over 1000 replies. My son was took Accutane ( Amesteem) when he was 14-15 years old. He is now 21 and has been through so much. His story and many others can be found on above site. For all of you that have taken these drugs, my heart goes out for you, I have witnessed it first hand. Accutane, Amnesteem and retinoid creams are destroying our youths health more than traffic accidents. These drugs must be taken off the market ASAP.
    Scott

  • August 26, 2012

    by C. Alexander

    i was preparing to go to an allergist to find the cause of this itchy rash I am getting all over my body when I started reading these posts.

    When my doctor asked about new meds or detergents, perfumes, etc., I wasn't thinking about the Tretinoin use because I don't use it on the areas that are breaking out. But if it is building up in my system by my skin asbsorbing it, that would make sense.

    Also was treated for a bacterial infection they said was caused by dry skin clogging my pores on my back, chest, arms, etc. about fourteen days ago. The Tretinoin is actually the only new thing in my home and when I think about it, the problems started about the first of June, a month after I started using the Tretinoin prescribed by my dermatologist.

    No one warned me about toxicity or any reactions, except on my face where I was using it.

  • August 12, 2012

    by male30

    I came across this thread as I was trying to find a possible link between a vitamin A peel I had, and becoming very sick.

    I just had a professionally-administered Vit.A chemical peel (Jessner+Vit.A) peel 2 days ago. Yesterday morning - the morning after - I had terrible stomach cramps, diarrhoea, nausea, vomiting, flu-like bone aching, headache, shivering.

    Seemed very much like a type of gastric-flu or something similar. I was throwing up, and extremely nauseous, and have been in bed for 24 hours basically, and only eaten 2 slices of dry toast and drank some water in the past 24 hours. I have been taking a bunch of paracetamol too (more damage to my liver)

    My eyesight has been blurry, and only now has my headache dissipated enough to type this comment.

    I am just wondering if I could have sustained acute Vitamin-A toxicity from that one peel alone? (As opposed to chronic toxicity from a build up of using retinoids consistently over a period of time)

    And does anyone know if there could be permanent damage from an acute toxicity of VIT.A, after the main symptoms of the episode have mostly dissipated?

    thanks

  • August 9, 2012

    by Marta

    Hi Kris
    Retin A mostly exfoliates. This can encourage faster cell turnover, but it doesn't prevent wrinkles or repair them. I would suggest a good anti-aging serum that can help repair and prevent. Here are some suggestions: <a href="http://www.truthinaging.com/face/five-best-anti-aging-serums-of-2012" rel="nofollow">http://www.truthinaging.com/face/five-best-anti-aging-serums-of-2012</a>

  • August 9, 2012

    by KRIS

    I've been using retin a for over two years for a couple lines above my lips...i do not smoke and use retin a like i'm supposed to. Yet i ahve gained two more lines since using it. And have had digestive issues since. I have just stopped using it to see if the digestive issues get better but do you think my lip lines will get better or have i done permenant damage to my skin. Please help. I thought i was doing something good for my skin and now i'm wondering if i have damaged it.

  • June 7, 2012

    by Theresa

    I have to chime in here. I haven't read all the posts, but I have been using Retin-A for about 20 years, too. I'm 46 now. I'm as healthy as 25 year old. I have yearly physicals and blood tests. I don't believe that this stuff is toxic. I think everyone needs to chill out.

  • April 6, 2012

    by Maria

    Marc, THANK YOU for your clarification. After reading the article on not combining retinoids and AHAs, then linking to this article, I was terribly disheartened. I just got La Vie Celeste's glycolic mask and La Vie Celeste Restorative Rose Hydrosol Eye Cream, which contains retinyl palmitate and I thought I'd have to dump them and start all over again.

    Kristen, thanks for sharing your story. I saw your interview with Rose-Marie Swift and videos of make-up tutorials. You have enviable skin that I attributed to great genes. Knowing your story gives the rest of us hope.

  • December 12, 2011

    by kristen

    Ann Jaline-- as far as the "bug bites" --- staph infections or a sort of bacteria type infection can come as a result from disruption to a hair follical... I had watched doctor OZ recently on TV when he had said it and it caught my attention recently because every once in awhile I would get red itchy breakouts from waxing... maybe a possibility

  • December 12, 2011

    by Kristen

    This is a topic I'm all too familiar with! Having battled acne all my life - I am VERY familiar with Retin-A. I have read so much research about the affects of vitamin A (or most vitamins/minerals/topicals) I could be a dermatologist. While it is hard to overdose from Vitamin A naturally -- because its not over abundant in foods... and its even hard to overdose on it orally - because when you buy Vitamin-A in the store, you are buying it in the SMALLEST amount and NOT in the form of pure vitamin A-- you are buying it in the form of Beta Carotene... commonly found in carrots. The acne drug Accutane is essentially large dosages of Vitamin A - and to be on this drug, not only do you have to have a pregnancy test (because of the birth defects) you have to have monthly blood tests to make sure that your liver is functioning correctly. In my desperate conquest for clear skin, I did go on Accutante and the side effects were close to unbearable... what happens essentially is that it causes your glands to shrink... your oil glands... which is why you get the dryness, the joint pains, the itchiness, nose bleeds, cracked lips, headaches...your eyes become red and irritated and it effects your vision, now your glands cannot produce oil and other fluid and keep your skin moisturized, on top of causing the body to slow its skin cell production, making your skin paper thin... and it even causes your liver to shrink. The retin-a will of course naturally cause your skin and lips on your face to dry and peel, and become red-- but if any side effects are worse and are happening in places other than dryness/irritation where you are applying it... or it is well beyond being remedied by daily moisturizer-- STOP its use. Vitamin A is fat soluble and excess is stored in the liver. Its not like B vitamins which are just excreted in your urine... so when your body has too much of it your liver stops to function properly creating a domino of effects. Another reason why people are not supposed to drink on accutane... So your body keeps collecting the vitamin A - its overload in the liver creates a Toxicity that contributes to the hairloss... which is caused by your body's averse reaction of the vitamin A shock and overdose, which also harms the way your body handles the hormones in your liver... accutane DESTROYED not only the volume of my hair but its texture. It destroyed my skin due to the scarring that occurred because the vitamin A changed the texture and thickness of my skin. People have also tried "overdosing" on vitamin A taking megadoses to recreate the effects of Accutane... which I have seen happen... all very bad ideas. Other people tend to get VERY generous with retina-s thinking more is better, but its not. So yes-- if you are having any adverse affects other than a little redness, peeling, and dryness on the site of application - then discontinue any intake of vitamin A and all use of topical retinoids. NEVER USE if pregnant or attempting to get pregnant. It is a SERIOUS SERIOUS compound-- and can have serious serious permanent effects not only on your skin, but your hair, joints and eye sight.

    While my body suffered the worst senarios of oral vitamin - a... (accutane) I did not suffer any side effects from using it topically.. And sad to say, other than making my skin greasy or red - retin-a didn't have any positive effects on my acne. Now -- however -- there is a similar retinoid called Tazorac (tazortene) which I SWEAR by. I live and die by it... And in fact, as long as you are not having any adverse effects to topical retinoids I recommend talking to a doctor about it. Use the LEAST amount as possible and always moisturize. For me not only does this drug help with acne - it helps erase dark spots and the appearance of scars, not matter what type. AND I have found in my own experience that it even stops scars from forming. It is almost like a mini chemical peel... and I am not a doctor -- I do have thick skin that tans easily and does not burn.. so the results are different for everyone-- but this drug is a "scar and dark spot" eraser for me. It works SO well to flatten out my skin, even my skin tone and diminish the appearance of scars and dark spots. I believe that it is more commonly used to treat psoriasis than acne. I've read about the science behind it and not only does it cause cause accelerated exfoliation... it causes/promotes your skin cells, and new cells to grow back normally. Again- its marketed for acne the same way as Retin-A -- and NOT for scar removal... but it is a miracle drug for me... and the only thing keeping my skin from constantly and severely scarring from persistent acne. Other than dry skin, redness and peeling I have never had any problems with it-- and I was a person extremely susceptible to the internal effects of vitamin A. It works great to keep your skin clear of blackheads as well. Trying both Retin-a and Retin-A micro-- they have never given me the healthy glow and repair that Tazorac does for my skin-- and I've been using it for - I think about 8 years. In my opinion..it is one of the BEST kept secrets in dermatology... it is night and day on how fast it works to accelerate exfoliation and cell regrowth...compared to retina.

    Also - for those of you women who want a similar peeling effect to help remove dark spots, new/forming scars and blackheads -- I recommend doing an aspirin mask every few days. Asprin contains Salicylic Acid- which is a main ingredient in acne medication to promote the peeling that keeps your pores unclogged... All you do is add a bit of water to uncoated aspirin, create a paste and apply it to your face. Let it dry for 15 minutes then carefully take it off. You will see how it immediately starts to peel and exfoliate dead skin and red spots. Wash and moisturize and you face right after. You can even use it as a spot treatment to help exfoliate scars, red spots or to dry out acne. Except for a little drying and peeling- its side effect free and aspirin is anti inflammatory.

  • December 11, 2011

    by Ann Jaline

    I just began looking up topical retinol side effects because getting it near my eyes has caused them to tear effusively for up to an hour after use and 3 times now I have put it on my neck and have had redness. swelling over my thyroid and a sore throat. I didn't link the retinol to the thyroid problem until today. At first I thought I had bug bites, then I thought it was a lotion meant to inhibit hair growth I got with my No No ! Hair system. I even thought I had gotten the No No! too close to my thyroid. But this last time I know I didn't do the other things, but I did use an anti-aging moisturizer that has retinol in it on my neck. I do have very sensitive skin and so far can't use many kinds of products without getting rashes or burns. Can the retinol be absorbed directly into the thyroid topically?

  • November 2, 2011

    by Marc

    I think this deserves a bit of an update and correction. Tretinoin, Retin-A etc do not contain the normal vitamin form of Vitamin-A, but rather a more uncommon form, retinoic-acid.

    Retinoic-acid and it's close cousin, Accutane, are teratogenic (they kill quickly dividing cells, like chemotherapy drugs), and are toxic. Although certain cells in our body do convert the vitamin form of vitamin-A into retinoic-acid, we don't have the ability to convert retinoic-acid back into the vitamin forms (retinol, retinal).

    While vitamin-A overdose is possible, and vitamin-A is easier to OD on than many other vitamins, they do NOT have the same teratogen property as retinoic-acid, and are not toxic at proper doses. The vitamin forms of vitamin-A do not cause impaired vision (they're good for your eyes), and don't cause any of the other nasty side effects associated with retinoic-acid (in fact, pregnant women need a certain amount of vitamin-A in their diet for healthy fetal development).

    Unfortunately, the label on Retin-A and some other products just says "retinol" even though that is not the truth. However, products which contain retinyl palmitate or retinyl acetate you can be sure it is the vitamin form and thus safe. Retinyl palmitate/acetate are esters, or in other words loosely combined with fats. This is the natural form of vitamin A found in foods, and is easily absorbed and converted by your body into the vitamin. If a product lists multiple forms of retinol beyond the stated safe forms, you might have reason to question. (usually retinoic acid products are also very expensive, which may help give it away)

    I hope this helps to resolve any confusion that might arise from the naming.

  • December 22, 2010

    by naz

    hi marta. first of all i would like to thank you and the people at the YBF. i have sent a mail to your ID.
    thanking you,
    naz.

  • December 20, 2010

    by Marta

    Naz, I know just what you need. Your Best Face Prep. It will help with white heads, pigmentation and give you a nice glow. Here's more about it:
    http://truthinaging.com/face/your-best-face-prep-reviewed-and-recommended-by-katya
    http://truthinaging.com/face/mark-puts-your-best-face-prep-restore-and-concentrate-to-the-test
    The nice people at YBF said they'll give you one to try out!! So please email me at Marta@truthinaging.com and I'll send one to you right away.

  • December 20, 2010

    by naz

    Hi marta. My skin is not that worse. The problem is, i get a lot of white heads on my nose and i have brown spots on my face but they are'nt very prominent.i want to get rid off the white heads and the brownspots permanently. And i want a glowing skin. This is what i need. Thank you.

  • December 19, 2010

    by marta

    Hi Naz, I was studiously trying to avoid giving you a definitive answer. I am not qualified to advise you to use something or not. I can only give you the information to hand so that you can make as informed a decision as possible. So, firstly, people who have commented here - such as Eileen, experienced vision and other issues when they increased the concentration of retin-A up to .1%. At a 0.025% you may not experience any side effects.

    Its a personal choice. With the information available, I would not use a Retin-A cream at any concentration. As much as anything else, there are alternatives that don't have these safety issues.

    Which brings me to ask you what are you trying to achieve? You mention that you are 30, so I imagine that you are not trying to remove wrinkles. You ask if you can use Retin-A around the eyes. Why would you want to? This is a powerful exfoliant that I wouldn't want to use on delicate eye area skin even if there was no evidence of compromised vision. There are plenty of excellent eye creams that don't contain retinols.

    Many people use Retin-A to deal with acne. But, again, there are some alternatives such as blue LED light that really do seem to work.

    I'd be happy to try to help you find some alternative solutions depending on what your goal is.

  • December 19, 2010

    by naz

    hi marta, first of all i would like to thank you for your reply. I am 30. i've started using tretinoin/retino-A 0.025% for the first time.And i've planned to use it thrice a week. is it ok? and i also want to know whether it will affect my vision? and will it cause skin cancer? can i apply my moisturiser over the retino-A cream? Can i apply Retino-A under my eyes? please do clarify my doubts. thank you.

  • December 18, 2010

    by marta

    Hi Naz, all tretinoin/retin-A creams can cause irritation and dryness, as well as increased sensitivity to sunlight. As far as toxicity goes, the research that I mention in this post suggests that it is dose dependent and evidence of toxicity was seen at 1%, much higher than the 0.025% amount you mention. Having said that, there hasn't been research that looks at the effects of low doses over time.

  • December 18, 2010

    by naz

    hi... is it safe to use "tretinoin cream U.S.P, Retino-A 0.025% on my face? please mention the side effects if any.. Thank you..

  • November 27, 2010

    by Junko

    Eileen ~ THANK YOU so very, very, very much for sharing your story! When I was scouring the internet for information to help myself...it seemed that I was the only one and that my problems couldn't be due to the tretinoin. Thank you for posting your account on TIA and on the web. Hopefully anyone looking in the future, will find stories to help them here!

  • November 27, 2010

    by Eileen

    I'm one who has used Retin A .01% for 25 years. Over time I up-dosed to .025% cream, then to gel, and then to .05%. Early this year I moved to the .1%. I don't recall when, two-three years prior?, I noticed the blurry eyes, but they got unbearable with the .1%. And the hair loss, this started 10 years ago and I never knew what it was connected to. When I traded to the .1% not only did my eyesight become worse, my eyes became dry, inside my nose dried out, mouth cracks formed, hair loss around my face increased, eyebrows shed, eyelashes AND I became very depressed over a period of time. After 6 months of intermittent use of the .1% I finally realized it was the retin A causing it. I got a liver vit A test and found my levels over the top toxic. It's been 6 months off the retin A . My eyesight cleared up in about 2-3 months, depression lifted in 3 months and hair shedding is still there but lowering. After researching there is no question this is what's been behind the hair loss. They use retin A .0125% in hair loss preparations, and I've read THIS strength causes too much shedding and irriation in some users who are trying to grow hair.

  • August 11, 2010

    by Jaysie

    Thanks for the reminder, Marta...I'll add "avoid sunscreens with retinol-type ingredients" to my one brain cell that's marked Retinoids.

  • August 11, 2010

    by marta

    Hi Jaysie, broadly, I think your summary is correct. However, there are concerns (voiced by the EWG) that retinyl palmitate is unsafe in sunscreens as it degrades under UV. http://truthinaging.com/sun-protection/retinyl-palmitate-sunscreen-and-skin-safety
    However, not all experts agree: http://truthinaging.com/sun-protection/dermatologists-claim-that-sunscreens-with-retinyl-palmitate-do-not-cause-cancer

  • August 10, 2010

    by Junko

    Kathy,
    I'm not sure about your hair loss, but what I can say regarding the recovery of my eyes is that 4 weeks of Tretinoin use = 12 weeks non-use for my eyes to recover to 90% of where they were before I used the Tretinoin. This is pretty amazing, as I was expecting 100% recovery in 4 weeks. I suppose though, the older we get the harder it is for our bodies to recover. I think Julie Kay posted words similar not too long ago.

  • August 10, 2010

    by Jaysie

    I've read this article and the comments at least 4 times since it was first posted and I still struggle to clearly understand the potential chemical consequences among "retinols" both good and bad.

    Marta, would it be safe to say that, FOR TOPICAL USE, prescription strength Vitamin A, known as tretinoin, is the version we need to be on-the-alert about because of *possible* toxic side effects? And that all other versions of retinols we see on cosmetic ingredient lists variously called retinyl palmitate, or retinyl ester, or retinaldehyde, or retinol, or retin-whatever, are relatively safe versions, barring any sensitivity or allergic-type reactions unique to an individual user?

    I'm trying to simplify when the Red Flag needs to go up. Maybe this is not possible if the percentage amounts are pertinent but not shown for all those over the counter products??

  • August 9, 2010

    by kathy

    I, like the others, have been using tretinoin .025% for several months. Since then I have experienced profound hair loss. No other symptoms to speak of. If I stop using it, do you have any sources that say how long it would take to determine this as the cause and see my hair loss cease? Only lab doc checked was tsh which was normal. Thanks for your research. Very informative!

  • July 15, 2010

    by Jeda

    >Marta wrote: I don’t really want to use something that is a known toxin – especially as these days there are so many alternatives.<

    But, Marta, ANYthing in excess can become a toxin. This is what I was trying to point out in a comment to the original post from junko-- it DOES matter how much of the stuff one is talking about and how it is administered and what the health of the individual is to start with. Anybody with a compromised liver/kidney function would be foolish to use any of these products for anti-aging, of course, because even a small risk is nevertheless a risk. BUT some of us are trying to help you see that using 0.025% Retin-A for adult acne-- this is far less than even the 0.1% that some are citing (which I am suspecting is a typo for 0.01%, since prescription strength runs at 0.025%?)--is a different context altogether because it is topical, and it is a miniscule amount compared to the oral chemotherapy form. Plus, acne is actually a condition that demands treatment not just for comfort and looks but to prevent worse infections and scarring. To my knowledge there aren't "so many alternatives" in the treatment of acne, particularly for the large numbers of us who are allergic to benzoyl peroxide, which is really magic on those for whom it works.

    But even this is a moot point. The point is: you are calling the substance itself a toxin, when in fact ANY substance in large amounts is potentially toxic. ALL substances are therefore "known toxins" if you take them in huge amounts. As I pointed out earlier, even WATER is a known toxin-- one can die from too much water in the system. Have you stopped drinking water because it is a known toxin?

    The dermatologist was taken aback because these studies were done on a different drug, basically-- the same chemical but a much larger dose and taken internally. It is not a drug he would be expected to know about or stay abreast of, since the drug he administers is something entirely different.

    I'm guessing that even topical tretinoin can cause toxic reactions IF one's liver and/or kidneys are already vulnerable-- this would be true of any new substance, so, it seems logical to me that if one wants/needs to use tretinoin topically, a simple blood test is enough to help you determine how you might react to it. But, as with all drugs, you always run a risk when trying a new preparation-- every body is different; every body reacts uniquely.

    But the label of "toxin" should be used with great care if it's going to be applied with such a large arc, to indict all forms of the substance, all strengths. I do appreciate this website for your heroic attempts to provide information to the public, and I believe you are absolutely sincere, but please don't confuse the topical preparations (in very small concentrations) with the oral administrations of huge amounts and then pronounce ALL forms of tretinoin to be "a known toxin." It is a complex issue that deserves a complex analysis and a correspondingly complex report.

  • July 7, 2010

    by deborah rodell

    Your honesty and research is applauded. I made copies and took them to my dermatologist who did not know how to respond! Well he did boo hoo this and told me it was perfectly safe and that so few people have any systems, thus this has not been an issue that we read about. Duh. I bought a tube 5 months ago and never use around my eyes and will finish it because I am "cheap" . But after it is gone I will need another fix for my skin, will keep reading for suggestions. Junko sorry to hear of your problems and glad you found out the source. Thanks as always for sharing. This is what I love about this site. We are all in this together huh ladies?

  • July 4, 2010

    by marta

    Yes it does, justagirl. And then it also goes on to provide the conclusions of four years later.

    "The intervention was terminated 6 months early because of an excessive number of deaths in the tretinoin-treated group. Post hoc analysis of this difference revealed minor imbalances in age, comorbidity, and smoking status, all of which were important predictors of death. After adjusting for these imbalances, the difference in mortality between the randomized groups remained statistically significant.

    Conclusions We observed an association of topical tretinoin therapy with death, but we do not infer a causal association that current evidence suggests is unlikely. http://archderm.ama-assn.org/cgi/content/full/145/1/18.

    Which you can interpret to be that there was no relationship or, as Dr Dellavalle, Dermatology Service, Department of Veterans Affairs Medical Center wrote (in the same link): "While debate will continue regarding whether the association between topical tretinoin and death found in the VATTC resulted from chance or a real biological effect, until additional data from other studies emerge, practitioners should view the results of the VATTC with discretion."

  • July 4, 2010

    by justagirl

    The article you sight regarding trials with veterans at http://www.ahrp.org/cms/content/view/521/9/ goes on to say that:

    In 2005, the authors published preliminary results in abstract form in the Journal of Investigative Dermatology, stating that there was NOT a statistically significant difference in overall mortality between tretinoin and placebo groups: "We conclude tretinoin did not cause the mortality difference between groups, and in retrospect the termination of the intervention was unnecessary."

  • July 3, 2010

    by Junko

    What each of us chooses to use, or not to use is a matter of personal choice, but I'm thinking about Truth In Aging's ABOUT page which outlines TIA's purpose. For me, TIA's purpose is what sets it apart from all the other mainstream beauty blog sites which do not focus on ingredients, safety and environmental issues. Truth In Aging promotes products as Marta says, do as little evil to us or the planet as possible. With this in mind, I would never expect Marta to take a pro stance on the use of prescription retinoids solely for wrinkle reduction purposes. The day I see her post something like that, will be the day I think she's delirious from an overdose of ORAC's!

  • July 3, 2010

    by marta

    Hi Marcella, I am certainly not qualified to advise anyone. I am simply trying to collate and summarize as much of the research as possible so that readers can make their own informed decision. Clearly a pregnant woman should not use retinoids because of potential fetal damage. My personal position is that I don't use retinoids - as much as anything else my skin is too sensitive. Furthermore, I don't really want to use something that is a known toxin - especially as these days there are so many alternatives. For years, dermatologists prescribed retinol because it worked and there was plenty of research behind it. In recent years however, there have been loads of breakthroughs with collagen stimulating peptides, growth factors and antioxidant botanicals. And - as far as we know - they are safe. We dig out and write about these alternatives all the time, so please roam around and be sure to check out our <a href="http://truthinaging.com/category/five-best" rel="nofollow">Five Bests</a> where we pull together products that we've tested, know to work and do as little evil to us or the planet as possible.

  • July 3, 2010

    by Marcella

    I have used retin-a for 2yrs .Does this mean i will get cancer?It has softened some deep wrinkles,and some small lines have gone away.
    So are you saying i should not use retin-a?i use0.1%.I wait for your answer about retin[a and cancer.Thanks

  • June 27, 2010

    by Christine

    I am an esthetician and regularly promote the use of topical retinoids, in addition to using them myself to manage my genetic acne tendency an as part of my age-management strategy.

    The studies you list that reference tretinoin are referring to orally-adminstered tretinoin, aka Accutane, which I absolutly agree has all these potential side effects of Vitamin A toxicity. I experienced many of them including night blindness, joint pain, and fatigue, during my orally-administered, dermatologist-supervised Accutane treatment as a teenager. What your article fails to point put that orally-administered tretinoin treatment doses are always intended to induce controlled, temporary hypervitaminosis.

    Topical retinoids, on the other hand, are dosed to increase skin's diverse functions (epithelial desquamation, fibroblast stimulation, production of extracellular matrix). Vis a vis topical retinoids, you would be experiencing extreme, burn-victim-like shedding, peeling, and oozing skin long before experiencing systemic Vitamin A toxicity as a result of any topical retinoid treatment..

  • June 27, 2010

    by Naja

    I have been using Retin A 0.1% daily for almost 20 years with no side effects. I suffer from acne and also appreciate that tretinoin is the most powerful anti-aging ingredient on the market. I have difficulty believing that a product, which was developed so many years ago for acne and which has been used by millions safely since then is "toxic."

    Surely, the number of people who have benefited from tretinoin greatly outnumber the individuals who for whatever reason have experienced adverse results. Don't all products, including over-the-counter ones, have side effects?

    One cancer study involving tretinoin and elderly veterans carries little weight with me. The medical histories and risk factors of these individuals are unknown. Moreover, the manner in which the study was conducted, including dosage administration and analysis of results, may be problematic in some respects. There are many variables involved.

    Outside of this one study, how many deaths in the United States have been solely and directly attributable to the use of tretinoin? If tretinoin was that toxic, I would expect a number of people outside of the study to be similarly affected.

    Retin-A was pivotal to the creation and development of the whole cosmepharmaceutical industry. I love this product and shall never be without it.

  • June 26, 2010

    by marta

    By the way, it seems if you do use tretinoin for antiaging, you have to keep it up according to this: Dr. Elise Olsen and associates (Olsen et al., 1997) discovered that reducing the frequency of tretinoin 0.05% cream from once daily to 3 times per week maintains, and in some cases, possibly further enhances reduction of photodamage. They also observed that cessation of tretinoin therapy for 6 months, however, resulted in some reversal of the beneficial effects seen after 48 weeks of treatment.

  • June 26, 2010

    by marta

    Hi Jaysie, I'll try to summarize what I've seen on doses. First retinoids that are NOT tretinoin. The typical cosmetic use of 0.5% seems to be fine for people who don't have sensitive skin. However, topical tretinoin is another matter. It is often used - and has been <a href="http://www.medscape.com/viewarticle/464026_3" rel="nofollow">studied</a> - for acne etc at 0.1% doses. But a 6-year randomized clinical trial conducted by the Veterans Administration involving 1,131 elderly veterans was conducted. In it 566 were randomized to test tretinoin cream (0.1%), and 565 to placebo. The purpose of trial was to establish the effectiveness of Retin-A as a chemoprevention intervention for nonmelanoma skin cancer. However, the results were chilling: "Cumulative Deaths among 1131 Study Participants shows that the retinoid treated group consistently had an excess number of deaths compared to the placebo group". Links to articles on this study are here:
    http://www.ahrp.org/cms/content/view/521/9/
    http://www.medscape.com/viewarticle/587057

  • June 26, 2010

    by marta

    Osmosis Correct has 0.5% retinaldehyde. I wrote about<a href="http://truthinaging.com/face/osmosis-boost-and-retinaldehyde" rel="nofollow"> Osmosis Boost and Retinaldehyde </a>and it can be converted by the body to either retinoic acid or retinol (which, in turn, can be converted to retinyl palmitate). Because of this metabolization, treating the skin with retinaldehyde could be effective, while reducing the side effects associated with heavy guns. A French <a href="http://content.karger.com/ProdukteDB/produkte.asp?Doi=51377" rel="nofollow">study</a> concluded that a 0.5% concentration is an effective antiager.

    But you want to know if it is safe. A German <a href="http://www.ncbi.nlm.nih.gov/pubmed/10473963" rel="nofollow">study</a> from 1999 says that it was tolerated better (caused less irritation) than other retinoic acid. Another <a href="http://www.informaworld.com/smpp/content~db=all~content=a792131176" rel="nofollow">study</a> in that year specifically says that cosmetic retinols are not systemic – tretinoin is systemic and that is why there is some cause for concern.

    I should think your 0.5% concentration of retinaldehyde is fine, as long as you are not experiencing any irritation.

  • June 26, 2010

    by Elsa

    I am using Osmosis Correct and it contains TRANS RETINAL. How safe is that in your opinion?
    I used a very strong topical retinA preperation that I bought on-line. I have not used it for about 1 1/2 years. At the time I started using it my vision started to change and my eyes became really dry. At the time I suspected a relationship between my eye symptoms and the preparation, but I continued using it regardless.
    I am therefore wondering if I should stop using trans-retinal as well as I have not been able to reverse my symptoms.

  • June 25, 2010

    by justagirl

    From what I understand, tretinoin is not used as a 'last resort' anti-cancer treatment. The primary use of tretinoin is for treatment of acute promyelocytic leukemia, in which there is a chromosomal translocation involving the retinoic acid receptor-alpha gene, causing it to fuse with another gene and preventing the maturation of cells. Tretinoin (retinoic acid) therapy is used to help induce the maturation of these cells. So it's not that it's particulary toxic and thus a 'last resort' treatment so much as that it has very limited and specific use as a cancer treatment. Even if it is used as a 'last resort', it's because there are other drugs that are more effective and/or have fewer side effects, which is not to say that the other treatments aren't toxic. Additionally, 'last resort' implies that other treatments like chemotherapy weren't effective. Chemotherapy is so toxic that to compare it to tretinoin is like asking which is worse, drinking gasoline or drinking weed killer?

    Even if tretinoin is so toxic that's it's a 'last resort' drug, you're e

  • June 25, 2010

    by Jaysie

    Marta - I'm wondering if, during your research on retinoids, you came across any definitive charts showing safe intakes of Vit A and/or its cosmetic cousins? Like a lot of things, Vit A and retinoids can be toxic depending on the dose and the body chemistry of the user. There are hordes of skin treatment products that contain forms of retinol in varying percentages. As you stated, a lack of retinol can cause night blindness so it would seem there must be some 'safe' level that would be good for the skin but not high enough to cause problems. Do you think beauty companies are being irresponsible by putting forms of retinol into products without disclosing the percentage?

  • June 25, 2010

    by marta

    Hi Kerence, the research I found was specific about tretinoin and pregnancy because it is systemic. You are OK with vitamin A supplements and food sources. As to other forms of retinoids, I am not sure. If it were me, I'd avoid preformed vit A if I was trying to get pregnant or was pregnant. But I'll keep foraging for info.

  • June 25, 2010

    by Jeni

    Hmmm the blurry vision side effect caught my attention because I've had problems with that for a year or two now and my eye doctors can't find the problem. I thought it was from a thyroid problem, but medication didn't help. I was next going to check for diabetes, and I know it's also a side effect from the pill. But I hadn't thought about retinoids. I rotate between Differin and Renova, but I don't use them every day - maybe a few times a week.

    The last paragraph especially caught my attention because I've had unexplained: weight gain, fullness in the ears, tinging fingers, etc. and a bunch of other ailments that didn't go away when I started my thyroid medication.

    A few days ago I started a topical hair loss treatment that also contains retinol. If retinoids are a problem for me, I wonder how long it would take for me to go off them to see a reduction in symptoms? Hmmm... I also also heard that ironically topical retinoids (not just Accutane or too much oral vitamin a) can cause hair loss (despite the fact that retinol is in a lot of hair loss products.)

  • June 24, 2010

    by Kerence

    So if I am trying to fall pregnant should I cut all products with any form of A even if they are not prescription?

  • June 24, 2010

    by marta

    When I was reading up on the retinas storing vitamin A, I was reminded that my granddad always used to tell me to eat my carrots because they'd help me see in the dark - turns out he knew what he was talking about.

  • June 24, 2010

    by marta

    Hi Jessica, I think any of the serums that we recommend will help a lot with wrinkles. Personally, I am finding the combination of the E'shee serum and KaplanMD's serum transformative. For keeping acne at bay, the Baby Quasar or an LED light treatment therapy really works.

  • June 24, 2010

    by Junko

    Wonderful research Marta. Most interesting was the part about the eyes taking in, storing and processing vitamin A. Wondering if those little fat pockets under my eyes is where the A is being stored. I want to mention again that the purpose behind sharing was my story was to bring this possible side-effect to light. I couldn't find anything on the internet when I was self-diagnosing. Initial symptoms were not severe but built up over time. My hope is that one day if someone is searching for symptoms similar to this, they'll pull up my story and be better off for having found it. Thanks again Marta for the follow-up research.

  • June 24, 2010

    by jessica

    So... any suggestions for alternatives? I love the way my skin has cleared up (wrinkle-and acne-wise) after being on it a year! I never really achieved this with glycolic or alpha hydrox.

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