Tretinoin in Singapore what it does, how to start it, and when to be careful

The basics

What tretinoin is and what it does

Tretinoin (all-trans retinoic acid) is the form of vitamin A that actually switches on retinoid receptors in skin cells. Milder retinoids such as retinol have to be converted into it first, which is why tretinoin works faster and irritates more.

In acne, tretinoin normalises the way cells lining the pore are shed, so fewer of them stick together into the plugs that become blackheads and whiteheads, and existing plugs loosen. It also has a calming effect on inflammation, and it is often combined with other acne treatments that work in different ways.

For sun-related ageing, tretinoin is one of the most thoroughly studied topical treatments. In a 48-week trial of 99 people with sun-damaged facial skin, both 0.1% and 0.025% tretinoin improved photoageing compared with a plain cream, and thickened the outer skin layer by about 30%. Changes in fine lines, texture and blotchy pigment build over months. Tretinoin does not lift sagging skin or replace lost volume.

Singapore rules

Is tretinoin prescription-only in Singapore?

Yes. Singapore's National Drug Formulary lists tretinoin 0.05% cream as a prescription-only medicine, with no exemption for supply without a prescription. The Health Sciences Authority (HSA) has said that tretinoin and hydroquinone are potent prescription ingredients that are prohibited in skincare cosmetic products and should only be used under strict medical supervision, and that tretinoin used inappropriately can cause redness and peeling.

HSA has also found cosmetic creams, often sold online with promises of fast whitening or clearer skin, that contained undeclared tretinoin and other potent ingredients. Be wary of any product that claims to contain tretinoin without a prescription, or that does not list its ingredients clearly.

Retinol, retinal (retinaldehyde) and retinyl esters are sold as cosmetic ingredients. Adapalene is also a prescription-only medicine, but a pharmacist may supply a small pack of up to 0.1% gel for acne to people aged 12 and over.

Strengths

Tretinoin strengths: why higher is not always better

Tretinoin is made as creams and gels in strengths such as 0.025%, 0.05% and 0.1%. Creams tend to suit drier or more sensitive skin; gels suit oilier skin but can sting more. Singapore's formulary lists a 0.05% cream, and which products are available here varies, so the doctor chooses from what is registered.

A stronger tube does not mean faster results. In the 48-week photoageing trial, 0.025% and 0.1% tretinoin gave similar improvement, but the 0.1% cream caused significantly more redness and scaling. For most people the useful question is which strength they can use steadily, not which is strongest.

In Asian skin, irritation matters for another reason: inflamed skin can darken afterwards (post-inflammatory hyperpigmentation, or PIH). Choosing a tolerable strength, base and frequency is part of avoiding new marks while treating old ones.

Getting started

How to start tretinoin: pea-size, buffering and retinisation

The first two to six weeks are often called retinisation: dryness, flaking, tightness and stinging while the skin adjusts. Some people with acne also see a flare of small spots in their usual areas during the first weeks. Both usually settle if you keep the frequency comfortable rather than pushing through.

Acne is usually judged after about three months of steady use. Sun-related changes take longer, often three to six months or more. Using tretinoin consistently at a tolerable frequency matters more than using it every night from day one.

• Use a pea-sized amount for the whole face, not per area.
• Apply at night to clean, fully dry skin; damp skin absorbs more and stings more.
• Start two or three nights a week for the first couple of weeks, then every other night, and only move to nightly if your skin stays comfortable.
• Keep it away from the eyelids, the creases beside the nose and the corners of the mouth, where irritation starts first.
• Buffer if you sting easily: apply moisturiser first, or sandwich the tretinoin between two thin layers of moisturiser.
• Do not use exfoliating acids, scrubs or peeling pads on the same night, and follow your doctor's timing for benzoyl peroxide, which can break down some tretinoin formulations.
• Stop and contact your doctor if you get swelling, weeping, burning or a rash that keeps spreading.

Compared

Tretinoin vs retinol vs adapalene

For acne, a pooled analysis of five randomised trials in 900 people found adapalene 0.1% gel matched tretinoin 0.025% gel for reducing spots, worked slightly faster in the first week and was better tolerated. For sun-related ageing, tretinoin has the larger body of evidence. Retinol is a reasonable cosmetic starting point, but it is slower and its effects are smaller.

If tretinoin is not suitable, for example during pregnancy or with very sensitive skin, a doctor may suggest azelaic acid, which is gentler and also helps marks and redness.

Pregnancy

Pregnancy, breastfeeding and tretinoin

Do not use tretinoin if you are pregnant or trying to conceive. Oral retinoids are known to cause serious birth defects; topical tretinoin is absorbed in much smaller amounts, but no one has shown it is safe in pregnancy.

A meta-analysis of 654 pregnancies exposed to topical retinoids, compared with 1,375 unexposed pregnancies, did not find a significant increase in major birth defects or miscarriage. That is reassuring if you used tretinoin before you knew you were pregnant, but the authors said it is not enough to justify using topical retinoids during pregnancy. If you find out you are pregnant, stop and tell your doctor.

If you are breastfeeding, ask your doctor before starting. Azelaic acid, niacinamide and sunscreen are common alternatives to discuss.

Sun and treatments

Sun care and tretinoin in Singapore's climate

Tretinoin makes the outer layer of skin thinner and more sensitive, so sunburn and irritation come more easily. Light also breaks tretinoin down, which is one reason it is applied at night. Singapore's UV is high all year, including on cloudy days and short commutes, so daily broad-spectrum sunscreen, reapplied when you are outdoors, is part of using tretinoin rather than an extra.

Heat and sweat on freshly treated skin make stinging more likely. Hats, shade and avoiding midday sun help, and sun protection also lowers the risk of dark marks after any irritation.

Tretinoin changes how skin responds to other treatments. Stop it on the area about a week before waxing, pause it for a few days before a HydraFacial, and follow your doctor's timing around peels and lasers. Always tell whoever is treating you that you use it.

Isotretinoin

Isotretinoin in Singapore: a different medicine with its own rules

Isotretinoin is related to tretinoin but is taken by mouth as a capsule, and it works on the oil glands themselves. It is used for severe nodular or cystic acne and acne that has not responded to other treatment; the American Academy of Dermatology strongly recommends it for acne that is severe, scarring, causing distress or not responding to standard care.

It needs a doctor's assessment and monitoring. Singapore's HealthHub leaflet advises women to use strict birth control from at least one month before, throughout, and for at least one month after a course, because isotretinoin can seriously harm an unborn baby. Cholesterol, triglycerides and liver tests are checked before and during treatment, and mood changes should be reported promptly.

• Expect dry lips, eyes, skin and nose; lip balm and moisturiser are needed daily.
• The skin burns more easily; use SPF 30 or higher broad-spectrum sunscreen.
• Avoid waxing, dermabrasion, peels and laser during treatment and for at least six months after stopping.
• Do not donate blood during treatment or for at least one month after.
• Avoid vitamin A supplements, certain acne antibiotics in the tetracycline group, and alcohol.

Where to go

Getting tretinoin prescribed in our network

Tretinoin is a prescription medicine. At IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, beside Orchard MRT, Dr Sin Yong examines your skin, checks for look-alike conditions such as fungal acne or perioral dermatitis, and decides whether tretinoin, adapalene, azelaic acid or another option suits you. He prescribes tretinoin after a consultation when appropriate, and discusses oral treatment, including whether isotretinoin is appropriate, where it is needed. Consultation and treatment are priced at consultation by the clinic; WhatsApp +65 8815 3008.

SkinRev Lab, at #B1-28 CityLink Mall by City Hall MRT, is a non-invasive centre and does not prescribe or inject. SKINLDM (S$288 with a basic facial, first visit S$68, before GST) is designed to calm skin that feels hot or sore from active breakouts or strong acne products, and HydraFacial Syndeo (from S$288 before GST; first-timer rate at the counter) clears congestion; pause tretinoin for a few days before a HydraFacial. Tell the team what you use at booking.

Sources

References & sources

1. National Drug Formulary (Government of Singapore). Tretinoin 0.05% w/w cream [SIN12368P], product information.
2. Health Sciences Authority (Singapore). HSA alert: 18 cosmetic products detected to contain potent undeclared ingredients including high levels of mercury. 20 April 2018.
3. HealthHub (Ministry of Health Singapore). Isotretinoin: medication information leaflet. Last reviewed 22 June 2023.
4. Griffiths CE, Kang S, Ellis CN, et al. Two concentrations of topical tretinoin (retinoic acid) cause similar improvement of photoaging but different degrees of irritation. A double-blind, vehicle-controlled comparison of 0.1% and 0.025% tretinoin creams. Arch Dermatol. 1995;131(9):1037-1044.
5. Cunliffe WJ, Poncet M, Loesche C, Verschoore M. A comparison of the efficacy and tolerability of adapalene 0.1% gel versus tretinoin 0.025% gel in patients with acne vulgaris: a meta-analysis of five randomized trials. Br J Dermatol. 1998;139 Suppl 52:48-56.
6. Kaplan YC, Ozsarfati J, Etwel F, et al. Pregnancy outcomes following first-trimester exposure to topical retinoids: a systematic review and meta-analysis. Br J Dermatol. 2015;173(5):1132-1141.
7. Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1-1006.e30.

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