Myth: Tretinoin Reduces Oily Skin

If you have oily skin and were counting on tretinoin to help, you may likely be disappointed. Although tretinoin has been shown to have many beneficial effects on the skin, reducing oil (sebum) production is not one of them.

Oil Production: Where Does it Come From?

When we refer to "oil" we are talking about sebum, a complex mixture of lipids produced by the sebaceous glands, which are found in the dermis (middle layer of the skin underneath the epidermis). They are most concentrated on the face, scalp, chest, and upper back. These glands are associated with hair follicles and release sebum through the hair follicle openings onto the skin’s surface.

Sebaceous gland attached to a hair follicle.

Sebum is composed of a mixture of triglycerides, free fatty acids, squalene, wax and sterol esters, and free sterols. We often think sebum plays a crucial role in moisturizing the skin and maintaining skin barrier function, but its exact function in promoting healthy skin is not clear. However, its cosmetic implications are fairly certain: most people don't like excessively oily skin.

Impact on Sebum Production: Tretinoin vs. Isotretinoin

A big part of the misconception about tretinoin's impact on oily skin is treating all retinoids the same (see post, "Tretinoin: What is it?"). Iso-tretinoin, known popularly as Accutane, is a powerful acne medication that can dramatically reduce the production of oil and shrink your sebaceous glands. (Nelson et al, 2006; Zouboulis et al., 1991). However, tretinoin and iso-tretinoin are biologically different molecules with correspondingly different effects on sebaceous glands and oil (sebum) production).

In cell cultures, isotretinoin significantly induces sebocyte (sebaceous gland cell) apoptosis (death) and reduced proliferation (growth), effectively decreasing sebum production. In contrast, tretinoin had minimal apoptotic effects and only slightly influenced sebocyte proliferation. (Nelson et al, 2006). Interestingly, the study found that isotretinoin’s effects were independent of retinoic acid receptors (RAR), while tretinoin’s weaker effects were RAR-dependent.

Molecule	RAR Binding Affinity	Effect on Sebaceous Glands	Impact on Sebum Production
Tretinoin	Binds strongly to RAR-α, RAR-β, and RAR-γ	No significant effect on sebaceous gland size or activity.	Minimal impact on sebum; primarily affects keratinization.
Isotretinoin	Does not bind directly to RARs; effects mediated through isomerization to ATRA	Shrinks sebaceous glands through apoptosis.	Significant reduction in sebum; effects can be long-lasting or permanent.
Tazarotene	Selectively binds to RAR-β and RAR-γ	No direct evidence that it modulates sebaceous gland activity or causes apoptosis.	Moderate reduction in sebum (patient perceived); effects are reversible.

A similar finding in vitro (outside the body in a lab setting) how tretinoin, isotretinoin, and acitretin (another retinoid) affected human sebocytes. They discovered that isotretinoin significantly reduced sebocyte proliferation, while tretinoin had only a weak inhibitory effect. Moreover, tretinoin did not substantially suppress lipid synthesis, reinforcing the idea that it does not directly reduce sebum production. (Zouboulis et al., 1991)

Another study investigated whether oral tretinoin affects sebum excretion. Twelve healthy male volunteers took 20 mg/day of tretinoin for four weeks and found that sebum excretion remained largely unchanged throughout the treatment period. Comparison with values obtained in the same subjects previously treated with oral isotretinoin showed that tretinoin was far less effective at suppressing sebum production. (Hommel et al., 1996)

All this technical info is great, but what about real-world observations?

Research does not support a strong connection between tretinoin use and decreased oil production, but many dermatologists still promote it as an effective agent for oil reduction (see here and here). Additionally, many patients have reported to me that they feel it helps their oily skin. If you and/or your dermatologist are happy with the results, don't mess with success. In fact, one study did show report an ~20% reduction in sebum production with use of tretinoin. (Pan et al, 2017) However, the study's lack of blinding and a true control group raises concerns about bias and confounding variables, as patients could have altered their skincare routines, and the vehicle itself may have impacted sebum secretion.

Is There an Alternative for Reducing Oiliness?

While tretinoin may not significantly reduce sebum production, other retinoids have shown promise. A study evaluated the effects of tazarotene 0.045% lotion, a synthetic retinoid, in patients with moderate-to-severe acne. Unlike tretinoin, tazarotene significantly improved both acne lesions and patient-reported skin oiliness. Over two-thirds of participants noticed a reduction in perceived oiliness by week 12, suggesting that tazarotene may be a more suitable option for individuals looking to manage oily skin. (Tanghetti et al., 2023) This was a double-blind randomized controlled trial, which theoretically eliminates the concerns previously mentioned in the study by Pan et al, 2017.

Conclusion: Tretinoin Helps Reduce Oily Skin, an Apparent Myth

The belief that tretinoin reduces sebum production is a as good as myth. While tretinoin plays a crucial role in the treatment of acne and photodamage, studies consistently show that it does not significantly suppress sebaceous gland activity. For those seeking to control excess oil, alternative treatments such as isotretinoin or tazarotene may be more effective options.

Dr. Ryan M. Trowbridge, MD, MS, MA

Harvard-Trained, Board-Certified Dermatologist and DermMythBuster

P.S. Have you come across any new or conflicting research on this topic? Please share—I’d love to explore it further with you!

Would you like to try tretinoin, isotretinoin, or tazarotene? You can obtain an online consultation from Dr. Trowbridge at Bridge Dermatology if you currently reside in California, Connecticut, Illinois, or Nebraska.

Citations

1. Nelson AM, Gilliland KL, Cong Z, Thiboutot DM. 13-cis Retinoic acid induces apoptosis and cell cycle arrest in human SEB-1 sebocytes. J Invest Dermatol. 2006;126(10):2178-2189. doi:10.1038/sj.jid.5700289

2. Pan J, Wang Q, Tu P. A Topical Medication of All-Trans Retinoic Acid Reduces Sebum Excretion Rate in Patients With Forehead Acne. Am J Ther. 2017;24(2):e207-e212. doi:10.1097/MJT.0000000000000390

3. Zouboulis CC, Korge B, Akamatsu H, et al. Effects of 13-cis-retinoic acid, all-trans-retinoic acid, and acitretin on the proliferation, lipid synthesis and keratin expression of cultured human sebocytes in vitro. J Invest Dermatol. 1991;96(5):792-797. doi:10.1111/1523-1747.ep12471782

4. Hommel L, Geiger JM, Harms M, Saurat JH. Sebum excretion rate in subjects treated with oral all-trans-retinoic acid. Dermatology. 1996;193(2):127-130. doi:10.1159/000246227 (ABSTRACT ONLY)

5. Tanghetti EA, Zeichner JA, Gold M, et al. Improvements in acne and skin oiliness with tazarotene 0.045% lotion in patients with oily skin. J Dermatolog Treat. 2023;34(1):2147391. doi:10.1080/09546634.2022.2147391.