An Updated Review of Topical Tretinoin in Dermatology: From Acne and Photoaging to Skin Cancer

Topical tretinoin (all-trans-retinoic acid) is a first-generation vitamin A derivative with well-established efficacy in acne vulgaris and photoaging. Owing to its pleiotropic effects on epidermal differentiation, collagen synthesis, and skin pigmentation, numerous off-label uses have been proposed across dermatology. This narrative review summarizes current evidence on the efficacy and safety of topical tretinoin for multiple dermatological conditions, based on studies published between January 2000 and July 2025. Robust data from randomized clinical trials (RCTs) and systematic reviews support its benefit in acne and photoaging, whereas smaller RCTs and prospective studies indicate potential efficacy for melasma, postinflammatory hyperpigmentation, striae distensae, flat warts, alopecia areata, androgenetic alopecia, hypertrophic scars and keloids, and actinic keratosis and as pretreatment before chemical peels or laser resurfacing. However, high-quality, adequately powered trials with standardized outcome measures are still needed to establish clinical guidelines. Regarding cutaneous oncology, a large RCT demonstrated no preventive effect of tretinoin on keratinocyte carcinomas. Adverse events are typically mild, localized, and transient, and available evidence does not support an association with systemic adverse effects.