Tretinoin Cream
Tretinoin (Retin-A) is a topical retinoid—a vitamin A derivative—used for acne and photoaging. It works mainly by binding retinoic acid receptors (RAR) and RXR in skin cells and changing gene expression in ways that normalize follicular keratinization, reduce comedone formation, and increase skin cell turnover. The key difference from Accutane (isotretinoin) is route and exposure: tretinoin is applied to the skin and studies show minimal percutaneous/systemic absorption (often ~1–2% in topical formulations), so it generally produces far less whole-body exposure than oral isotretinoin.
In PFS/PSSD/PAS discussions, tretinoin comes up because it’s still a retinoid/vitamin A–pathway drug, and a risk for those with the syndrome. Post-Accutane/“post-retinoid” sexual dysfunction is most strongly associated with oral isotretinoin, and regulators/medical discussions have acknowledged persistent sexual side-effect concerns with isotretinoin specifically. For tretinoin, systemic exposure is usually low, but some sensitive individuals anecdotally report flares and in rare anecdotes permanent worsening.
Crash Anecdotes:
https://www.reddit.com/r/AccutaneRecovery/comments/17nvsav/are_retinolretionoid_creams_safe/
My Personal Risk Ranking:
Moderate Risk of Permanent Worsening (for PFS/PSSD/PAS):
If you currently have PFS/PSSD/PAS, these substances may carry an moderate risk of worsening symptoms—potentially in a lasting way—and is best avoided.