@samanthaschneidermd Replying to @Y.A Mk Not all retinoids are built the same. Tretinoin is the OG — a 1st-gen retinoid that's been around since the 70s, binds to multiple retinoic acid receptors, and is considered the gold standard for anti-aging AND acne. Trifarotene (Aklief) is the new kid — a 4th-gen retinoid approved in 2019 that selectively targets the RAR-gamma receptor (the most common one in your skin), meaning potentially fewer side effects and better tolerability (though studies didn’t show a big change in tolerability). Big differentiator? Trifarotene is specifically approved for truncal acne (think: back, chest, shoulders) — not just the face — AND has shown real results for post-inflammatory hyperpigmentation (PIH) and acne scarring. Both are prescription-only. For most people, tretinoin still wins on value. But if body acne or PIH is your main concern, trifarotene might be worth the convo with your derm. Have more acne questions? Drop them below 👇🏼 #dermatologist #acnetreatments #tretinoin ♬ original sound - Samantha Schneider, MD

If you're researching prescription retinoids for acne, you've likely come across tretinoin and trifarotene. Both belong to the retinoid family and are effective acne treatments, but they aren't exactly the same. 

Understanding how they differ can help you have a more informed conversation with your dermatologist about which option may be right for your skin.

What Are Retinoids?

Retinoids are vitamin A derivatives that help treat acne by:

• Increasing skin cell turnover
• Preventing clogged pores
• Reducing inflammation
• Improving overall skin texture

They are considered one of the most effective long-term treatments for acne and are also commonly used to improve signs of photoaging.

How Tretinoin Works

Tretinoin has been used for decades to treat acne and sun-damaged skin.

It works by binding to retinoic acid receptors (RARs) found in the skin. There are three main receptor types:

• RAR-alpha
• RAR-beta
• RAR-gamma

Tretinoin is considered non-selective, meaning it binds to all three receptor types rather than targeting one specifically.

How Trifarotene Is Different

Trifarotene is a newer prescription retinoid that was developed to be more selective for the RAR-gamma receptor.

RAR-gamma receptors are the most abundant retinoic acid receptors in the skin, particularly in areas involved in acne development.

Researchers hoped that targeting this receptor more specifically might reduce common retinoid side effects, such as:

• Redness
• Dryness
• Peeling
• Irritation

Does Trifarotene Cause Less Irritation?

Although receptor selectivity sounded promising, clinical trials have not shown a significant difference in side effects between tretinoin and trifarotene.

Both medications can cause irritation, especially during the first few weeks of treatment, and both typically require gradual introduction and consistent moisturization.

One Major Advantage of Trifarotene

Where trifarotene truly stands out is its FDA approval for acne on the trunk, including:

• Chest acne
• Back acne
• Shoulder acne

It also has strong clinical data supporting improvement in:

• Post-inflammatory hyperpigmentation (the dark marks left after acne heals)
• Acne-related scarring

For people struggling with body acne or lingering discoloration after breakouts, trifarotene may offer additional benefits.

Should You Switch from Tretinoin?

Not necessarily.

If you're already using tretinoin, your acne is well controlled, and you're not experiencing bothersome side effects, there may be little reason to change treatments.

In dermatology, an effective treatment that your skin tolerates well is often the best choice.

However, if you're dealing with:

• Persistent chest or back acne
• Acne that leaves dark marks behind
• A treatment plan that isn't giving you the desired results

…it may be worth asking your dermatologist whether trifarotene is a better fit.

The Bottom Line

Both tretinoin and trifarotene are effective prescription retinoids for acne treatment.

Tretinoin remains an excellent option for many patients, while trifarotene offers unique advantages for treating acne on the chest and back and may be particularly helpful for improving post-acne discoloration.

The best choice depends on your skin, the location of your acne, your treatment goals, and how well your skin tolerates retinoids. A dermatologist can help determine which medication is most appropriate for your individual needs.

Follow Dr. Schneider on                TikTok          Instagram          Facebook

Want the transcript for this video instead?  

Tretinoin is a retinoid just like triferatine. The difference is that tretinoin is not specific, (0:08) meaning that there are retinoic acid receptors, alpha, beta, and gamma, and tretinoin binds to (0:15) all of them. It does not bind to one more than another.
Triferatine was developed because (0:20) it is more specific for RAR gamma, and it was thought that this might have less topical side (0:27) effects like irritation, redness, peeling, and that these gamma receptors are more prevalent in (0:35) the sebaceous skin and in acne, and so it might be more specific for the acne patient. (0:40) Now in clinical trials when they've looked at these, there's not a significant difference (0:45) in terms of side effects between the two, but the big advantage with triferatine is it is FDA (0:51) approved for acne on the trunk, so on the chest, on the back, and it does have really good data (0:58) for helping with scarring and for dark marks left behind after acne. So that is the main difference.
(1:05) If somebody is already on tretinoin, and they're getting great results, and they're not having any (1:10) issues, and they don't have acne like on the trunk where they can't get it approved, for example, (1:16) then I'm not necessarily in favor of switching. If it's working, you don't need to change, (1:21) but if this is acne that is on the chest, on the back, or dealing with a lot of post-inflammatory (1:28) hyperpigmentation, dark marks after acne, triferatine might be a great choice. (1:32) I hope that answers your question.
If you have any others, leave them below.