Is Tretinoin Doing More Harm Than Good? What a Skin Expert Wants You to Know
Tretinoin can improve fine lines, acne and skin texture, but overuse may lead to irritation, particularly for people with sensitive skin or taking certain medications. Skin health practitioner Lashelle Ullie explains when to pull back and how to protect your skin barrier.
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Is tretinoin just hype? Or a hero ingredient? Melissa Magsaysay posed the question to her guest on an episode of the Live + Well podcast before admitting her own enthusiasm for the popular skincare treatment. “I use tretinoin and I’m obsessed,” she said. “I think I’m developing an addiction.”
But skin health practitioner and educator Lashelle Ullie wasn’t so quick to endorse it. “It’s situational,” he said.
His response reflected a larger theme of the conversation. Skincare isn’t one-size-fits-all, particularly for people managing chronic illnesses or autoimmune conditions.
Ullie started in makeup more than 20 years ago, then became a licensed esthetician focused on men’s skin health and compromised skin, from eczema and seborrheic dermatitis to post-surgical care. He is upfront that “it is out of my scope of practice to diagnose,” but every consultation starts with the same question: “Are you on any medications?”
Ullie’s reasoning comes down to how the body works. “This is why I equate back to skin health versus skincare, because it’s the largest organ of the body,” he said. “And everything shows up on it, and you need to understand how to pivot.”
Is tretinoin hype or hero
Ullie isn’t anti-tretinoin. “I think it’s a great tool for people with actual skin conditions, and yes, it does help with age management, fine lines and things,” he said. “But it can be abused, and it can be very, very harmful.”
In Ullie’s view, overuse is often less about the product than the mindset behind it. “If you’re overusing it and thinking about age management... it’s less about the tretinoin,” he said. “It’s because you trying to, like, hold back something.”
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There’s a specific risk for melanated skin. Ullie told Magsaysay that overusing tretinoin can over-sensitize the skin and lead to hyperpigmentation, and on Asian, Mediterranean and Hispanic skin in particular, “that pigmentation’s hard to reverse.”
When medications and actives pile up
For people on prescription medication, the stakes go up, because the drugs can change the skin too. “Medications can thin out skin... Skincare can thin out skin. Think about retinol,” Ullie said.
In the treatment room, Ullie sees it show up as darkness under the eyes, flakiness, pores that look larger and “a discoloration in the skin where it kind of looks sallow.” With GLP-1s, he said, “it is grabbing at that collagen wall.” On lighter skin especially, there’s redness and flushing, sometimes rosacea. “Medications pull nutrients too,” he said.
So when Magsaysay asked whether someone on a skin-thinning medication should ease up on retinol, the answer came fast. “Always. Relax. We need to kind of keep the barrier strong,” Ullie said. “Pull back on that retinol a little bit.” That’s a pause, not a lifetime ban: if skin is thin, warm and red, the first goal is getting it back to a stable place, and retinoids can come back later.
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Ullie recalled working with a woman whose medication for alopecia appeared to be affecting her skin. What initially looked like acne turned out to be papules, small, raised bumps that can resemble breakouts. It wasn’t until he asked about her medications that he began to identify a possible connection.
Even people with thicker, more resilient skin can experience unexpected changes. Ullie described a longtime client whose hyperpigmentation began shifting after she started taking GLP-1 medication. Although her skin had previously tolerated more intensive treatments, he reconsidered his approach after reviewing her allergy panel and consulting a dermatologist. He began treating her skin as hypersensitive, underscoring why skincare routines may need to change alongside a person’s health.
From anti-aging to age management
Magsaysay pointed out that Ullie never once said “anti-aging” during their conversation. That’s on purpose. “I go age management,” he said. “We’re gonna age.” The work, as he puts it, is “assessing... pivoting, managing.” It also means looking at the whole person. “Our bodies are not compartmentalized. Our organs are not compartmentalized... Why are we doing that with our health?” Ullie said.
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That philosophy carries over to the size of a routine. “Simple is best,” he said. For clients going through chronic illness, that can mean “three to four products max.” The logic: “If products are good and the ingredients are good and you understand what your skin needs and you are consistent... you don’t need to do 10 products.” Ullie had a pointed note for women, too: “I think you’ve been told you didn’t need simple.”
Simple has its limits, though. The most ridiculous skincare move Ullie has heard from a male client involved shampoo. “I just let it all fall from my head to my face, all the way down to my back,” the client explained.
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How to use tretinoin safely, barrier first
When skin is stressed by medication or by overdoing it on actives, Ullie’s approach comes back to a few basics.
Build a hydration foundation. Hyaluronic acid is Ullie’s desert island ingredient. “Your skin needs water like the body does,” he said. Serums do the heavy lifting: “The serum, for me, is where the cellular change happens in the skin.” A ceramide-based moisturizer goes on top. “Your creams are great... but it’s really there to protect and nourish.”
Mind your exfoliants. “You just wanna be careful with actives,” Ullie said, naming AHAs, BHAs and heavy salicylic acid. When he asks clients how they exfoliate, the answer is usually salicylic acid, “and that can be very taxing on the skin.” He prefers gentle enzyme exfoliants instead, including an oil-gel enzyme formula made for rosacea-prone skin that he uses on clients sensitized by their medications.
Wear SPF every day. Even with clients who will only commit to one product, Ullie pairs the serum with sunscreen. “I need an SPF on top of that so that it can do its job.”
Know when to pivot. “You can’t pivot your medications,” Ullie said, but the routine around them can change, and pausing tretinoin is part of that. “If you feel like you need to take a step back, that’s fine.”
Ullie works alongside dermatologists, refers out when something is beyond an esthetician’s scope and doesn’t promise miracles. “I don’t overpromise. I’m not a snake oil salesman,” he said. What he does push is paying attention to the full picture, especially for anyone navigating a health issue. “Don’t compartmentalize your medical health with your skin health,” Ullie said. “It’s both intertwined.”
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Listen to the full episode of the Live + Well podcast on Spotify and Apple Podcasts.
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