# R-36 — Bausch Health Altreno — Tretinoin lotion 0.05%

Tretinoin at a full 0.05% in a lotion carrying sodium hyaluronate, soluble collagen and glycerin — and the trial data show why that matters: dryness in 4% of users, stinging in 3%. This is what happens when a manufacturer treats the vehicle as part of the dose.

- **Canonical:** https://www.30plusskin.care/reviews/altreno-tretinoin-lotion-review
- **Site:** 30+/SKIN — Skincare, published as a spec sheet.
- **Issue:** ISSUE NO. 13 / REV. 2026.10
- **Standing terms:** INDEPENDENT · AFFILIATE-FUNDED · NOT MEDICAL ADVICE

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## Verdict

- **Stance:** RECOMMENDED — Buy it. The formula, the disclosure and the price all hold up.
- **Weighted score:** 79/100 across 75% of the scoring model
- **Score scope:** See assessed criteria
- **Category:** PRESCRIPTION MANUFACTURED / ACNE — USED OFF-LABEL FOR PHOTOAGEING
- **Price:** $123 — PER 45 G TUBE · NO SUBSCRIPTION
- **Container size:** 45 G
- **Prescription:** yes
- **Compounded:** no
- **Assessment basis:** DESK REVIEW
- **Last updated:** 2026-08-02
- **Manufacturer page:** https://www.altreno.com/

The interesting thing about Altreno is not the drug. It is tretinoin at 0.05%, a concentration that has been available for forty years. The interesting thing is the vehicle: an oil-in-water lotion built with sodium hyaluronate, soluble collagen, glycerin and mineral oil, engineered so that a full-strength retinoid can be tolerated by people who could not tolerate the gel.

The tolerability numbers justify the effort. In two trials totalling 1,640 subjects, application-site dryness was reported by 4% of Altreno users and application-site pain — stinging or burning — by 3%. Those are the only two reactions that crossed 1% and beat vehicle. Set against the standard expectation for 0.05% tretinoin, that is a genuinely low irritation profile, and it is the whole argument for the product.

The efficacy is ordinary and honestly reported. Success on the evaluator's global severity score — clear or almost clear plus a two-grade improvement — was 16.5% against 6.9% on vehicle in the first trial, and 19.8% against 12.5% in the second. Non-inflammatory lesions fell by about 47% against 27% to 32% on vehicle. Real, modest, unspectacular, and printed with the vehicle arm alongside.

Two caveats for this site's readers specifically. The indication is acne vulgaris, not photoageing — 45% of the trial subjects were under eighteen, and nothing in this label supports a wrinkle claim. And the lotion contains methylparaben and benzyl alcohol, which matters only if you react to them, but is the kind of thing you can only know because the excipients are published.

## Actives, as published

| Active | Concentration | Role | Benchmark | Assessment | Flagged |
| --- | --- | --- | --- | --- | --- |
| Tretinoin | 0.05% | Retinoic acid receptor agonist — reduces follicular epithelial cohesiveness and microcomedone formation | 0.025% to 0.1% across the acne trial literature | Mid-range and undiluted. Worth stating plainly against the compounded competition: four of the seven tretinoin concentrations we found in one telehealth catalogue sat below the bottom of the trial range, and one sat at 0.001%. This is 0.05% in a tube, printed on the carton, with a fill weight. | no |

## Scoring

| Criterion | Weight | Score | Note |
| --- | --- | --- | --- |
| EVIDENCE FOR THE ACTIVE | 30% | 74/100 | Two vehicle-controlled trials, 1,640 subjects, 12 weeks, with published success rates, lesion counts and a vehicle arm. Marked down because the effect size is modest, because the indication is acne rather than the photoageing most readers of this site would be buying it for, and because 45% of subjects were under eighteen — a population unlike the one asking about it here. |
| FORMULATION INTEGRITY | 20% | 82/100 | The vehicle is the product. An oil-in-water lotion with sodium hyaluronate, soluble collagen, glycerin and mineral oil, designed to carry full-strength tretinoin at a fraction of the usual irritation — and the trial data support the design rather than merely asserting it. Full excipient list, stated fill weight, pharmaceutical manufacture. Held back only for methylparaben and benzyl alcohol, both declared. |
| DISCLOSURE | 15% | 92/100 | Concentration, fill weight, complete excipient list, both trials, both vehicle arms, adverse reaction rates against vehicle, trial demographics including the age split, and pregnancy data from animal studies. Marked down only because the practical question — how this compares with generic tretinoin cream on irritation — has never been tested head to head. |
| TOLERANCE IN USE | 15% | not scorable | Not assessed by us, and this is the criterion the product is designed to win. The label reports 4% dryness and 3% stinging or burning against vehicle rates under 1%. A panel would establish whether that holds outside a trial and how it compares with generic tretinoin cream, which is the comparison that decides whether the price premium is worth paying. |
| TEXTURE & WEAR | 10% | not scorable | Not assessed. A lotion rather than a cream or gel is a real difference in use and deserves a panel. |
| COST PER APPLICATION | 10% | 70/100 | Around $123 for 45 g cash, frequently covered for acne, and the fill weight is published so cost per gram is computable. Expensive against generic tretinoin at roughly a third of that, but the gap is the smallest of any branded retinoid in this register, and unlike a subscription it is a single tube you own. |

_A criterion that cannot be assessed from published information is not guessed at. Its weight is removed from the denominator, and the coverage figure above says how much of the model survived._

## Strengths

- Tretinoin at a full 0.05%, printed on the carton, with the fill weight.
- Complete excipient list published, so you can check for anything you react to.
- Application-site dryness 4% and stinging 3% — low for a full-strength retinoid, and measured against vehicle.
- Both trials published, including the one where the vehicle arm performed better.
- Trial demographics published, including that 45% of subjects were under eighteen.
- A vehicle designed as part of the therapy rather than as inert filler.
- A tube you buy once, not a recurring monthly charge.
- Cash price within reach of generic, unlike every other branded retinoid here.

## Weaknesses

- Indicated for acne only. Any photoageing use is off-label and unsupported by this label.
- Effect size is modest — under one in five reached the success endpoint at 12 weeks.
- In the second trial, the vehicle arm reached 12.5%, narrowing the drug's advantage to about seven points.
- Contains methylparaben and benzyl alcohol.
- No head-to-head trial against generic tretinoin cream, so the tolerability advantage is measured against vehicle, not against the cheaper alternative.
- Almost half the trial population was under eighteen, which is not the population this site writes for.
- Pregnancy: retinoid class, so it comes off the table when you are trying to conceive.

## Suits

- Someone who wants full-strength tretinoin and has failed on gels or standard creams because of irritation.
- Someone with adult acne who also wants the collateral photoageing benefit and understands the second use is off-label.
- Someone with dry or reactive skin who needs the vehicle to be doing some work.
- Someone who wants a branded retinoid without the several-hundred-dollar price of the others in this register.
- Someone who prefers a tube and a prescription to a monthly charge.

## Avoid if

- You are pregnant, trying to conceive or breastfeeding.
- You react to parabens or benzyl alcohol — both are in this lotion and both are declared.
- You want data for wrinkles specifically. This label has none; R-34 is the product that does.
- Generic tretinoin already works for you without irritation, in which case the vehicle premium buys nothing.
- You want a product tested on people your age, if you are over forty — the trials skew young.

## The full assessment

### What it is

Tretinoin 0.05% in an opaque, pale yellow oil-in-water lotion, approved for acne vulgaris in patients nine and older, applied once daily. A 45 g tube, around $123 cash. It exists because the vehicle, not the molecule, is the variable that had not been optimised.

**RECORD**

| Field | Value |
| --- | --- |
| BRAND | BAUSCH HEALTH |
| PRODUCT | ALTRENO (TRETINOIN) LOTION 0.05% |
| ACTIVE | TRETINOIN 0.05% — 0.5 MG PER GRAM |
| VEHICLE | LOTION · SODIUM HYALURONATE · SOLUBLE COLLAGEN · GLYCERIN |
| APPROVAL | FDA APPROVED — NDA, NOT COMPOUNDED |
| INDICATION | ACNE VULGARIS, AGE 9+ |
| TRIAL DURATION | 12 WEEKS · 2 TRIALS · N=1,640 |
| SIZE | 45 G — PUBLISHED |
| PRICE | ~$123 CASH |

### The excipient list is the argument

Each gram contains 0.5 mg of tretinoin in a base of benzyl alcohol, butylated hydroxytoluene, carbomer copolymer type B, carbomer homopolymer type A, glycerin, methylparaben, mineral oil, octoxynol-9, purified water, sodium hyaluronate, soluble collagen and trolamine.

Sodium hyaluronate, soluble collagen, glycerin and mineral oil are not there to solubilise the drug. They are there because the limiting factor on topical tretinoin has never been potency — it has been how many people stop using it in week three. A vehicle that hydrates and occludes while carrying a retinoid is a design decision aimed squarely at adherence.

> **THE VEHICLE IS PART OF THE DOSE** — This register keeps running into the same confusion: a concentration quoted without a vehicle is not a specification. The same 0.05% tretinoin in an alcohol gel, an emollient cream and a hyaluronate lotion will deliver different amounts of drug to different depths at different rates, and will be tolerated by different numbers of people. Altreno and Renova (R-34) are the same molecule at strengths a factor of two and a half apart, in vehicles designed for opposite ends of the same problem. Neither concentration alone tells you what you are putting on.

### What the tolerability data actually say

**FIG. 1 — ADVERSE REACTIONS AT ≥1%, 12 WEEKS** — Altreno N=767, vehicle N=783. Only two reactions crossed 1% and exceeded vehicle. For a full-strength tretinoin, this is a low irritation profile — although the comparison that matters commercially, against generic tretinoin cream, has never been run.

| Item | Value (% OF SUBJECTS) | Note |
| --- | --- | --- |
| APPLICATION-SITE DRYNESS — ALTRENO | 4 | 29 of 767 subjects |
| APPLICATION-SITE DRYNESS — VEHICLE | 1 | 1 of 783 |
| APPLICATION-SITE PAIN — ALTRENO | 3 | 25 of 767 — stinging, burning or pain |
| APPLICATION-SITE PAIN — VEHICLE | 1 | 3 of 783 |

_Scale maximum: 10% OF SUBJECTS._

Anyone who has started a retinoid and been told that peeling is the treatment working should sit with those numbers. Ninety-six per cent of subjects on full-strength tretinoin did not report dryness. Retinisation is a formulation outcome as much as a pharmacological one, and a well-built vehicle removes most of it.

### The efficacy, with the vehicle arm

**FIG. 2 — SUCCESS ON THE EVALUATOR'S GLOBAL SEVERITY SCORE AT WEEK 12** — Success required clear or almost clear plus at least a two-grade improvement from baseline. Trial 1: N=406 against 414. Trial 2: N=413 against 407. Note how much the vehicle arm moved in trial 2 — a reminder that the drug's advantage is the gap, not the headline.

| Item | Value (% SUCCESS) | Note |
| --- | --- | --- |
| ALTRENO — TRIAL 1 | 16.5 | Against 6.9% on vehicle: a 9.6-point gap |
| VEHICLE — TRIAL 1 | 6.9 | The lotion base alone |
| ALTRENO — TRIAL 2 | 19.8 | Against 12.5% on vehicle: a 7.3-point gap |
| VEHICLE — TRIAL 2 | 12.5 | Nearly double the vehicle response of trial 1 |

_Scale maximum: 25% SUCCESS._

Non-inflammatory lesions — the comedones a retinoid is supposed to be best at — fell 47.5% and 45.6% against 27.3% and 31.9% on vehicle. Inflammatory lesions fell 50.9% and 53.4% against 40.4% and 41.5%. The retinoid signal is where you would expect it: strongest on comedones, present but narrower on inflammatory lesions.

### The label does not say wrinkles

Altreno is indicated for acne vulgaris. It says nothing about fine lines, photoageing, pigmentation or texture, because it was never trialled for any of them.

Prescribing it off-label for photoageing is common, defensible and pharmacologically sensible — tretinoin is tretinoin, and R-34 shows what the molecule does to fine wrinkles at 0.02%. But it is off-label, and the honest version of that sentence belongs in the conversation with your prescriber rather than in the marketing of whichever service is selling it to you. Forty-five per cent of the subjects in these trials were under eighteen; the average reader of this site was not represented in them.

### If you are considering it

- If irritation is what stopped you last time, this is the branded retinoid to ask about first.
- Ask what it costs you with insurance under an acne diagnosis, and what it costs cash — the answer differs by a factor of several.
- Read the excipient list if you react to parabens or benzyl alcohol.
- Expect 12 weeks before judging it. Both trials read out at week 12.
- Once nightly. More is not better and the label says so for the class.
- Sunscreen daily — retinoids increase sunburn susceptibility, and the class carries photocarcinogenicity signals in animal work.
- If you want it for lines rather than spots, say so, and understand you are choosing a well-formulated off-label option rather than an approved one.

### Where we stand

At 79 this is the best-scoring retinoid in the register, and it gets there without an unusual molecule, an unusual concentration or a clever claim. It publishes what is in it, it publishes what happened, and it spent its development budget on the part of the product most companies treat as packaging.

The lesson generalises past this tube. When a compounded service tells you it has personalised your tretinoin to 0.018%, ask what it is dissolved in. The concentration is the number that is easy to quote. The vehicle is the number that decides whether you are still using it in March.

**READ ALONGSIDE**

- [R-34 Bausch Health Renova](/reviews/renova-tretinoin-cream-002-review) — CONDITIONAL 72/100 — The same molecule, approved for wrinkles rather than acne, at 0.02% in an emollient cream.
- [R-38 Bausch Health Retin-A Micro](/reviews/retin-a-micro-gel-review) — CONDITIONAL 76/100 — The third vehicle strategy for the same drug: a microsphere reservoir.
- [L-02 Retinisation is not a result](/ledger/retinisation-is-not-a-result) — Why 4% dryness matters more than any concentration on a label.

## Where to buy

| Retailer | Price | Link | Note | Commission-bearing |
| --- | --- | --- | --- | --- |
| Prescriber + retail pharmacy | ~$123 / 45 g | https://www.altreno.com/ | Prescription only. Cash prices for the 45 g tube run around $121 to $137. Often covered when prescribed for acne. | no |

We earn nothing on this link. If you are being prescribed this for lines rather than spots, that is off-label use — reasonable, common, and worth naming out loud with your prescriber.

**Featured alternative:** [CoreAge Rx Smooth Move](https://www.coreagerx.com/product/smooth-move/?utm_source=30plusskin&utm_medium=affiliate&utm_campaign=review&utm_content=altreno-tretinoin-lotion-review&utm_term=markdown) — Tretinoin with niacinamide and vitamin C for fine lines and texture. From $42 / month advertised.

## Sources

- [FDA-approved labelling — ALTRENO (tretinoin) lotion, 0.05%, Bausch Health US, LLC](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1412aba5-71aa-4cce-8db4-c189bed1852c) — The 0.05% strength stated as 0.5 mg per gram; the complete excipient list including sodium hyaluronate, soluble collagen, glycerin, methylparaben and benzyl alcohol; the two 12-week trials (NCT02491060, NCT02535871) with EGSS success of 16.5% against 6.9% and 19.8% against 12.5%; lesion count reductions; the adverse reaction table showing 4% dryness and 3% application-site pain against vehicle; and the trial demographics including that 45% of subjects were under eighteen. Read 2 August 2026.
- [GoodRx — Altreno pricing](https://www.goodrx.com/altreno) — Cash pricing around $121 to $137 for the 45 g tube of 0.05%. Retrieved 2 August 2026.

## Related records

- [R-75 Mayne Pharma TWYNEO Cream](/reviews/twyneo-tretinoin-benzoyl-peroxide-review) — CONDITIONAL
- [L-17 Adult acne prescription combinations: what the ingredients change](/ledger/adult-acne-prescription-combinations)
- [L-09 The vehicle is a dose](/ledger/the-vehicle-is-a-dose)
- [L-02 Retinisation is not a result](/ledger/retinisation-is-not-a-result)
- [R-34 Bausch Health Renova](/reviews/renova-tretinoin-cream-002-review) — CONDITIONAL
- [R-08 Musely The Eye Serum](/reviews/musely-the-eye-serum-review) — CAUTION

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- [Review register](/reviews)
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