The biggest downside to tretinoin is, you probably guessed it, skin sensitivity and inflammation. “It can result in significant irritation, redness, peeling and inflammation in certain individuals,” explains Dr. Sheraz. If you’ve tried OTC retinol in the past and you’re sensitive to it, you can expect to be sensitive if you switch to tretinoin, because it’s even stronger. It’s also important to note that due to its drying effect, tretinoin can occasionally cause eczema flareups. “This is why a substantial moisturizer should always be used alongside it,” says Dr. Sheraz. Another disclaimer: Like retinol and retinal, tretinoin can’t be used if you’re pregnant.