Birth Control Pills vs Tazarotene

Birth Control Pills: Birth control pills containing estrogen and a progestin. Four are FDA-approved for acne, and they work by lowering the amount of active testosterone in the blood. Tazarotene: A strong prescription retinoid for acne, psoriasis and sun damage. It does more than the gentler retinoids and irritates more, and it must not be used in pregnancy.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist
An illustrative blister pack and white sleeve labeled Birth Control Pills.Tazarotene — Header Image

Which one is right for you?

Choose Birth Control Pills if…

Choose for hormonal acne along the jaw and chin when you also want contraception and have no clot risk factors.

  • Breakouts that track your cycle
  • You want contraception anyway
  • You don't smoke and have no clot or migraine-with-aura history

Choose Tazarotene if…

Choose for acne or psoriasis that needs a stronger retinoid than tretinoin or adapalene, and you can tolerate more irritation.

  • Gentler retinoids haven't been enough
  • Oily, tolerant skin
  • Pregnancy is not possible
Often combined

Can you take them together?

Often used together for acne. Tazarotene must not be used in pregnancy, so reliable contraception such as the pill is a sensible pairing.

At a glance

● Birth Control Pills
● Tazarotene
Type
Combined hormonal pill (estrogen + progestin)
Strong topical retinoid
What it does
Lowers active testosterone, so less oil
Unclogs pores and slows skin-cell overgrowth
Best for
Hormonal acne in people who also want contraception
Acne, psoriasis and sun damage
Prescription
Yes in most states
Yes
Form
Tablet
Cream, gel, foam or lotion
How often
One tablet daily
Once nightly
Course length
Ongoing
Ongoing
Time to results
About 3 months
8–12 weeks
Main side effect
Nausea, breast tenderness, spotting
Dryness, redness and peeling
Blood tests
None; blood pressure checks
None
Pregnancy
Not used in pregnancy
Never
Cost
Low; generic, often no copay
High; often needs prior authorization

What it treats

Compare uses by strength of evidence. Evidence level describes confidence in a benefit, not its size.

Evidence level
Birth Control Pills
Tazarotene
Strong evidenceMost established uses
Inflamed acne on light skin. The spots sit in a patch of pink, and the ring of redness around each one is easy to see. A few have a yellow-white head, and the skin between them is dry and flaking.

Acne

Reduces hormonal breakouts.
Inflamed acne on light skin. The spots sit in a patch of pink, and the ring of redness around each one is easy to see. A few have a yellow-white head, and the skin between them is dry and flaking.

Acne

Clears breakouts.
Two thick, sharply bordered plaques on a knee on fair light skin. They are salmon-pink to red with loose silvery-white scale on top.

Psoriasis

Thins plaques, often with a steroid.
Moderate evidenceSome supportive research
Hirsutism on light skin.

Hirsutism

Slows unwanted hair growth.
Visible sebum shine and natural pores on the nose and cheek.

Oily Skin

Lowers oil production.
A relaxed forehead with faint shallow horizontal fine lines.

Wrinkles and Fine Lines

Improves sun-damaged skin.
Not effective
Acne scarring on light skin. Small sharply cut pits and broad shallow dips across a cheek, several sitting inside faint flat pink marks, with no active spots.

Acne Scarring

Doesn't change scars.
—
Can make it worse
Flat tan patches with soft irregular edges across the forehead and upper cheek of an adult with light skin, the surface completely smooth.

Melasma

Hormones can trigger or darken melasma.
Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Very irritating to sensitive skin.
Extreme close-up of light skin in an active eczema flare, too close to tell which part of the body it is. Blotchy pink-red inflammation covers the whole frame with no clear edge, with small raised bumps, fine dry scale and a few fresh scratch marks.

Eczema

Dries inflamed skin.
How it works

Birth Control Pills

Birth Control Pills. Combined pills can reduce hormone-driven acne. 1. Reduces ovarian androgens: Combined hormones lower androgen production by the ovaries. 2. Binds more testosterone: Estrogen raises SHBG, leaving less testosterone free to act. 3. Turns down oil stimulation: Less available androgen means less oil-gland stimulation. 4. Reduces acne over time: Hormone-driven breakouts can gradually improve.
Open full-size diagram
Diagram explanation and sources

Reduces ovarian androgens: Combined hormones lower androgen production by the ovaries. Binds more testosterone: Estrogen raises SHBG, leaving less testosterone free to act. Turns down oil stimulation: Less available androgen means less oil-gland stimulation. Reduces acne over time: Hormone-driven breakouts can gradually improve.

This refers to combined estrogen-progestin pills, not progestin-only contraception. Estrogen effects include suppression of ovarian androgen production and increased SHBG, reducing free testosterone. Specific formulations and clinical responses differ.

Source 1 · Source 2

Tazarotene

Tazarotene. Changes skin-cell signals to treat acne and excess buildup. 1. Activates retinoid receptors: Skin converts it to an active form that changes gene signals. 2. Helps unclog pores: Normalizes cell buildup inside follicles. 3. Reduces excess skin growth: Helps psoriasis cells grow and mature more normally. 4. Improves sun-damaged skin: Can improve fine wrinkles and uneven pigmentation.
Open full-size diagram
Diagram explanation and sources

Activates retinoid receptors: Skin converts it to an active form that changes gene signals. Helps unclog pores: Normalizes cell buildup inside follicles. Reduces excess skin growth: Helps psoriasis cells grow and mature more normally. Improves sun-damaged skin: Can improve fine wrinkles and uneven pigmentation.

Tazarotene is converted to tazarotenic acid, which preferentially activates RAR-beta/gamma. Full clinical mechanisms are not defined. Acne, psoriasis and photodamage evidence comes from different formulations/strengths; clinical benefits are not guaranteed.

Source 1 · Source 2 · Source 3

How you take it

Treatment plan

The pack is the dose.

Starting dose: One active tablet daily, begun where in the cycle your prescriber says.
Going up: No increase. If acne has not responded by six months, change the formulation or add another drug.
Usual dose: One tablet daily at about the same time.
Total course: As long as contraception and acne control are both wanted.

When to Apply: At night only, on completely dry skin — about twenty minutes after washing, because damp skin absorbs more and stings more. A pea-sized amount covers the whole face. Moisturizer underneath, on top, or both. Sunscreen every morning is part of the treatment.

How to Start: Two or three nights a week for the first two to four weeks, then build toward nightly as the skin allows. Most people who quit started nightly. For thick psoriasis plaques some doctors use short contact — applied, then washed off after twenty to thirty minutes — but only if you were told to.

If It Irritates: Moisturizer before and after, drop back a night or two a week, and take two or three nights off if the skin is raw. Do not scale up other actives at the same time. Cold, wind and hot showers make it worse.

If It’s Not Working: Give it a full twelve weeks. If acne is still active, step up the strength, change to the gel, or add benzoyl peroxide or an oral option. Check first that you are treating the whole area, not dabbing spots.

When to take it

One tablet daily at the same time, with food if it causes nausea. Backup contraception covers the first week unless you start at a set point.

Not covered in this guide yet
If you miss a dose

Take it as soon as you remember, even if that means two in a day. For more than one, follow the pack instructions and use backup contraception. Missed pills affect pregnancy protection far more than acne.

Not covered in this guide yet
Monitoring

Blood pressure and a careful history come before the first prescription: migraines, past clots, smoking, family history. Blood tests are not routinely needed.

People stay on this for years, and what drifts is risk, not the drug. Clot risk is highest in the first year and after restarting, and rises with age, weight, smoking and immobility. Blood pressure is rechecked periodically, and the decision is revisited around age 35.

No blood tests are needed. Two things get monitored: how the skin is tolerating it, and pregnancy status.

Because tazarotene is contraindicated in pregnancy, anyone who could become pregnant should expect a conversation about reliable contraception before starting, and in some settings a pregnancy test. Very little reaches the bloodstream, but the restriction is absolute.

The other checkpoint is a review at around twelve weeks: hold the strength, step up, or add something. People stay on this for years, and nothing accumulates that needs testing.

When you’ll see results

Approximate windows, not promises.

● Birth Control Pills
● Tazarotene
Weeks 1 to 4

Weeks 1 to 4Nausea, breast tenderness and spotting between periods. Acne may briefly worsen.

Weeks 1 to 4The adjustment: Dryness, flaking around the nose and mouth, mild redness, peaking in weeks two to three. Acne can look worse first as forming clogs surface.

Weeks 4 to 12

Weeks 4 to 12Oiliness drops and inflamed spots become less frequent.

After 12 weeks

After 12 weeksThe fair judgment point, though improvement often runs to six months. Nothing changed by then means a different formulation or drug.

First few minutes

First few minutesApplying it: A pea-sized amount on dry skin at night. Mild stinging is normal.

Weeks 4 to 8

Weeks 4 to 8Adapting: Peeling settles and new spots get less frequent. Most quit before reaching this.

Weeks 8 to 12

Weeks 8 to 12Judge it here for acne: Fewer new spots, fewer blackheads and whiteheads. Trials measured here, and it keeps building. Psoriasis plaques thin on the same timeline and often stay thinner after stopping.

4 to 6 months

4 to 6 monthsTexture and fine lines: Gradual smoothing. A months-to-years treatment, not a course.

6 months or more

6 months or moreMottled pigment and dark marks: The slowest of all. Sunscreen does as much work as the retinoid.

Throughout

ThroughoutSun and flushing: Skin burns more easily, so daily sunscreen is not optional. Stinging, and a flush after alcohol or hot drinks, settle.

Side effects

Sorted by what to do about them.

Birth Control Pills

Tazarotene

Common
Common
  • Nausea, usually gone by month three
  • Breast tenderness
  • Spotting between periods
Common
  • Dryness, redness and peeling
  • Burning or stinging
  • Burning more easily in the sun
Tell your doctor
Tell your doctor
  • New or severe headaches, especially with vision changes
  • Low mood that does not lift
Tell your doctor
  • Irritation that doesn't settle with less frequent use
Stop and get care
Stop and get care
  • Pain, swelling or warmth in one calf
  • Sudden breathlessness or chest pain
  • Sudden weakness, numbness or trouble speaking
Stop and get care
  • Blistering or swelling

Safety and who should avoid it

Pregnancy
Stop
Not taken in pregnancy.
Never
A negative pregnancy test and contraception are expected.
Breastfeeding
Avoid early
Estrogen can reduce milk supply; progestin-only methods are preferred early on.
Avoid
Not recommended.
Children
After periods start
Used in teens once periods are established.
12 and older
Approved from 12.
Monitoring
Blood pressure
Checked before and a few months in.
None
Review at 12 weeks.
Key interactions
Check
Rifampin, St John's wort and some anti-seizure drugs reduce how well it works.
Check
Other retinoids, strong acids, waxing.
Other cautions
Avoid
Smoking at 35+, past blood clots, migraine with aura, uncontrolled blood pressure, breast cancer, liver disease.
Avoid
Eczema, rosacea, sunburnt or broken skin.

Cost and getting it

Getting it and cost

Most combined pills are generic and cheap, and many plans cover contraception with no copay. The branded acne-approved versions cost more with no advantage. Availability without a prescription varies by state.

This is the honest weak point. The lotion and the foam are brand-only and expensive, coverage is inconsistent, and prior authorization is common — plans usually want a cheaper retinoid tried first.

Generic cream and gel cost considerably less, though still more than tretinoin. Adapalene is sold without a prescription in many places and is the least expensive retinoid. If cost is the barrier, ask about generic cream or gel at 0.05%.

When you stop

Comes back?
Often, and acne can flare in the first few months after stopping.
Acne and psoriasis return gradually.
Taper needed?
No.
No.
After the last dose
Fertility returns within a cycle or two. Have the next acne step in place first.
Many switch to a gentler retinoid for maintenance.

Common questions

Birth Control Pills:Which pills actually help acne?

Combined pills, which contain estrogen. Four are FDA-approved for acne; many others work similarly. The mini-pill, implant and hormonal coil can make acne worse.

Birth Control Pills:Will my acne get worse first?

Sometimes, in the first month or two. It settles.

Birth Control Pills:Does my acne antibiotic stop the pill working?

Rifampin does. Doxycycline and the other acne antibiotics do not.

Birth Control Pills:How risky are blood clots really?

The increase is real, but absolute risk stays low in healthy non-smokers, and pregnancy itself carries a higher clot risk. It rises sharply with smoking after 35, a family history of clots, and migraine with aura.

Birth Control Pills:What happens to my skin when I stop?

Acne commonly flares for a few months. Plan the next step before you stop.

Tazarotene:How long before I see anything?

Little for the first month, real change between weeks eight and twelve. Texture and pigment take longer.

Tazarotene:Why is my acne worse in the first few weeks?

Clogs already forming are being pushed to the surface sooner. It settles by weeks six to eight.

Tazarotene:Can I use it if I am pregnant or trying?

No. Tazarotene is contraindicated in pregnancy and should be stopped before trying to conceive. Ask your doctor what to use instead.

Tazarotene:Is it stronger than tretinoin?

Generally yes, and more irritating for the same reason. Whether it works better depends on whether you can use it consistently.

Tazarotene:Do I need to stop before waxing or a facial?

Yes — about a week beforehand, and tell whoever is treating you that you use a prescription retinoid.

Tazarotene:Can I use it with benzoyl peroxide?

Yes. Unlike tretinoin, it is not broken down by benzoyl peroxide. The pair can be drying, so use one in the morning and one at night.

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