Tretinoin, RetinA, and Tazorac are a few topical retinoids you may have heard of to help with skin care needs such as acne or wrinkles. Many dermatologists consider retinoids as a must-have in your skincare regimen, however, those outside the field are likely unaware of how they work or how to use them. Time and time again my patients complain their retinoids are just too irritating and made their skin peel, so they end up discontinuing them. Here, I will dive into how retinoids work, why they are so essential, as well as share a few tips on how to get the best results from this staple in skincare.
Topical retinoids are prescription vitamin A derivatives that normalize follicular keratinization, boost collagen, and promote cell turnover to make way for new cell growth. Adding a retinoid to your regimen will unclog and minimize pores, reinforce skin thickness, smooth out texture, and minimize the effects of sun damage. I might venture to say it is one of the top prescribed topical medication, only behind by topical steroids. A well-known and very common side effect of topical retinoid use is dryness and peeling which deter patients away from using them. Here are some ways to get around this.
Pro-Tips for use:
- Skin should be cleansed and dry at time of application. Use a thin layer over the full face and start every couple of nights, increasing to every other night and then nightly as tolerated.
- The irritation and dryness can, of course, be abated with moisturizer. I would recommend moisturizers containing ceramides which fortify the skin barrier and retain moisture.
- Moisturizers can be applied BEFORE the retinoid as a barrier to reduce irritation.
- Even though patients may be hesitant to apply retinoid around the eyes due to irritation, applying retinoids carefully around the eyes will plump up the periorbital skin and minimize the fine lines and crepey-ness that usually develops here as we age.
- If patients are struggling with tolerance of retinoids, a way to enhance tolerance is to do a short-contact method. This is where patients can start applying the medication for 5 minutes, then wash it off.
- Any additional use of toners, astringents, AHA/BHA creams, and other acne medications will increase skin irritation all together. Find the right regimen that increases your tolerability so you are able to use all necessary products. Do not hesitate to take breaks from retinoids when necessary!
- A common misconception is that retinoids make you sunburn more easily. It is actually only perceived sun sensitivity from retinoid irritation. Sunscreen is still highly recommended.
For acne patients, retinoids are considered core therapy as they reduce visible lesions and prevent new lesion formation. They are necessary for unclogging pores, reducing the microcomedones which clog pores, and for the anti-inflammatory effects. On top of that, they boost efficacy of other acne medications by enhancing penetration. Secondary acne lesions, such as scarring and post-inflammatory hyperpigmentation, will also be reduced. Retinoids should be continued after acne clearance to maintain results.
Azelaic acid (Finacea) or salicylic acid are alternatives for patients who have sensitive skin. These patients may just have intolerance to retinoids or have sensitive skin conditions such as rosacea or eczema. These agents have similar comedolytic activity, however may be less effective. Additionally, azelaic acid is an option for pregnant patients who are unable to use retinoids due to harm to the baby.
Dedicate 3-6 months of sustained retinoid use to see any notable difference in the skin. The best results will be seen at 6-12 months. As I tell all my patients– there will be some dryness when first starting a retinoid but push through and be diligent with the regimen. The pay-off will be well worth it!
by Heather Tran PA-C