Askanesthetician's Blog

An esthetician explores skincare issues and concerns

Can Anyone Use Retin-A? October 11, 2012

Recently a long-time reader of this blog (thank you Louise for all your support!) asked me to address the issue of Retin-A use in my blog from a different angle than I have before.  So far the posts I’ve written about Retin-A have been an overview post on the subject (All About Retinol) and another post explaining why Retin-A remains the anti-aging superstar ingredient that it is (Back in Vogue: Retin-A).  Though this post will have some overlap with my past posts about Retin-A and retinol I do hope that this latest post will help explain how anyone can use Retin-A or retinol effectively and just how to do that.

I think it is best to start this post with a summary – what does Retin-A do and what is the difference between the different Vitamin A derived ingredients we see in skincare products?  Dr. Leslie Baumann does a good job of breaking things down:

First and foremost, retinoids speed the rate at which skin cells turn over, which means they thin the layer of dead skin cells and help keep healthy, younger-looking cells on the surface. Retinoids also promote the skin to produce more collagen while preventing the breakdown of existing collagen.This thickens the dermal layer of skin and helps minimize the appearance of lines and wrinkles. Here’s the lowdown on the different members of the retinoid family, which are all derivatives of vitamin A.

Beta carotene: If you eat too many carrots and your skin turns orangey yellow, it’s because you’ve ODed on beta carotene. (Don’t worry, it’s actually good for you.) This is a great antioxidant, so it’s important to get beta carotene from food. Don’t waste your money on topical creams with carrots or beta carotene because it does not absorb when applied to the skin.

2.Tretinoin (Retin-A): Perhaps the best known retinoid (and the gold standard for skin improvement), tretinoin got its start as an acne treatment before its inventor, Albert Kligman, MD, realized that patients on the medication had less wrinkles than those who were not. Dr. Kligman then developed Renova, a tretinoin cream that got FDA approval for the treatment of wrinkles. A little fact: Tretinoin does not cause sun sensitivity, however it is less effective when exposed to UV light, and this is why it’s best used at night. Other brand names of tretinoin now include Atralin (formulated with hydrating glycerin), Refissa, and Retin-A Micro.

3.Adapalene: This is considered a second-generation retinoid because its chemical structure is different than naturally occurring retinoids. The brand name is Differin, and it is more stable when exposed to the sun and less irritating. The prescription EpiDuo contains adapalene and benzoyl peroxide to help fight acne. In recent news, adapalene is now available as a generic.

4.Tazarotene: A third-generation retinoid, this is stronger than adapalene, less irritating and more sun-stable. I like it for patients who have been able to tolerate tretinoin and/or adapalene without any problems.

5.Retinol: This is the over-the-counter version of tretinoin, but the big drawback is that it’s very unstable, and the product packaging is crucial for its effectiveness. Johnson & Johnson has had the patent on retinol packaging, which is why my favorite OTC retinols are from RoC and Neutrogena. It’s much weaker than tretinoin, but studies do show it works to improve wrinkles. I like to start my patients on retinol and then work them up to tretinoin, and then tazarotene.

6.Retinyl esters (retinyl palmitate and retinyl linoleate): These ingredients are broken down into retinol once they’re applied to the skin. However, it takes time for them to absorb which is why there’s some controversy surrounding retinyl palmitate—based on a report by the Environmental Working Group. They aren’t irritating (because they don’t really absorb), but they don’t really work, so I say skip them.

7.Retinaldehyde: This penetrates better than retinyl esters, but not as well as retinol (which is why it’s less irritating). If you’re looking for results and bang for your buck, stick with retinol or a prescription.

(From Retinoids: An Essential Ingredient for “Wrinkled” SkinSkin Type Solutions LibraryTips)

As great as Retin-A is for the skin many people cannot use it because it causes them too much irritation.  The Vogue article The Return to Retinol explains:

The thing is, Retin-A and its various prescription descendants (Renova, Tazorac, Differin)—may have launched a thousand lineless faces, but they also launched as many irritated ones: scaly, red, angry. In those early days (fifteen years ago), retinoids could be used only at night because of their sensitivity to light; they could make skin extra-sensitive and made time in the sun, even incidental exposure, a cardinal sin. “Everyone was really excited from the beginning, but the big issues were dryness and irritation—mostly because people would apply too much,” says dermatologist Fredric Brandt, M.D., the New York– and Miami-based skin-care Svengali who has thousands of seemingly ageless women in his thrall (retinoid enthusiasts Madonna and Gwyneth Paltrow included). But even when skin wasn’t in outright crisis mode, a telltale sort of “retinoid face” could develop: spookily taut and shiny, like Barbie plastic. This is because the retinoic-acid molecule works a little too well: It’s so tiny it can penetrate all the layers of the skin, prompting extra-speedy cell turnover and exfoliation in the process. “You’re helping fix photo-aging, brown spots, acne, roughness, and collagen breakdown,” says Brandt. Miraculous, yes; gentle, no.

So what can you do in order to prevent irritation if you want to use Retin-A (and I personally strongly recommend Retin-A for those people who want to combat the signs of aging or who have acne and have tried numerous other anti-acne treatments to no avail), but cannot live with flaky, irritated, and red skin?  Start off slowly – use a retinol, an OTC product, before using a prescription product. You can try a product that is meant for sensitive skin like ROC Retinol Correction Sensitive Night Cream  (truthfully I don’t know how well this product works, but it worth a try if you have sensitive skin or are wary of trying a stronger product)  first before working your way up to a stronger product.  In a sense you will prepare your skin to tolerate stronger prescription products in the future.  According to Dr. Ellen Marmur in her book Simple Skin Beauty there are a few other ways to prevent skin irritation associated with using Retin-A (pages 278-279):

Prescription retinoids are the strongest and most effective form of retinoic acid.  Over-the-counter products contain milder vitamin A analogs; either retinol or retinyl palmitate (retinyl palmitate beign the weakest).  In order to have an effect on retinoid receptors, these must be converted to retinoic acid inside the body, and that conversion may not happen with the trace amount of low-strength vitamin A contained in a beauty product.  Although the results are therefore inconsistent, an OTC retinol might be worth at try if you’re skittish about using a prescription medication or if you have especially sensitive skin.  Stabilized, high-strength retinol may be somewhat effective, but look for one that states the percentage of retinol on the label.  Otherwise there’s probably just a tiny, ineffectual amount in the product.  (Personally, I would rather use a prescription retinoid with a percentage of medication that I know works.)

Side Effects:  Retinoic acid is a drug and there are risks associated with its use.  Since it decreases sebum (remember, this is still an acne medication), it makes the skin extremely dry.  (If that’s the case for you, applying moisturizer on top of retinoic acid is the answer, and it won’t dilute its potency.)  It makes the skin photosensitive, so daily sunscreen is a must – which is also why retinoic acid should be used at night.  It tends to irritate even moderately sensitive skin, so be careful not to overdo exfoliants such as glycolic acids (one a week is plenty).  For the same reason, be sure to stop using retinoids three to five days before having any skin procedures done, from simple waxing and facials to medical peels or lasers.  For those who have a hard time tolerating even a low-dose prescription retinoid, I recommend trying short-term applications: apply a pea-size amount over the whole face and neck, leave it on for fifteen minutes, then rinse it off.  You may get the same benefits as wearing it overnight.

Another thing to keep in mind is that even though having flaky and red skin is a side effect from using Retin-A it is a temporary one.  Your skin will get used to the product and those skin irritations will gradually disappear.  But if you live in a cold or dry climate your skin might constantly feel dry with Retin-A use.  Simply use a moisturizer twice daily at least or more if necessary to combat this dryness.  Be sure to wait about 10 or 15 minutes after applying your Retin-A before applying your moisturizer on top so that you allow the Retin-A to absorb properly into your skin.  Lastly, keep in mind that Retin-A comes in a wide variety of formulations.  Refissa, for instance, is a 0.05% tretinoin cream that is buffered so that it causes much less irritation for the user.  Many people do not peel at all when they use this product.

Summary of Different Ways to Prevent Irritation When Using Retin-A:

  • Only use a pea size amount for your entire face.  There is no need to use more.
  • Start off slow – use your Retin-A only twice a week or every other night for at least two weeks before determining if you want to use it more often.  For some people using Retin-A twice a week is enough.
  • If you are wary of using a prescription product start off with an OTC product.  Be sure to follow the manufacturer’s instructions for use.  After using a product like this for a few months you can move on to prescription one.
  • Ask for a prescription buffered product like Refissa if you know your skin is reactive and/or dry.
  • Work through the initial phase of irritation. That means be patient – you’ll see results in about three months.  Don’t give up on the product before then.  If you start and then stop and then start again using Retin-A your skin will get stuck in phase one of use.  Simply put your skin will constantly be irritated and red.
  • Use a moisturizer on top of your Retin-A.  Some of my favorite moisturizers to combine with Retin-A use are the renewal products from Epionce.  Be sure to wait at least 10 minutes after applying your Retin-A before applying a moisturizer on top.
  • Avoid irritating your skin further by overusing other facial exfoliating products like glycolic acid.  Products with Vitamin C can even be too irritating for some people if they are using Retin-A.
  • Use sun protection daily.

OTC Products 

I don’t want to call this recommended products since I haven’t tried any of them, but all the products below come from reputable companies:

Sources and Further Reading:

Image from anti-aging-skin-care-guide.com

 

23 Responses to “Can Anyone Use Retin-A?”

  1. Katie Says:

    Wonderful post!! Thank you so much on breaking down what Retin-A is how to go about adding it into your skin care routine. I have mild-moderate acne mostly around the jaw/chin that is stubborn and nothing seems to be clearing it up. So I might give try a low dose.

  2. Louise Says:

    Thank you so much! This really is a valuable resource, I’m sure a lot of people will find it helpful! I certainly have.

  3. Johnny Says:

    Awesome blog ! I love Retin A and its benefits seriously everyone always comments how better my skin is. I been using retin a cream 1.0% for 3 months, 3 times a week and i do carefully follow the directions so my skin doesn’t get irritated, but still its sooo sensitive, that i have change my whole skin care to care to sensitive dry skin care now . My only problem now is moisturising.

    I can’t use a moisturiser containing water as the first ingredient because its burns like hell and my face doesn’t calm down until a few hours but even then my face looks raw and red and sometimes it feels like its hot ……. My only solution i found i can only use is Vaseline mix with lanolin . My skin calms down controls the the flakiness and itchy irritation. Sorry to blabber on but my question is

    Is it ok to layer Vaseline on top of my retin a after 20 mins.? its the only thing that’s rich enough that i can find that doesn’t make my skin angry and red .

  4. Sarah Says:

    Hi! Thanks so much for this post! I’ve found it very informative as I have recently started a prescription of epiduo for adult acne that seems to have crept out of nowhere. My question is do you think it’s better to moisturize before or after applying Retin A? Or does it not make a difference? I am experiencing very dry and flaky skin so I find that moisturizing is definitely a must especially now while my skin is in the adjustment phase to the Retin A.

    My other question is should you still exfoliate while using Retin A? I think twice a week could be too much irritation for my skin now but is once a week suitable for a newbie to Retin A?…I really appreciate your blog and all the information you share!

    • Thanks for your comment and questions. I am glad that my post was helpful.

      I’ve read before that some dermatologists recommend applying moisturizer UNDER Retin-A though I’ve always done the reverse. I would play around with when you apply your moisturizer in order to find the right order of products for you.

      If your skin is very dry and irritated I would keep the exfoliation to a minimum for now – once a week would be more than enough. You didn’t mention how you were exfoliating your skin. I would suggest staying away from harsh scrubs. Since you have acne you might find that using a salicylic acid cleanser, serum, or lotion is a good way for you to exfoliate since it will help further unclog your pores, dissolve excess oil, and reduce inflammation.

      I hope I’ve answered your questions!

      • Sarah Says:

        Thank you so very much! I will experiment with the before and after application of moisturizer and see which I prefer. I may not even notice a difference.

        I’m actually looking for a gentler exfoliant and will try the Neova smoothing gel next – thanks to a previous post of yours 😉 My Origins scrub has become too harsh. Thanks again!

      • I’m glad to hear that I could help! In terms of a gentle exfoliant I would recommend one of the Paula’s Choice’s BHA serums:

        http://www.paulaschoice.com/category/bha-aha-exfoliants#bha

        You can actually get samples before buying a full size in order to see if they work for you. Good luck!

  5. Johnny Says:

    Hi again thanks for your helps with the links and recommendations. There been really helpful and very interesting to read.
    Now i look for post care skin care that really helps, Avene thermal spring water spray helps a lot with the hydration and it cools down my skin , Tecniche Intrinsic Face Cream my skin loves it seriously my skin is sooo much calmer and soothe just soo happy now that i don’t look like an burnt victim lol but now im on look at for a creamy cleanser that’s pH balance.
    Anyways thanks you for your help again and useful links look forward to more updates : )

  6. Rae Says:

    Planning on doing the tretinoin-rinse-off-after-15-minutes idea for my undereye.

    I turned 29. I’ve been using tretinoin since 2 years ago. Didn’t develop any fine lines except for my undereye (where I don’t put tretinoin).

    What do you think?

    • I actually apply my Retin-A under my eyes once or twice a week and leave it on without any issues. My undereye area is hollowing out so I am trying to build up my collagen there. I would apply a very little bit under your eyes and see how you feel. If you think it is too much I would rinse it off, but if you don’t feel anything I would just leave it on all night.

  7. […] Ask An Esthetician wonders if anyone can use Retin A? […]

  8. Ana Says:

    Well, this got bookmarked 😀 !

  9. miss babs Says:

    Does a high percentage of retinol work well with hydroquinone or alpha arbutin? I’m considering afirm 3x on my face and body to lighten discoloration. Is it possible to buy a very low dosage of tretinoin without prescription at a pharmacy or online? Is retino a comparable to its U.S. counterpart? I’m con considering retinaldehyde as well.Any advice? Thx

    • Thanks for your questions. Your questions are a bit out of my area of expertise since they are really cosmetic chemistry questions. I would suggest sending your questions to The Beauty Brains website.

      In the meantime I can say that retinol will eventually work as well as Retin-A; it just takes longer to work. How retinol works with hydroquinone and arbutin I can’t say. Retin-A and hydroquinone work well together, but remember that Retin-A and retinol are not chemically identical.

      It is against the law in the US to buy tretinoin without a prescription or from a source that is not a doctor. Tretinoin cannot be sold online legally in the US.

      Instead of experimenting on your own with getting rid of your hyperpigmentation I would consult an dermatologist or an esthetician.

      Good luck!

  10. Ambika Das Says:

    Thanks for your informative article on Retin A. I would be very grateful for your response to the following questions. I use Retin A 0.025% (Indian brand) for wrinkles (forty year Indian woman). I have used full strength for two years and am still sensitive and dry. What would be the bare minimum way to use retin a 0.025% while still ensuring efficacy?

    1. I mix retin a (half a pea size) with moisturiser (pea size) and use it twice a week. Is this enough to sustain results?
    2. Is short term therapy effective with retin a, too? (I only know that tazret is). Can short term therapy be done during day time inside a dark room (no sunlight)? Is fifteen minutes the least amount of time to ensure effectiveness? Thanks so much.

    • Thank you for your questions. Without having seen photos of how you looked before you started using Retin-A and how you look now and without knowing your skincare goals it is hard for me to answer your questions. I am not sure if I am the right source to actually answer your questions. I would suggest seeing a skincare therapist or dermatologist in order to get an answer.
      For some people using Retin-A only a few times a week can maintain the way they want their skin to look. I am not sure that using Retin-A for 15 minutes and then washing it off would be particularly effective (if that is what you meant in your second question). That would be a good question to ask a doctor. Good luck!


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