What are topical retinoids?
Topical retinoids (Tretinoin, Retin-A Micro, Di erin, Tazorac) are most commonly used for the treatment of acne, but they are also used for other purposes, such as treatment of photodamaged skin (fine lines, wrinkling, dyspigmentation).
Retinoids are derivatives of vitamin A and are effective in both comedonal acne (blackheads and whiteheads) as well as inflammatory acne (red bumps).* Retinoids should be applied to all acne prone areas every night after the skin is washed with a mild cleanser (Cetaphil, Dove). They can be applied in the morning if you prefer.
Treat the entire area (forehead, etc) — retinoids are preventative and do not work well for “spot” treatment. If you never get acne in a certain area, then you do not have to use the retinoid there. Use topical retinoids sparingly — a pea-sized amount should cover most of your face. It is preferable that when the retinoid is applied no other topical product is used at the same time, i.e. moisturizer, other acne medications, make-up.
Retinoids commonly cause some irritation such as mild redness, peeling, and dryness. Irritation is especially common around the eyes and mouth — avoid treating this area unless you develop acne there regularly. Many patients use an oil-free moisturizer during the day.
If excessive irritation develops, stop the retinoid until the irritation resolves, then restart it at a reduced frequency, such as every other day or every third day. The key is to find a regular schedule that your skin will tolerate. Retinoids may cause your acne to flare some in the first few weeks of treatment — this is normal and will resolve.
Retinoids work very slowly. Don’t stop it just because you do not see any improvement in a few weeks; they generally take at least several weeks to work.* If you are using a retinoid for treatment of photodamage, keep in mind that it takes many months to see improvement.*
Retinoids are generally used in combination with other medications to treat acne, such as topical/oral antibiotics and benzoyl peroxide.
Retinoids should not be used if you are pregnant or trying to get pregnant. They also should not be used if you are breastfeeding.
Many patients are concerned about retinoids causing sun sensitivity, but this effect is usually overstated. If you are going to spend a fair amount of time in the sun, you should be using a sunscreen regardless of retinoid use!
Tazorac is often considered the “strongest” retinoid and Differin the “weakest”; one retinoid may be work better for you than another. The key is to find one that is strong enough to be effective, but gentle enough to avoid excessive irritation.
Waxing. Retinoids make the skin more sensitive; some people will have an irritant reaction if they wax an area of skin where retinoids have been applied. Although this is infrequent, to avoid it you should discontinue applying a retinoid to the area you want to wax 1-2 weeks before waxing.