Retin A and Retinols

Everyday I prescribe or recommend retinoid ( Retin A or retinol ) products to my patients (and my friends and family). After sunscreen it is the number one anti-aging compound. Retin A and retinol are synthetic forms of vitamin A. Retinoid compounds have been shown to help improve fine lines and wrinkles and are first line treatments for acne. They also improve the texture and clarity of the skin by exfoliating the top layer of dead skin cells. Most of the studies have been done with prescription strength tretinoin, but many non prescription retinols can also give good results.

Some types of prescription Retin A you might recognize:
1. Tretinoin: generic retin A in three strengths .025, .05, .1
2. Tazorac: a very strong retinoid. Available in gel and cream form
3. Retin A Micro, Atralin, Renova and more: brand name tretinoin. Some brand names have improved delivery systems that decrease irritation and peeling. Atralin is my favorite. The downside is they are expensive.
4. Differin: a gentle retinoid for teen acne

Non prescription retinol products may vary in the concentration or delivery, but can be less expensive (ROC Brand) and cause less irritation. I never thought I could use Retin A because my skin was too sensitive. I started using skinceuticals 0.5 retinol and after six months I could use a prescription strength a few times per week.

The downsides to Retin A and retinol products:
1. Irritation, redness and peeling. This is normal and expected. There are ways to avoid and minimize this side effect. Start out using a low strength tretinoin or retinol and use it only 1-3 times per week (at night). Use a moisturizer over your retin A at night and in the morning.
2. Sun sensitivity. This is also normal and expected. Retin A removes the dead layer of akin cells- which is why your skin looks brighter. But dead skin cells protect the skin from sun exposure. Minimize sun exposure when using Retinoid products, wear sunscreen at all times and wear a hat when outside for prolonged time. I recommend stopping all Retinoid products one week before going on a sun or ski vacation.
3. Increased sensitivity to products and waxing. Again, the dead skin cell layer (which causes your skin to look dull) helps protect the skin from irritating products and procedures. Stop all retinoid products a week before waxing or a peel. Also keep in mind that your skin may be more sensitive to new products (especially plant based or chemical sunscreen)

4. Cost. Retinoids can be expensive, especially brand name prescription and high end retinol products. The expensive products are beneficial for people with sensitive skin, as the delivery systems are more advanced and help prevent some of the problems mentioned in #1. Generic tretinoin is very affordable with a large tube costing less than $100. This tube will last you 6-12 months and is a good investment. When you get the prescription from your doctor, ask for a paper prescription and then go to http://www.goodrx.com. This website allows you to enter the name of the prescription and your location. It will give you the lowest cost pharmacy. You will be surprised at how much the cost varies between pharmacies.

5. They work slowly. You must have patience when using retinoids. You will see results over months to years, not days. Stick with the program and you will see the results.

Retinoids are products that should be part of your nightly skincare (at night because they are in activated by sunlight)- however, you may not be able to use them every day. The retinoid regimen that I follow varies by the time of year and my activities. In Seattle the climate is very mild and I can use a retinoid product (either Retin A or retinol) several times per week. If I lived in a dryer or colder climate I would not be able to use retinoids in the winter because my skin is sensitive. I don’t bring retinoid products on ski or sun vacations.  Generally, I use a retinoid product every other day. Some days this is a prescription strength (either Atralin .05% or Perfect A cream .1%) but usually no more than twice per week. On the alternate days I use a retinol product (Beauty Pacifica Super 3, Skinceuticals .5 or 1% Retinol or Neocutis Retinol). I have sensitive skin so I always use a moisturizer over my retinoid. If my skin starts showing signs of irritation (burning, peeling, redness) I stop using all the retinoid products until the signs resolve. I stop using all retinoids at least a week before any peel or laser procedure.


I hope this post has given you useful information on retinoid products. I welcome questions and comments. Ask your dermatologist for a prescription today!


Where to splurge and where to save (on skincare products)

A benefit of my job is getting to try new (and free) products. But these are not the products that I use everyday. Just like everyone else, I chose which products to spend (money) on and which ones to save on. These are my splurge and save categories:

Where to save your money:
1. Face cleanser. Cleansers don’t stay on the skin very long and the bottles tend to go fast. Here are a few inexpensive washes that I like.
Cetaphil Gentle Cleanser: I always use for my kids and for my face during the winter or after procedures like laser or a chemical peel.
Neutrogena creamy salicylic acid cleanser: A gentle acne wash

2. Body cream and lotion. I don’t like scented body creams so all are non scented and come in a large size.
Cetaphil Moisturizing Cream
CeraVe Moisturizing Cream
Vanicream Moisturizing Cream

3. Hand cream. Again, I prefer non scented. These all hydrate and don’t leave hands greasy.
Neutrogena Norwegian Hand Formula
CeraVe Therapuetic Hand Cream

4. Shampoo and conditioner. I wash my hair EVERY day, so these go fast.
L’Oreal sulfate free line- they are all great, though some have strong scent and others are fine.
Neutrogena Moisturizing Shampoo and Conditioner
John Frieda line

And now for my Splurge products:
1. Serums. There are millions of serums, some are good, some are not. Serums spend time on your skin. I started using serums around age 30 and I think it has helped my skin age gracefully. I use an antioxidant serum in the morning and a glycolic serum at night. Sometimes I add a vitamin C serum for brightening or a vitamin B serum for extra moisture.
Skinceuticals CE Ferulic or Phloretin CF
Skinceuticals Retexuring Activator
Skinceuticals B serum
Perfect C Serum

2. Eye Cream. I have tried many eye creams and the only two I will use:
Neocutis Lumiere
Skinceuticals AGE Eye Cream

3. Moisturizers and day cream. I have very sensitive skin and am prone to breakouts, so I chose this category carefully.
EltaMd PM Moisturizer
Neocutis Journee with SPF 30 (I use every day)
Neocutis Biocream (great in dry weather and post procedure)
Neocutis Biogel (great in dry weather and post procedure)

4. Sunscreen. I splurge on face sunscreen and save on body- again because my skin is sensitive and breakout prone. I use the Neocutis Journee on indoor days and one of these on more outdoor days.
EltaMD UV Clear (good for breakout prone skin)
EltaMD UV Physical (a lightly tinted no chemical sunscreen)

5. Retinols and Retin A. These are the most important anti aging product, so if you only spend in one place- do it here. A prescription generic cream will probably cost 60-100 and last 6-12 months.
The Perfect A (.1 percent tretinoin and vitamin C)
Super 3 retinol

6. Bleaching creams. Some work, most don’t. Here are a few that work well.
Perfect Bleaching Cream (hydroquinone and kojic acid)
Neocutis Perle (non hydroquinone option)

I hope this post helps you determine where to save and where to splurge. Most people don’t need products from all of the splurge categories (so don’t get overwhelmed). If you are my patient reading this and still need or want help, my wonderful medical aestheticians (Amy and Rene) provide complimentary skin care consultation, so ask for an appointment when you call (206-860-4605).