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 shown to help improve fine lines and wrinkles and are first line treatments for acne. They also improve the texture and clarity of 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 retinoids can also have good results.

Some types of prescription Retin-A you might recognize:

1. Tretinoin: generic Retin-A in three strengths (0.025, 0.05, 0.1)
2. Tazorac: a very strong retinoid. Available in gel and cream form
3. Retin-A Micro, Atralin, Renova and more: A brand name for  tretinoin. Some brand names have improved delivery systems that decrease irritation and peeling. Atralin is my favorite. The downside is they are expensive.

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. Another great non-prescription retinol is Differin. This product use to require a prescription, but now you can find it at the local drug store! 

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). You can also use in conjunction with a moisturizer or apply a moisturizer after applying the retinol. 
2. Sun sensitivity. This is also normal and expected. Retin-A removes the dead layer of skin cells – which is why your skin looks brighter. But dead skin cells protect the skin from sun exposure. Minimize sun exposure when using Retinol products, wear sunscreen at all times and wear a hat when outside for prolonged time. I recommend stopping all Retinol 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 retinol 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 a 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 de-activated by sunlight),  however, you may not be able to use them every day. The retinoid regimen 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 retinol products on ski or sun vacations. Generally, I use a retinoid product every other day. Some days this is a prescription strength (either Atralin 0.05% or Perfect A cream 0.1%), but usually no more than twice per week. On the alternate days, I use a retinol product (Beauty Pacifica Super 3, Skinceuticals 0.5 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, or 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 touched upon some useful information on retinol products. I welcome any questions and comments. Ask your dermatologist for a prescription today!