Tretinoin (Retin-A): what you need to know – Q&A with Dr Dray

Tretinoin (Retin-A), what is it?

Tretinoin (Retin-A) is a type of medicine that belongs to the group of medicines called retinoids.  Retinoids are compounds derived from Vitamin A.  These compounds work by initiating skin cell turnover and facilitating new cell growth.  They also stimulate collagen production and thicken the deeper layers of the skin, which is the source of wrinkles.  Retinoid can correct pigmentation related issues by sloughing off discolored spots and interfering with some of the biology of pigment production.

Retinols and retinaldehyde  are sold over-the-counter (without a prescription) in various cosmetic creams, lotions, gels, and serums.  Unlike tretinoin, these ingredients require the skin’s enzymes to modify them to their active state.  Therefore, they are less robust and less reliable in comparison to tretinoin, or other retinoids. 

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Examples of the more potent retinoids available by prescription include:

• Tretinoin
• Isotretinoin
• Adapalene
• Alitretinoin

Adapalene gel is now available over-the-counter (without a prescription) in the US for acne.

What is tretinoin used for?

Tretinoin is effective for:

• Mild to moderately severe acne.  It may take six weeks or longer before improvement in the acne is noted.
• Sun damage (photoaging).  Long-term use (>6 months) may reduce fine wrinkles and fine lines.
• Melasma

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What side effects occur with tretinoin?

Tretinoin can be very irritating to the skin, especially in the beginning.  You are more likely to experience this side effect if you have sensitive or rosacea-prone skin.  Irritation is also more likely and more robust if tretinoin is applied to wet skin, so always apply it to dry skin.  Excessive use (too much or too often) can result in redness, swelling, peeling, and blistering in the areas where it was applied. 

The skin around our eyes, in the corners of our mouth and nose, and on our neck is especially susceptible to irritation from tretinoin.  Avoid applying it to or near those areas unless otherwise advised to by your treating physician.

Because tretinoin exfoliates the top layer of the skin, it raises the risk of sunburn. 

Exposure to wind or cold, as well as  the use of soaps, cleansers, toners/astringents, peels, and certain cosmetics can worsen the irritation caused by tretinoin.

Some users report an initial worsening of their acne (aka “the purge”) in the first few weeks of treatment.  This typically settles after several weeks of continued use.

Retinoids taken by mouth may cause birth defects.  Topical retinoids, such as tretinoin, are not indicated in those who are pregnant, contemplating pregnancy, or breastfeeding. 

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How do I use tretinoin?

Tretinoin can be applied to a freshly washed and dry face at night time.   To reduce stinging, apply it to dry skin about 30 minutes after washing.

Apply only a tiny pea-sized amount to all areas, spreading the pea-sized amount as far as it will go.

Don’t let it get in your eyes, the corners of the mouth, or the corners of the nose.

Apply a sunscreen to exposed skin in the morning.

Select fragrance-free, gentle,  non-soap cleansers, moisturizers, and sunscreens. 

While it is okay to wear your makeup, minimizing the use of makeups and cosmetics helps to reduce the chances of excessive irritation.

Be cautious about applying too many other products along with tretinoin.  If you are using topical acne treatments, such as those containing benzoyl peroxide, salicylic acid, or glycolic acid, be sure an ask your doctor if you should stop these before using tretinoin.

Tretinoin comes in a cream and a gel.  Usually the cream is less irritating than the gel.  Lower concentrations of tretinoin can still be effective while being less irritating than higher concentrations.  If there is a choice, then start with a lower concentration.

Use tretinoin on alternate nights at first, so as to allow your skin to get used to the peeling and irritation.  Once the irritation subsides it can be used every night.

Most people are able to tolerate retinoids with no irritation over time.  However, if your skin turns scarlet red and peels dramatically, even with cautious use, tretinoin may not be appropriate for you. 

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What skin care products are good to use with tretinoin?

MOISTURIZING CREAMS

• Cerave moisturizing cream http://amzn.to/2yXNyLI
• Cerave PM http://amzn.to/2nhBOxZ
• Neutrogena oil free moisturizer http://amzn.to/2jzbRoJ
• Simply Pure Hydrating serum: https://goo.gl/1rXVTm
• La Roche Posay Toleriane 
• Differin balancing moisturizer http://amzn.to/2AjATlz

SUNSCREENS

• La Roche Posay http://amzn.to/2AUeARe
• Cerave AM  http://amzn.to/2yPMg0W
• Eucerin Daily Protection http://amzn.to/2j0kdFD
• Avene  SPF50 
• Differin SPF30 http://amzn.to/2kZOnNU

NON-SOAP CLEANSERS

• Differin Balancing Cleanser  http://amzn.to/2zUDtzv
• Eucerin sensitive skin 
• La Roche Posay Toleraine  

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