Retin-A (Tretinoin)

When you see the words chemical peel, you probably don’t think Retin-A (Tretinoin), but it is, in fact, a chemical peel.  Retin-A is a chemical derivative of vitamin A, and it works by increasing the cell turnover of the skin, which causes peeling, and by increasing collagen.  It’s also used to treat and prevent acne.  Sound like a chemical peel? 

I’ve been noticing that my glycolic acid (alpha hydroxy acid) has lost some of its beneficial effect lately, and I read a blog recently that mentioned this phenomenon, called accommodating.  I think a lot of women (and men) can relate to products losing their potency after a few months.  The theory behind this phenomenon is that the skin (or body) acclimates to the medication within 3-4 months and adjusts itself, so with my glycolic acid, the cell turnover has slowed down again.

To counter this effect, I’ve decided to use Retin-A for a couple of months, and then I’ll go back to the glycolic acid.  I still plan to do my TCA peels.  My next one is scheduled for 11/26.

I started Retin-A .01% last night, so I will photograph and post my progress and side effects.  Today there is no noticeable flaking or dryness, but I expect some flaking tomorrow, based on past usage.

Here are a few tricks and tips to avoid or minimize irritation. 

• Use Tretinoin only during the winter months and take a break during the summer months since your skin is more susceptible to sun damage during use.
• Start with a lower dose, and work your way up in strength, since the body will adjust after 3-4 months.
• When you first start using Retin-A, apply it only once or twice a week; if after a couple of weeks, you notice no irritation, you can move to every-other night, then nightly if it works well.  
• If you still have problems using it only once or twice a week, try applying a water-based moisturizer before or after the RetinA.  The side effects are usually the worst in the first 2-5 weeks of application. As your skin adjusts to the medicine, you can apply it more frequently. 
• Apply a pea-size of Retin-A at night on clean skin, about 30-60 minutes after cleansing. A small amount goes a long way.  If you notice irritation, you can wash it off after a couple of hours; this is called short-contact therapy.  My dermatologist suggested this, and I’ve done it in the past.
• In the morning, exfoliate your face with a mild facial scrub or washcloth. This will help remove the noticeable flaking.  I’ve used a sanitized motorized toothbrush for this, and it’s very effective, but be careful not to press while exfoliating.
• After cleansing, apply a water-based moisturizer to make the drying effect of the Tretinoin more tolerable. My favorite is shea butter.
• If noticeable flaking occurs, gently exfoliate and apply more moisturizer, or just apply moisturizer. I usually start to peel about 2 days after each application, and I continue to peel for several days.
• Use sunscreen during the day because Retin-A will make you more susceptible to sun damage, and that will defeat your purpose.
• You may notice some inflammation and redness in some areas. I've found that a green stick or redness corrector works well to neutralize this.
• If the irritation increases, stop using it for a couple of days.  I get a bit of rosacea if I use Retin-A continuously without taking a break.  I can use it once every two weeks without rosacea-type irritation, so don't get discouraged if you can't use it often.  You may also want to try washing it off after a couple of hours to see if that works for you.
• If you still have irritation, and you're using a generic brand, try Renova or Refissa; they're both formulated with emollients. 
• As a last resort, you may want to ditch the Retin-A and go with an OTC retinol (such as ROC), which is a precursor for retinal.  There are other brands, but this one is the least expensive that I've seen.  Since your body won't convert it all to retinal, it will be more tolerable, albeit less effective.

I'll post again tomorrow or Friday with updated photos.