Topical skin care products, ranging from generic drugstore moisturizers to medications requiring a prescription from a doctor, make up a billion dollar industry.
Aimed at treating (and preventing) photo/sun and age damaged skin, topical skin care products can truly improve one’s facial appearance, self-esteem, and health and can be used to treat conditions such as acne, hyperpigmentation, melasma, rosacea, dry skin and wrinkles.
Products used to treat sun- and age-damaged skin are focused on exfoliating skin, stimulating epidermal renewal, increasing collage and elastic production, improving dark spots, and increasing skin hydration. There are also products that aim at preventing sun damage and the effects of aging by protecting the skin against free radical and ultraviolet (UV) radiation. Today we will focus on retinoids which are in the treatment category of topical skin care products.
Retinoids are Vitamin A derivatives and analogs and range from retinaldehyde (a less potent derivative, mostly commonly found in over-the-counter products) to tretinoin (retin-A) which is a potent prescription vitamin A derivative. The retinoids work to promote healthy skin by:
- increasing skin turnover through increasing the process by which dead skin cells fall off
- inhibiting the production of dark spots
- decreasing clogged pores
- stimulating collagen production and antioxidant production.
Retinoids have the biggest benefit for people with sun damaged skin.
- If prescription tretinoins are used, rapid rejuvenating effects can be seen in as little as 1 month.
- Results can be seen with the use of over-the-counter retinols or retinaldehyde or retinol esters, but results will take longer to be appreciated. Most patients report seeing an improvement in their skin in 3-6 months with these lesser strength retinol derivatives above.
- Consistent use of retinoids will result in improved skin texture, decreased dark spots, decreased rate and severity of acne break-outs and reduction of fine lines.
While retinoids are a fantastic addition to your skin care regimen (and highly recommended for most women over the age of 30), there are a few things to think about.
Prescription strength retinoids are very stimulating and thus should be used with caution in patients who have rosacea or sensitive skin because they can cause an increase in red skin. There is also a phenomenon called “retinoid dermatitis” characterized by increased skin redness, sensitivity and flaking. The retinoid dermatitis is not a sign that the cream is working, but may signify that the strength is too high and that the product may need to be mixed with a moisturizer to dilute the strength and lessen the irritating side effect. The skin usually improves within 4-6 weeks.
Prescription strength retinoids should be stopped 1-2 weeks prior to in-office procedures such as chemical peels and laser resurfacing and can be restarted within 2 weeks after the treatment. Many patients will have skin sensitivity (without redness) and need to be mindful of other facial treatments such as facials and facial waxing because the products used in those treatments can further irritate the skin. Many physicians recommend threading for facial hair management instead of waxing if you use prescription strength retinoids in order to limit the chance of skin irritation.
A sunblock of 30 or higher SPF should be a part of your skin care regimen regardless of whether or not you use retinoids, but if you do use a retinoid product, then sunblock is a must.
3 Tips for Successful Use
Almost every skin can benefit from retinoids. A BASIC skin care regimen should consist of a gentle (non-foamy, non-alkaline) cleanser, a daily sunblock, and a nightly moisturizer. The sunblock will work to protect the skin from UV radiation and its damaging effects, and the moisturizer will keep skin moist and from drying out (which leads to wrinkles and fine line formation).
Here are some tips for successfully adding retinoids to your nightly regimen:
1. If your skin is sensitive: you may want to start with an over-the-counter retinol or retinaldehyde, which are slower-acting and less irritating than prescription tretinoin. Although the benefits will take longer to realize, the trade-off is that there is less irritation.
2. Be patient: Start with a pea-sized amount for the entire face every other night, or every third night for the first two weeks or so. Slowly work your way up to daily use, but do not hesitate to back down in frequency if you feel that your skin is irritated.
3. Optimize your routine: Start with the basics and make sure to have a daily AM sunscreen and daily PM moisturizer. Protecting and preparing your skin with these basic products will help your skin adapt to retinoids much easier. Click below on our first skincare post to get our personal/industry favorites for over-the-counter sunscreens and moisturizers!
Draelos ZD. Retinoids in cosmetics. Cosmet Dermatol. 2005; 18:3-5
Rolwski SL. Clinical Review: Topical Retinoids. Dermatol Nurs. 2003; 15: 447-465
By Melynda Barnes, MD & Leslie Kim, MD - Co-Founders and Facial Plastic Surgeons