Southwest Florida's Health and Wellness Magazine Health and Wellness Articles
By Dr. Anita Grassi
Retin A is the brand name for prescription topical tretinoin or all-trans retinoic acid, a vitamin A derivative that was first FDA-approved in the 1970’s for the treatment of acne. Since its introduction tretinoin has become a first-line agent in the treatment of both acne and photodamage. Retinol, a non-prescription form of retinoic acid, is converted to tretinoin in the body and produces similar beneficial effects but is considered not as strong as its prescription counterpart.
Tretinoin improves acne by binding to specific skin receptors that increase cell turnover and decrease cohesiveness, resulting in exfoliation and reduced follicular plugging. It also reduces sebaceous gland production, decreasing oily skin. In addition, tretinoin promotes collagen formation and reduces pigmentation making it an effective tool for the treatment of photodamaged skin. Tretinoin is one of the best studied anti-aging ingredients and has multiple double-blind controlled clinical trials which demonstrate improvement of fine wrinkling and brown discoloration.
Despite its multiple benefits, the use of tretinoin cream and to a lesser degree retinol may be limited by the side effect of skin irritation. Patients with sensitive skin may not tolerate the potential redness, dryness, and flaking it causes. This is especially true at the start of treatment since the side effects tend to lessen as the skin adapts over time. Several strengths and formulations including creams, gels and lotions are available to tailor the product to specific skin types. Newer emollient creams and microencapsulated versions may increase tolerability. Both tretinoin and retinol also cause sun-sensitivity and are degraded by sunlight so should be applied at night followed by routine sunscreen use during the day.
Follow the guidelines below to help minimize tretinoin side effects and obtain the best results:
• At bedtime, wash your face with a gentle cleanser and pat dry. Application of tretinoin to wet skin may increase absorption and hence side effects. Some formulations suggest waiting 15 mins after washing before applying. Remember that other products such as toners and benzoyl peroxide cleansers may worsen the dryness so are best stopped altogether or at least delayed until morning.
• Apply a thin layer to your face and avoid sensitive areas such as the corners of the mouth. Avoid eyelids altogether.
• Start slowly. Your dermatologist will likely prescribe a lower concentration of tretinoin at first and may suggest reduced frequency such as 2-3 times per week initially. As your skin adjusts with time, gradually increase use to every night at bedtime.
• Moisturize and apply sunscreen with SPF 30 or higher every morning. Applying moisturizer with tretinoin at night helps lessen potential irritation but also may dilute the concentration.
• Be patient. Acne often looks worse at first and can take 2-3 months to clear. Expect 4-6 months to see visible improvement in photodamaged skin.
If you are still unable to tolerate tretinoin, then non-prescription retinol cream may be a better choice. Talk to your dermatologist about a regimen that will best suit your skin type and achieve your goals.
DR. ANITA GRASSI
Board Certified Dermatolgist
Dr. Anita Grassi is a board-certified dermatologist who joins Skin Wellness Physicians after a long career in both academic and private practice in the Boston area. She spent 30 years in practice at the Dermatology Laser and Cosmetic Center at xpert for Massachusetts General Hospital in Boston, MA, where she gained experience in cutting-edge laser treatments of skin disorders. She also served on the faculty of Harvard Medical School as an assistant professor and was instrumental in training many residents and fellows in medical dermatology, laser, and cosmetic procedures. Furthermore, she co-founded a private practice in Watertown, MA, bringing the same level of skillful dermatologic care into the community setting.
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