Top 10 heideas for success using a retinoid

Fifty years after the first retinoid was approved by the FDA as a topical treatment for acne vulgaris, these vitamin A derivatives are accepted for a second use: as powerful agents to treat and prevent aged and photoaged skin. In fact, the scientific evidence for their efficacy is greater than for any other ingredient category than sunscreens.  They are available in prescription form – examples include generic tretinoin, adapalene or tazarotene and brand names Altreno®, Retin A®, Differin® and Tazorac® – and over-the-counter – for example products containing retinol by almost every major cosmeceutical brand from low to high end.  Despite this, many people don’t use them because of fears of irritation or sun sensitivity.

It’s true that the number one complaint when starting a retinoid is skin irritation which may include redness, scale, itch and stinging when you apply other products. Those symptoms will lessen over time as your skin undergoes a period of adjustment called retinization.  Retinoid use may also make your skin temporarily more sensitive to the sun.  However, following some simple guidelines can help you reduce and even avoid both.  In a series of my #heideasreels #heideasonthego videos, I outlined my top 10 hints for success using a retinoid:

Retinoid hint # 1: Remember when applying retinoids, more is not better. A pea-sized amount is all you need. I tell people to put that little blob on the top of their hand. Apply a dab from that on your forehead, nose, cheeks and chin, then rub it in.  Another pea works for your neck and chest, then rub in what’s left to the top of your hands.

Retinoid hint # 2: Ease into it. Whether it’s an over-the-counter product or a prescription, start gradually: once or twice a week for the first two weeks.  If you tolerate that well, progress to three times a week, four times a week and onward at two week intervals as tolerated until you’re using it nightly.  If at any time, you experience redness, scale, itch, or burning in the morning or the evening, stop the product , treat as outlined in hint #5 below until it is clear, then restart the product at a reduced frequency.  You’ll still get benefit! 

Retinoid hint #3: Unless specifically told to do so, avoid applying your retinoid to areas like the eyelids.  The upper eyelid skin folds on itself and skin of both upper and lower lids is thinner and has fewer sebaceous follicles (oil glands) than the rest of the face.  That means greater absorption of topical ingredients and an increased risk of irritation.  Instead stop application at the orbital rim, that boney ridge that surrounds the eye from the brow to the upper cheek.  As you sleep, some of the product will still spread to those areas, but in smaller quantities.  When using a retinoid specifically designed for eyelid skin, you can apply it within the boney area but I still recommend avoiding the lowermost folding part of the upper lid that covers the eyelid itself.

Retinoid hint #4:  Moisturize before and/or after your retinoid.  You canuse a moisturizing serum, like one containing a hyaluronic acid, before the retinoid without blocking it’s absorption.  Alternatively or additionally, apply a bland moisturizing cream or lotion (one without exfoliating or potentially drying ingredients) over your retinoid.  I prefer people to apply something moisturizing before or after the retinoid rather than mixing them together to ensure that what you are applying spreads the retinoid evening.  Although theoretically, we should wait 20 min between topical product application, no one has time for that. So just apply it right over and get yourself to bed.

Retinoid hint #5: There are ways to manage side effects of retinoids.  If you get irritation – redness, burning, stinging, scale — while using a retinoid, stop it and start using an over-the-counter hydrocortisone cream twice a day in addition to a bland moisturizer to reduce the inflammation. If there is scale without other symptoms, you can gently exfoliate using a wash cloth or a very fine micro dermabrasion scrub in little circular movements with light pressure in the shower.  But don’t neglect moisturizing afterwards.  Because those stuck -on dead cells will quickly return if you don’t hydrate and seal the skin after exfoliating.

Retinoid hint #6: If you are starting a retinoid under the care of a dermatologist, ask if you need to adjust the rest of your regimen.  You may be able to continue everything.  However, in general, as your skin gets use to the retinoid, I recommend discontinuing any other products that might be drying your skin. Make sure your cleanser leaves your skin soft and supple, not dry or tight.  Avoid astringent, toners and heavy duty peels or scrubs.  You’ll get more bang for your buck getting that retinoid into your skin than you do from the other products. Once you are comfortable with the retinoid, if you want to re-introduce a non alcohol gentle toner to help take your make up off, a gentle micro dermabrasion scrub to help with some excess scale or an additional alpha hydroxy acid or salicylic acid do it gradually, one product at a time.   

Retinoid hint #7: Retinoids are the great sweepers.  Healthy skin desquamates on it’s own: it sluffs off the old dead cells of the stratum corneum, the outer layer of dead skin cells that protect the living skin below as new cells replace them.  That process is impaired by sun damage, age and certain dermatologic diseases.  Retinoids help those dead cells detach and exfoliate.  That has implications for unrelated things you do regularly.  Let anyone doing a procedure know that you are using the retinoid.  Waxing normally pulls some of the superficial dead cells off with the wax.  So stop your retinoid at least two days before you wax hair on the face to avoid excess skin cells being pulled off with the wax leaving a wound and wait 2 days to restart it.  Using some over-the-counter 1hydrocortisone cream before and after waxing may also reduce inflammation. If you plan any other procedures like facials, chemical or laser or other peels, check with the person doing them if you need to discontinue the retinoid and how many days before and after.

Retinoid hint #8: Retinoids are used as part of an overall regimen for acne, photoaging, pigmentation and aging.  You’ll likely be using other products.  Be sure that they don’t cancel each other out.  For example, most retinoids should not be applied at the same time as a benzoyl peroxide (adapalene is an exception).  Some growth factor products may be less effective used with a retinoid.  In other cases, a retinoid may increase the absorption of another product’s active ingredients which may be a good or a bad thing.  So do check with your dermatologist if you have questions.

Retinoid hint #9: Retinoids are usually sold in opaque packaging and applied at night.  That’s because most can be deactivated by ultraviolet light.  Adapalene is an exception and there are over-the-counter retinol products containing sun protective ingredients.

Retinoid hint #10:  Seeing improvement with a retinoid takes time.  You may start to see results in about 2 months, but significant improvement may take 6 months or more.  Once you see improvement, stick with it – you will have continued improvement of the skin structure and help maintain it.  If you feel you’ve hit a plateau with your results and you have no irritation, speak with your dermatologist about easing into a more potent formulation.

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