Retinoids for anti-aging and acne: a recipe for success

A topical retinoid is a powerhouse in your medicine cabinet and your cosmetic bag. Why? The science behind regular use of a retinoid cream shows they can decrease fine lines, improve hyperpigmentation, and smooth your skin. They may even offer some modest improvement for scars. For those of us that are acne-prone, they also help tame breakouts (this is their original indication and the most common reason I prescribe them).

However, starting a retinoid (a topical vitamin-A derived treatment) can be a frustrating experience initially, as it can cause dryness, peeling, and even the odd acne breakout. Here are some tips to help you “retinize” your skin with ease.

  1. Go slow! Start out just 2 nights a week for 2 weeks, or until you are confident you are tolerating it without too much dryness or peeling.
  2. Apply in the evening. Many retinoids are not light-stable, meaning they do not perform as well when exposed to sunlight. This is why evening is the best time to apply.
  3. First, wash your face with a gentle cleanser such as Dove bar for sensitive skin or Cetaphil gentle facewash.
  4. After washing, apply a gentle unscented moisturizer such as Toleriane Ultra or Fluide by La Roche-Posay or Neutrogena Hydroboost.
  5. Wait a few minutes (at least 5) until the moisturizer is dry- this is a good time to brush teeth and go through other nighttime rituals.
  6. Now, apply a small pea-sized amount of the retinol or prescription-strength retinoid (if this has been prescribed by your doctor) to the entire face. Yes, one small pea-size is enough for the whole face. Dot it across your forehead, cheeks, nose and chin, then spread evenly across the skin. Avoid the area around the eyes, as this can be extra sensitive. Continue to do this 2 nights per week.
  7. After 2-4 weeks, if the skin is not too dry or irritated, increase your use to every second night, and after another 2-4 weeks increase to nightly use once you are tolerating the product. Don’t be afraid to go slow.
  8. Those with dry and sensitive skin may need to progress through these steps more slowly. If you overdo it, fear not- take a break for a few nights and use a moisturizer until your skin recovers, then start again but use it less frequently for a few more weeks. It doesn’t matter how long it takes you to get to nightly use- the key is not to overdo it initially, and to stick with it even if you need to take a break.
  9. Wear a daily broad-spectrum sunscreen with an SPF of at least 30, re-apply when you are outdoors, wear a hat and try to stay in the shade. Retinoids improve the health of your skin, but they thin the “dead” layer of skin cells, leaving your skin slightly more vulnerable to the effects of the sun, so protect yourself.

If you do not experience peeling or dryness at all, question the efficacy of your product. Depending on the exact molecule and the concentration, efficacy can be different. Once you have “retinized” to your product, you may tolerate an increased percentage. Your dermatologist can help you chose the right product, and will know if your skin is ready for a prescription-strength retinoid.

Topical retinoids are safe and most beneficial when used long term, so once you are using it regularly, keep it up! Be aware, in most cases they should be stopped during pregnancy and breastfeeding- your dermatologist can discuss this with you.

This article is intended to provide general information and is not intended as a substitute for assessment and care from your doctor.