Dermatologist Dr. Cynthia Bailey answers your questions about skin care combination with tretinoin and glycolic acid.
Hi Dr. Bailey, I am 49 years old. I would like to try the combination of tretinoin and glycolic acid use. I currently use Tretinoin 0.05% for sun damage and aging purposes. Is it possible to add Glycolic acid to my routine also? I am wondering if there is a Glycolic face cream I can add? During the day I am currently using Daily Moisturizing Face Cream for Dry to Normal Skin and the Citrix Antioxidant SPF30 sunscreen.
Thanks so much! Heather
I love both tretinoin and glycolic acid for sun damage and anti aging skin care. Tretinoin and glycolic acid are both powerful anti aging skin care ingredients that make very noticeable improvements in the appearance of the skin.
What are the benefits of the combination of tretinoin and glycolic acid for your skin?
- Lightening of age spots
- Smoother skin with more exfoliation to give skin a more luminous character
- Even more benefit to reverse wrinkles by building new collagen just underneath the surface of the skin.
Can you do even more with the combination of tretinoin and glycolic acid to fight skin aging?
Yes, the ultimate anti aging skin care product combo is to use both of these and throw in a strong professional level vitamin C product every 4th day. Each of these ingredients works to rejuvenate the skin by a different mechanism, and thus combination therapy yields more age reversal that using just one alone.
What are the side effects of a powerful anti aging skin care routine like this?
Unfortunately, all these highly effective anti aging ingredients are irritating. Only people with really tolerant skin can combine tretinoin and glycolic acid therapy. People with sensitive skin (especially people with rosacea, eczema or facial seborrheic dermatitis) typically have to pick either tretinoin OR glycolic acid. People who can’t tolerate using tretinoin with glycolic acid can sometimes tolerate using just one of these ingredients with a topical vitamin C product. This is because the vitamin C is not exfoliating. Vitamin C is, however, irritating to exfoliated skin so it's still a little tricky.
The reason that it’s tricky to combine these wonderful and effective anti aging ingredients is that the glycolic acid and the tretinoin are both very exfoliating. Exfoliated skin has a more refined and luminous appearance, but also absorbs things faster. Because the glycolic acid and the vitamin C both have an acid pH, they can be irritating to exfoliated skin. In addition, tretinoin causes a ‘break in’ rash (called retinoid dermatitis) when a person first starts using it. The skin adjusts in about a month and the retinoid dermatitis typically goes away, but skin with retinoid dermatitis gets really irritated from the acid pH of the glycolic acid or the vitamin C products. For those unable to overcome the retinoid dermatitis, retinol can offer similar benefits and is much easier to tolerate. It also does not require a prescription.
How do you start a powerful anti aging skin care routine with the combination of tretinoin, glycolic acid and vitamin C?
I start with tretinoin first. When people want to try to combine anti aging home therapy, my favorite method is to start them on the tretinoin at night for at least 2 months. Then I add glycolic acid. When their skin has adjusted to the tretinoin, we add a professional level glycolic acid during the day as I describe below. My top choice is my Glycolic Acid 15% Face Cream.
Then I add vitamin C. When the combination is tolerated and can be applied every day, then we throw in the Vitamin C Anti-Wrinkle Professional Treatment Serum at least twice a week in place of the glycolic acid.
To help the skin tolerate this powerful anti aging treatment, I add Green Tea Antioxidant Treatment Cream. I’ve found that adding the Green Tea Cream to the skin care routine really helps increase a person’s skin tolerate more anti aging skin care products than it otherwise would.
Dermatologist's 5 important tips to starting combination treatment with tretinoin and glycolic acid:
- When a person wants to try combining glycolic acid and tretinoin therapy I recommend they start with one first, let the skin adjust for a month or two, then add the second.
- They use the second product a few days a week to begin with.
- Gradually, as their skin adjusts to the new second product, they work up to using the second product every day.
- If parts of their face do well with the combination but other areas become irritated, then they don’t put the second product on the sensitive areas.
- When their skin gets irritated for any reason, they need to stop both products until the skin is back to normal, at which point they repeat this process over a shorter period of time.
Of course, any person using an exfoliating anti aging skin care routine must use a broad spectrum facial sunscreen 365 days a year!
I'm biased in my opinion that broad spectrum zinc oxide sunscreens give the best protection for precious skin. My patients MUST wear a zinc oxide sunscreen with a minimum of 5% or more zinc oxide sunscreen. For years I used Citrix Sunscreen in my practice because it gave us the best protection. As I update this post in 2019, we now have even better pure zinc oxide products. My Sheer Strength Pure Physical Sunscreens give the best protection available today and are weightless on your skin. They look great too, without any white color tone on the skin. Find my Sheer Strength Pure Physical SPF 50+ Sunscreens here where I feature all the sunscreens and sun protection tools that I have used in my practice.
I personally use my Sheer Strength Matte Tinted SPF 50+ Sunscreen on my face daily and my Sheer Strength Pure Physical SPF 50+ Spray Sunscreen on my neck, chest, ears and the back of my hands and arms if exposed. These are pure zinc sunscreens. The Matte Tinted contains over 3.2% iron oxide to block visible light that can darken pigment problems. The Spray is very kind to my clothing such as necklines and scarfs!
Know that with skin care that powerfully exfoliates skin, more damaging sun rays will penetrate into your precious skin. You must stop them. So, I also want people to wear hats and try to keep their face out of direct sunlight as much as possible. Find my favorite hat and my Sheer Strength Sunscreens in my Sunsavvy Around Town Kit. This is important for skin cancer prevention, and it’s also critical for their anti aging skin rejuvenation to be effective.
Because combination therapy is complicated and involves layering products on the skin, I write out the order of product application for my patients. The typical product application regimen.
An example of a Dr. Bailey Complete Skin Care Routine for anti-aging skin care treatment is as follows:
CORRECT: Green Tea Antioxidant Treatment Cream
Glycolic acid product (choose based on your skin type) or Vitamin C Anti-Wrinkle Professional Serum
PROTECT: Always use an SPF with 5% or more zinc oxide sunscreen. My personal favorite right now is my Sheer Strength Pure Physical Matte Tinted SPF 50+ Sunscreen.
CLEANSE: Wash with a gentle cleanser as above
CORRECT: Green Tea Cream. We apply tretinoin but after applying moisturizer and waiting at least 50 min! This is an important tip to helping skin tolerate tretinoin with less peeling and adjustment drama!!
HYDRATE: Daily Moisturizing Face Cream
In addition to the 15-minute wait with Tretinoin, we begin every 3rd night and gradually work up to every night.
Additional tips for using tretinoin for anti-aging skin care from my dermatology practice (for over 30 years!):
If a person finds that they are unable to tolerate both tretinoin and glycolic home therapy, then I recommend they try combining tretinoin at night, vitamin C during the day.
Instead of using glycolic acid daily, we try occasional glycolic acid peels done carefully by a skin care professional. Again, the exfoliation achieved with tretinoin makes the peels tricky and the skin care professional needs to be experienced with this situation. The risk is that the peel may be go too deep and injure the skin, potentially causing scarring.
Remember, professional skin care is capable of creating powerful skin rejuvenation, but there are risks; professional anti aging skin care products have to be strong in order to overcoming nature, it’s not like buying some fluffy, ineffective products at the department store.
I wish you the best of luck. Be sure to talk with your tretinoin prescribing doctor about what you’ve learned here. This information is general information and I can’t promise it is appropriate for your specific skin.
Heather, I hope you found this helpful and informative. Thanks for sending me your question.
Cynthia Bailey MD, Dermatologist
Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.