One of our most popular prescription medications in dermatology is tretinoin (Retin A). Why? Because it is one of the most powerful skin care products in the war against aging skin. It's tricky to use though. I'm a big tretinoin fan and here I'll give you tips from my practice for how to use tretinoin with a lower risk of skin irritation and dryness.
Retin-A Tretinoin for Anti-Aging, Acne and Wrinkles
Why is tretinoin such a popular anti-aging skin care product?
Many scientific studies, and my own experience utilizing tretinoin personally and in my practice, have shown these powerful results:
- Tretinoin has proven itself to reduce, reverse and prevent wrinkles. (The younger a person starts using it, meaning in their teens and twenties, the more benefits they receive. But, it’s never too late to start using it!)
- Tretinoin helps lighten and prevent age spots.
- Tretinoin builds collagen to thicken and increase the structural strength of treated skin.
- Tretinoin helps fight crepey skin.
- Skin just looks better and younger when people use tretinoin.
When used correctly, tretinoin does amazing things for skin!
I love tretinoin and have personally used it for over 32 years. My skin looks better now than it did then! I've also written thousands of prescriptions for it during this same time and I've helped the same number of patients integrate it into their skin care treatments.Dermatologist Cynthia Bailey, MD
I recently had some interesting conversations with two patients, both of whom expressed gratitude for my recommending tretinoin years ago. They both attributed the healthy condition of their skin to their years of tretinoin skin therapy.
The first patient is a woman in her early 60s with rosacea (learn more about rosacea in the rosacea articles I've written about this common skin problem) and a history of skin cancer who said that she had more wrinkles 15 years ago when she started using tretinoin than she does today! Her pores appear smaller and her skin texture is better, both of which she credits to her tretinoin usage.
The second patient just turned 39 and looks like she is in her mid-twenties, no exaggeration. She started using tretinoin when I treated her for acne when she was 27 and also believes she looks better now than she did then. She even said the woman giving her a pedicure on her birthday this year was stunned to find out she was over 30!
Most dermatologists and people who use tretinoin (Retin-A) love it. But it's tricky to use. Here's some of what I've learned over the years as I have helped even the most sensitive complexions tolerate tretinoin:
What you need to know about using tretinoin Retin-A.
- When you apply tretinoin to moist skin it is more likely to cause peeling and irritation.
- Tretinoin, the active ingredient in Retin-A, breaks down in sunlight. This means tretinoin is best used at bedtime.
- Some of the common and really good ingredients in other skin care products are not compatible with tretinoin.
Tretinoin therapy is well worth the effort in my opinion, but there are tricks to doing it right.
Tips for getting the most out of tretinoin.
Retin-A Tretinoin is clearly a powerful skin care treatment, but there are tricks for using it to get the greatest benefits. Here’s what I tell my patients:
- Always apply tretinoin to your skin at bedtime. Never use it during the day.
- Never layer tretinoin with benzoyl peroxide and ideally don't apply it when you also have some of the popular acid products on your skin such as vitamin C or salicylic acid. However, glycolic acid and tretinoin are compatible.
- Always wait at least 15-30 minutes after cleansing and applying any other skin care products (such as Green Tea Antioxidant Skin Therapy and/or a simple moisturizer) to your skin before you apply tretinoin to help reduce peeling and dryness.
I personally keep my tube of tretinoin on my bedside table and read a little to pass the time before I apply it.
Tretinoin often causes peeling and a little skin irritation in the beginning, called 'retinoid dermatitis'.
Over my years of experience with tretinoin I've developed a few more tips to help skin calmly adjust to tretinoin with minimal peeling and irritation from retinoid dermatitis.
Dermatologist Dr. Cynthia Bailey's Tips from Her Practice for Using Retin-A.
- I have my patients apply only a 'pearl-sized' portion of tretinoin to their face. If they are using it on their chest and neck then each get another 'pearl'.
- I tell my patients that it is important to begin using tretinoin gradually to allow the skin to adjust. I have my patients use it twice a week (every third night) for the first couple of months. During this time, a little scaliness and irritation is normal at first, but if the treated skin becomes really sensitive, I have them back off the tretinoin for a bit. We let their skin return to normal before beginning treatment again. As skin adjusts, we slowly try to increase to using it every night.
- If skin becomes red and irritated for any reason (e.g., wind burn, sun burned, harsh skin care products, surgical or cosmetic procedures etc.), I instruct my patients not to apply tretinoin until their skin has entirely returned to normal. This is because tretinoin irritates irritated skin!
- If skin continues to be irritated and just won’t adjust to tretinoin treatment, I switch my patients to an entirely non-irritating skin cleanser like Extremely Gentle Foaming Facial Cleanser or Calming Zinc ® Soap. Many other cleansers are simply too irritating for tretinoin-treated skin.
- Another great trick to help skin love tretinoin is to use Green Tea Antioxidant Skin Therapy. I always add it to the skin care routine when I start a patient on tretinoin. Green tea polyphenol antioxidants are anti-inflammatory and deeply soothing. Sometimes just adding Green Tea Antioxidant Skin Therapy creates all the difference between a positive and a troublesome experience with this great medicine. I recommending that Green Tea Skin Therapy be applied morning and night right after washing and towel drying skin. I have my patients apply tretinoin on top. Click here to learn more about Green Tea Antioxidant Skin Therapy
I love all of Dr. Bailey’s products, but if I had to choose just one, I would have to go with the Green Tea Antioxidant Skin Therapy. I love the way it makes my skin feel and keeps my skin from getting all flaky from the Retin-A. Anne F.
What are some important precautions with tretinoin use?
Since Retin-A can be a tricky medicine, you need to be aware of the following warnings:
- Tretinoin-treated skin is very exfoliated and should not be waxed for hair removal.
- Any doctor or skin care specialist performing a procedure such as a chemical peel, microdermabrasion, laser or light treatments, etc., needs to know if you are on tretinoin. It could interfere with your other treatments so they may ask you to stop using it for a period of time before and after your procedure.
- Anyone who is or may be pregnant should not use tretinoin.
- It is critically important for anyone using any retinoid to take the strongest precautions in the sun. As mentioned above, skin treated with Tretinoin is very exfoliated. This means that, if tretinoin users do not aggressively embrace sun protection, they will have more sun damage on their skin than if they never used tretinoin. In short, if you use a retinoid, you should wear a really good sunscreen on your treated skin every day.
I am very particular about what sunscreen my retinoid patients use. I recommend only mineral zinc oxide sunscreens because I have found them to be the least likely to irritate tretinoin treated skin and they give the best protection. My personal favorite is my pure zinc oxide Sheer Strength Pure Physical Sunscreen in a Tinted (I wear this every day), Spray or Invisible Creme formulation. I touch up my SPF with mineral Powder Refresh SPF 30 Tinted Sunscreen if I am outdoors for extended time.
Are retinoid skin care products worth the trouble?
Scientific studies and my medical experience give me so many reasons to be a big fan of retinoids, including tretinoin. Skin has special receptors just for retinoids (the vitamin A family, of which tretinoin is a member). Through these receptors, tretinoin (and its cousin retinol, which is non-prescription) transform skin!
- It has proven itself to reduce, reverse, and prevent wrinkles. The younger a person starts (teens and twenties), the more benefit they receive, but it's never too late!
- It helps lighten and prevent age spots.
- It builds collagen to thicken and increase the structural strength of treated skin.
- It helps reduce crepey skin.
- It turns off the collagen destruction that happens from UV ray exposure.
- Skin is proven to just look better and younger when a person uses tretinoin.
What skin care products does Dermatologist Dr. Cynthia Bailey use with tretinoin Retin-A?
I'm updating this post in 2021. I have used tretinoin now for 33 years! Holy cow - and I'm still a huge fan. I alternate between tretinoin and my Retinol Anti-Wrinkle Night Cream depending on what my skin wants and if I can wait the 15 minutes or not before falling asleep. But, just about every night my face, neck and chest get a retinoid to sleep with. The science is that convincing and I love how it's helped my skin look better and better over the years.
Extremely Gentle Foaming Facial Cleanser is my go-to cleanser that I use every night to cleanse my skin. It is pH balanced for my retinoid treated sensitive skin yet it gets all makeup, product and gunk off my face without being drying. I LOVE this simple cleanser.Bamboo and Clay Thermal Exfoliating Scrub is what I use twice a week in the morning to brighten my complexion for the day and to get off any stubborn tretinoin 'peelies'. They make me crazy! I gently massage the scrub onto wet skin and rinse well - off come the bamboo granules, dead cells and peelies. My skin looks dewy and amazing for a 60+ year old gal.
I use my Natural Hydrating Pore Minimizing Facial Toner on a cotton pad twice a day right after washing. My skin is obsessed with it - soothing, cooling, pore tightening, hydrating and the rose hydrosol is the best subtle scent ever. I searched the world for this hydrosol and it really is the best.
My Layered Up Besties Kit contains the two key hydrating and soothing products for tretinoin use. The Instantly Luminous Multi-Action Serum provides skin with the right high-tech hyaluronic acid and other skin hydrators to instantly plump and satisfy my thirsty skin. I follow that with a small dollop of my Green Tea Antioxidant Skin Therapy. This product combo is like none other. It loads skin with the best proven antioxidants to fight free radicals, plump any fine lines and wrinkles and help firm crepey skin. I never travel without this product combo - ever.
I've used one of my Daily Face Creams for over 30 years. Yes, the formulations have changed with the technological advances of the times, but the key elements of these products are the same. From my late 20s to early 40s I used my Daily Moisturizing Face Cream for Oily Skin. After menopause (oh yea) I switched to my Daily Moisturizing Face Cream for Dry Skin. These creams help protect and replenish the outer skin barrier to support healthy skin that is able to tolerate retinoid therapy. At night, I apply my Retinol Cream under my Face Cream. On Retin-A nights, I apply tretinoin over this Face Cream after reading for 15 minutes.
Every morning I top my skin care routine with my Sheer Strength Pure Physical Matte Tinted SPF 50+ Sunscreen. This pure zinc oxide sunscreen is hypoallergenic and non-irritating for even the most sensitive tretinoin treated complexions - like mine. The iron oxide tinting blends into all skin tones and also blocks visible light that can darken pigment skin problems like melasma. Its weightless texture is ideal for under makeup and it absorbs oil during the day. It even plays well with my hot flashes!
I touch up my SPF with my Sheer Strength Pure Physical SPF 30 Refresh Powder Sunscreen to be certain my retinoid-treated skin is always UV protected. It's easy to keep this in my purse. The tinting blends with all skin tones and reduces shine from oil or sweat.
I'm such a tretinoin and retinoid fan that I've created kits to help build the perfect skin care routine to tolerate these powerful age-fighting ingredients.
My Complete Skin Care Kit has the key products for tretinoin use.
Brilliant and Glorious Kit gives you yet other product options.
Skin Cleanse Zen combo gives you the key skin cleansing routine to support Retin A use
My Fort Knox for Your Face kit gives you my favorite facial moisturizer and sunscreen for daily use with retinoids.
If you are embarking on tretinoin or retinol treatment I hope you find my tips helpful. I'm a huge fan of retinoids and have used them professionally and personally for 32+ years and counting.
My application photo for my dermatology residency, taken in 1985, tells the story. Retinoids work! They even helped this ex-tanning-addicted blond from California. - Dermatologist Dr. Bailey
Please remember that while I am discussing how I use a prescription product in my practice, this information is for informational purposes only. Be certain to discuss tretinoin use with your prescribing physician.
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