Treating Acne with Retin A: Does it Work?
Retin-A is the world’s most commonly prescribed medication for the severe kind of acne that causes nodules and cysts. It is also sometimes used in non-prescription strength to treat mild to moderate common acne. It is particularly good for people who have a lot of blackheads and whiteheads, otherwise known as comedonal acne.
Retin-A is the only treatment that addresses all the causes of acne1. It changes the responsiveness of the skin to stress. It helps the skin adjust to fluctuations in estrogen and testosterone, it stops excess sebum production, and it speeds up the growth of skin around pores.
This incredibly useful acne drug can be used as a pill you take by mouth or as lotion you put on your skin. But the use of Retin-A is often complicated by side effects2 .
- Retin-A is available in prescription and over-the-counter forms.
- The prescription product may be necessary for deep infected pores and stubborn acne spots.
- Almost anyone can use some strength of Retin-A, but the ideal candidate has dry, chemical-resistant, slightly loose skin.
- Retin-A and topical tretinoin combined with benzoyl peroxide does a better job of getting rid of acne bacteria.
- Retin-A combined with a vitamin E product does a better job of preventing and treating brown spots, especially on Asian skin.
- Even if you “never burn,” even if you have black skin, use sunscreen when you use Retin-A.
- Don’t eat celery or take St. John’s wort when you use either tretinoin topical or Retin-A.
How it Works
Retin A works by accelerating the turnover rate of skin cells3.It reduces the buildup of dead skin cells on pores. This means that the there will be no blocked pores to promote the formation of pimples on the skin. It also works by making blackheads less sticky as plugs come to the surface of the skin and are expelled out. It will take regular use over a period of time before you can start seeing any positive changes on your skin, though.
Retin A is also good at removing any dark spots that are left behind by acne. It can be used as an anti- aging treatment to reduce wrinkles and fine lines4 on your skin. It will also clear your skin and make it brighter and smoother.
Are You an Ideal Candidate for Retin-A?
The people who respond best to Retin-A for acne have dry skin that is not easily irritated by chemicals and that tends to turn brown after irritation or sunburn, and that is wrinkle-prone rather than tight. What kind of skin should be treated with Retin-A?
- Skin that turns gray or ash-toned when it is not moisturized.
- Skin that has a little “give” when the face moves, wrinkling when there is a smile of a frown.
- Skin that does not break out when it is exposed to alcohol, botanicals, or essential oils.
- Skin that does not flush during embarrassment or after drinking alcohol.
- Skin affected by sun spots, age spots, and brown spots left when acne heals.
- Skin that is just a little wrinkly, rather than skin that has no wrinkles at all.
Retin-A is used on almost all skin types except the most sensitive5. The people who will notice the greatest benefit from Retin-A treatment, however, are those who need to keep the skin tone even, concealing spots caused by acne or overexposure to the sun.
Should You Use Tretinoin Topical or Prescription Retin-A?
Retin-A comes in two forms. The non-prescription strength of Retin-A is known as tretinoin topical (tretinoin is the chemical name of Retin-A). This product can be very useful in keeping your skin clear, especially if you combine it with a low-concentration (up to 2.5%) of benzoyl peroxide to disinfect pores as Retin-A opens them.
Retin-A is also available by prescription. In most countries, you can get up to 0.05% Retin-A over the counter, but to get 0.10% Retin-A, you will need a prescription. Both products are considered safe enough to use with minimal supervision. You do not need, for example, to sign an affidavit pledging that you will use two types of birth control if you’re a woman, as you do to get Accutane. Other brand names for Retin A include Avita, Retin-A Micro and Tretinoin.
Tretinoin topical gels are not for people who are extremely sensitive to sun, and if you use tretinoin topical, you will need to use sunblock6, even if you have black skin (although SPF-15 will be enough). If you take an ACE-inhibitor such as lisinopril or ramipril for high blood pressure or if you take St. John’s wort for depression, you should use extra sun protection because the combination of products can make skin especially sensitive (but maybe not like we once thought… see more information on this at the bottom of this article). Also, you absolutely, positively must cap the tube of tretinoin topical gel every time you use it, or exposure to the air will destroy the product inside—in less than a day.
Prescription-strength Retin-A is used for harder-to-treat spots and blemishes. The only difference between prescription Retin-A and tretinoin topical, other than the price, is how much the skin is stimulated. Tretinoin topical costs about $50 a tube, but the trip to the dermatologist to get the prescription strength will cost about $500 a visit, usually not covered by insurance.
Some of the side effects of using Retin A include dry skin, peeling, flaking, itchiness, redness, stinging and burning sensation. These side effects are more evident when you start using the product for the first time but these symptoms will ease with time.
What About Renova?
Renova is a formulation of Retin-A7 into a cream. It is usually used to treat age spots and wrinkles. It is not a good idea for acne-affected skin, since the cream formulation can clog pores. However, if you have extremely dry skin and your physician permits, it can be less expensive than tretinoin topical.
Secrets of Success for Using Retin-A
If you have decided you want to treat blemishes and acne spots with Retin-A, there are things you can do that will help the product work a lot better on your skin. Here are seven important suggestions.
1. You always need to cleanse your skin about 20 minutes before you use you topical tretinoin or Retin-A. The product is more easily absorbed into your skin if the pH of your skin is slightly acidic. Be sure not to use a foamy, detergent cleanser (they are usually very alkaline, and they aren’t good for your skin) or splash a little freshly squeezed lemon juice on your skin at the end of your cleansing routine. Rinse the lemon juice off your skin and pat dry at least 5 minutes before you use the tretinoin product.
2. If you have Asian skin and you are using Retin-A to treat or prevent spots, alternate with a vitamin E treatment. Like Retin-A and retinol products, vitamin E has to come in an opaque tube. Jar products and products in clear containers will break down upon exposure to oxygen or light.
3. Alternate Retin-A with benzoyl peroxide in the lowest available concentration, preferably 2.5% or less. Retin-A is mildly antibacterial, but benzoyl peroxide will get acne bacteria that Retin-A does not.
4. Be sure to use sun protection, even if you have black skin. This will prevent sunburn, and, if you have Asian, brown, or black skin, sun spots. Even if you never burn and you don’t tan, Retin-A and tretinoin topical might make your skin sensitive to the sun (see below).
5. Avoid eating celery, celeriac, and a North American vegetable known as the “prairie turnip.” Don’t take St. John’s wort8. These vegetables and St. John’s wort also make the skin more sensitive to sun.
6. If tretinoin topical makes your skin too red, switch to a skin care product that contains retinol. It has to be packaged in an opaque tube to keep the product stable.
7. Avoid any products that irritate your skin, especially alcohol, cinnamon, and most essential oils. These can close the pores you are trying to open.
One of the biggest myths circulating out there is that Retin A will increase sensitivity to sunlight. Recent research shows this may not be true. Even though retinoids break down when they are exposed to the sun, some experts now say they do not increase your chances of getting sunburn. In the past, it was thought that retinoids resulted in increased risk of sunburn since most people reported feeling a sense of burning immediately they walked into the sun after applying Retin A. According to clinical research9, retinoids do not cause a reduction in minimal erythemal dose on the human skin, which is basically the amount of UV light your skin can absorb before it starts to burn. So technically, even when you use Retin-A, you still need to keep up with basic acne skin care. This is easiest with a system like Exposed Skin Care.
- Farnes S.W., Setness P.A. Retinoid therapy for aging skin and acne. Journal of Postgraduate Medicine. 1992;92(6):191-6,199-200.
- Kim B.H. Safety Evaluation and Anti-wrinkle Effects of Retinoids on Skin. Toxicological Research. 2010;26(1):61–66.
- Futoryan T., Gilchrest B.A. Retinoids and the skin. Nutrition Reviews. 1994;52(9):299-310.
- Neill U.S. Skin care in the aging female: myths and truths. The Journal of Clinical Investigation. 2012;122(2):473–477.
- Buchanan P.J., Gilman R.H. Retinoids: Literature Review and Suggested Algorithm for Use Prior to Facial Resurfacing Procedures. Journal of Cutaneous and Aesthetic Surgery. 2016;9(3):139–144.
- Thorne E.G. Long-term clinical experience with a topical retinoid. The British Journal of Dermatology. 1992;127Suppl41:31-6.
- Appa Y. Retinoid therapy: compatible skin care. Skin Pharmacology and Applied Skin Physiology (Journal). 1999;12(3):111-9.
- Khalifa S. Photodynamic Sensory Neuropathy in a Patient Treated With St John’s Wort. The Primary Care Companion for CNS Disorders. 2015;17(4):10.4088/PCC.15l01790.
- Haylett A.K., Felton S., Denning D.W., Rhodes L.E. Voriconazole-induced photosensitivity: photobiological assessment of a case series of 12 patients. The British Journal of Dermatology. 2013;168(1):179-85.
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