Topical retinoid treatment for acne

What are retinoids and why do they work?

Retinoids are medications that are related structurally or functionally to Vitamin-A. They work in the treatment of acne by helping to unclog pores, control inflammation, and decrease the production of sebum (oil) in the skin. Commonly used retinoids are tretinoin, adapalene (Differin), and tazarotene (Tazorac).

How to use a topical retinoid

At first, retinoids may irritate the skin, causing redness, flaking, peeling, or possibly tenderness. Following the guidelines below can minimize these side effects.

1. Start gradually. When you first begin to use retinoids, don’t apply the medication every day. Slowly working up to daily use will help your skin adjust to the medication so you can get the most from the retinoid without being irritated by it. We recommend the following regimen.
   1. Apply the medication 1 to 3 times weekly or every other day for three weeks, and then increase to daily use, as tolerated.
   2. If your skin becomes irritated, stop using the retinoid for a few days.
   3. Eventually your skin will adapt to the retinoid so you’ll be able to apply the medication daily, or at least every other day, without irritation.
2. Sunlight can break down retinoids, so it’s best to apply them at night. Start with a clean face by using a gentle cleanser and patting your skin dry. Wait at least another 15 to 20 minutes for skin to dry completely, and then apply the medication.
   Gently rub a pea-sized amount over your entire face. Avoid getting the medication into your eyes. Because retinoid medications are not moisturizers, they can be drying. Therefore, after the application of a retinoid, it’s important to follow up with a good hydrating moisturizer. Look for one labeled “noncomedogenic” or formulated for “acne-prone skin.”
3. Be gentle when washing your face. Cleansing with your bare hands is fine. Use only gentle cleansers, such as CeraVe® Foaming Facial Cleanser or Cetaphil® Gentle Skin Cleanser. During your visit, we may recommend a wash containing benzoyl peroxide or salicylic acid, medications that help in the treatment of acne. Pat skin dry with a soft cloth or towel. Do not rub your skin because rubbing promotes irritation.
4. Sunscreens are necessary when using a retinoid. We recommend a sunscreen containing zinc oxide or titanium dioxide, such as Elta MD®.
5. Avoid irritants! Do not use astringents, toners, exfoliants, masks, alpha-hydroxy acid, or glycolic acid-based products. Although these products may be suitable for future use, they’re too irritating to apply during the initial process of getting your skin accustomed to the retinoid.
6. Discontinue your Vitamin-A products prior to facial procedures such as a chemical peel, microdermabrasion, laser hair removal, or even facial waxing.
7. Do not use during pregnancy! Oral retinoids cause birth defects. To be safe, we want you to stop your topical medications if you think you may be pregnant.

How long does retinoid treatment take?

The period between initiating treatment and seeing improvement is highly variable, but it’s at least 2 to 4 months. This is why retinoids are used on the entire face and are not recommended for spot treatment of individual acne lesions.

When to return for checkups during retinoid treatment for acne?

To monitor for possible side effects and to enhance your chances of a successful outcome, we’ll ask you to come in for your first checkup 2 months after initiating retinoid treatment. Following the first two visits, we recommend return visits at 6-month intervals during the first year and less frequently thereafter.