Adventures in topical tretinoin (Retin-A)
May 28, 2014 1:28 PM   Subscribe

I'm about to try a generic equivalent of Retin-A for acne, and I am nervous. "Purge phase"? Peeling? Redness? Am I in for straight-up Walking Dead Face before I see results? Personal experiences, insights and best practices would be greatly appreciated.
posted by Flipping_Hades_Terwilliger to Health & Fitness (18 answers total) 4 users marked this as a favorite
I used Retin-A as a teenager for acne and I'm using it again as a thirtysomething for fine lines and I have never experienced any of those side-effects.
posted by erst at 1:39 PM on May 28, 2014

Per my dermatologist's advice, I started with mixing it with Cetaphil and applying it every other day. I experienced a fair amount of dryness/peeling (although nothing as extreme as "Walking Dead Face"), so I started doing it every 3-4 days. She instructed me that, as long as I used it at least once a week, I would be getting the benefits of it. Using it once or twice a week, I don't have any side effects unless I get my face waxed 1-2 days after. (Don't do that.)
posted by pitrified at 1:42 PM on May 28, 2014 [1 favorite]

I put a thin layer of retin-a on top of my nighttime moisturizer and use it every other night. I do experience the peeling and dryness every once in a while. I just back off and do a night of just moisturizer. Exfolicating definitely helped with the peeling. Make sure to wear SPF in the day time too. I didn't experience purging, just dryness/peeling.
posted by zw98105 at 1:50 PM on May 28, 2014

I started using it about two months ago so I've just done all the research and experimenting recently. I use it last thing at night, after moisturizer, giving the moisturizer time to set in. The first couple weeks I did peel and was pretty red and sensitive; when I got too sensitive I would skip a night or two. I still peel a teeny bit but I use a very gentle sugar scrub to kinda slough off the dry peely bit in the morning if I'm putting makeup on. It isn't that bad. I'm using 0.05% and have very pale sensitive Irish skin.
posted by celtalitha at 1:55 PM on May 28, 2014

ok - a few tips:

1) start with the lowest dosage available
2) wash you face at night with cold water and a very gentle cleanser, then wait 15 minutes for your face to dry. (even waiting 5 minutes helps)
3) apply a thin layer of retin-a (start every 2nd or 3rd night, and work up after week at each level.)
4) if you have flaking skin, scrub GENTLY with a washcloth in the AM.
5) use a very plain day moisturizer without any anti-aging ingredients (at least at first)
posted by mercredi at 2:00 PM on May 28, 2014 [2 favorites]

I am late twenties and using it for acne. I don't think there was a significant "purge phase" but there was some peeling and redness which dissipated with correcting my routine. My skin has never been clearer in my life! Here's what I do:

Night time:

* Remove every last speck of makeup (if you wear it). This is no joke THE most important part of clear skin. Do not skip it even if you are tired and want nothing more than to sleep. I use a product called Sterilid Eyelid Cleanser for my eyes, which has proven to be gentle and not the cause of breakouts.
* Wash your face with a cleanser that you know will not cause you breakouts. This seems obvious but is harder than you might imagine. Believe it or not, I use Neutrogena Healthy Skin Anti-Wrinkle Anti-Blemish Cleanser. I have not found it to be too harsh used along with Retin-a (but I don't use it morning and night, as you'll see.) You may need to use something more gentle.
* Exfoliate gently while cleansing at night. I use the cloth that came with a sample of this stuff (I don't use the cleanser). I wouldn't use a cloth that is abrasive in any way, and make sure you keep it clean. This cloth is a very soft muslin.
* Dab your face dry gently with a paper or fabric towel.
* Once dry, with clean hands, put a pea-sized amount of Retin-A on your wrist or on the back of your (left) hand. With your right index finger, put dabs of the product on your forehead, cheeks, chin and nose. If you are left handed or want to do it some other way, switch it up!
* Massage in gently, using any leftover product from the pea-sized dab to fill in the gaps. A little does go a long way.

In the morning:

* With lukewarm water, gently exfoliate your face with the cloth again.
* Gently dry your face.
* Apply a good moisturizer. I actually use this cream one. Since it's a tub, always make sure your hands are clean when using it. A little goes a long way here, too.

After this, I use a BB cream (yes, on top of cream moisturizer!) or mineral makeup with SPF. Sometimes a combination of both (mineral on top of BB cream in my oilier areas). SPF is important! Your face with be more sensitive to the sun, so if you don't wear makeup you should chose a moisturize with SPF instead.

I have combination skin, so I tend to have dry areas AND oily areas, even in the summer. This has helped me so much. Let me know if you have questions!
posted by ancient star at 2:04 PM on May 28, 2014 [1 favorite]

I used retinoids for a long time and I think that the worst of the peeling and purging only happens to an unfortunate few. But, I do remember that it takes quite a while for them to actually start working. If you were using other topical acne products and now you have to stop and wait for the retin-a to work, your skin might get worse temporarily.

Also, moisturize! Seriously, fucking moisturize and wear sunblock!
posted by ablazingsaddle at 2:11 PM on May 28, 2014

In addition to the advice above, I suggest you stop using Retin-A about a week prior to any sort of facial waxing or if you plan on going on a sunny vacation. The skin is way thinner and more sensitive while using Retin-A. Also apply sunscreen every day for the same reason.
posted by Karotz at 2:17 PM on May 28, 2014

Best answer: You have to sneak up on Retin A. Start with low doses and leave it a few days in between uses, build up slowly to nightly on the lowest strength, slowly increase dose strength as needed, going back to the few days between uses with and increasing uses slowly with each increase in strength. If you don't want to buy lots of tubes of various strengths you can mix it with something like Cetaphil to dilute it a little.

Make sure you face is clean before using.

Wear a good physical broad spectrum sunblock.

Get a good moisturizer and use it, ask your dermatologist for recommendations for one that won't aggravate your acne.
posted by wwax at 3:06 PM on May 28, 2014

I used Retin-A extensively as a kid/teen, and am now taking isotretinoin (Accutane). For icthyosis, not acne, but...

How much has your derm spoken to you about how they expect you to use the ointment? Some docs are pretty much, "Here, try this stuff" and leave it to you to figure out, others (in my experience) talk it through more. Finding the minimum effective dose was tough for me.

Some of the people who I know who have had bad experiences with it use it a lot more often (or in higher doses). Every night can be overkill for some, and as others have said here a lot less frequently can be effective. (Before starting on isotretinoin I was using a different topical retinoid around once a month.)

The other thing that takes some by surprise is that the topical retinoids don't work instantaneously. So by not seeing immediate results, they slap more on and then they over-peel when it all kicks in. So...take it slow, don't be in a hurry. Minimum effective dose is the name of the game...
posted by QuantumMeruit at 3:17 PM on May 28, 2014

I used Retin-A as a teen. I only had some peeling and dryness, nothing too serious. If I felt my face getting too dry or irritated, I cut back to using it every other day. In general, Retin-A made my skin more touchy and sensitive when it came to handling makeup and such, but my face never looked disastrous. As others have said, moisturizer and sunblock are absolutely key.
posted by yasaman at 3:25 PM on May 28, 2014

I never had any 'purge' phase but my fairly sensitive skin does get red and peel if I start off with full strength.

My suggestion: the first time you use it mix a tiny drop of the prescription cream with three times as much of your regular face lotion. Gradually increase the ratio of tretinoin to lotion until you can use it full strength, over 4-5 nights.

I did this when I restarted tretinoin after my daughter was born and had no redness or peeling.
posted by arrmatie at 3:33 PM on May 28, 2014

Best answer: I have a great derm and Retin-A has been a godsend. She gave me these VERY specific instructions and I saw great results within the first week.

— Wash your face.
— Dry it.
— Apply a pea-sized amount to one fingertip.
— Lightly touch all your fingers to the pea-sized amount, so that a tiny little bit is on every fingertip.
— Gently massage all over the affected areas (she added, hey if you want the anti-wrinkle benefit, go for your whole face if you want, too).

— Wear sunscreen every day.

— Wear sunscreen every hour.

The main thing is not to use too much. That will get you peeling. Tiny baby pea sized amount. That's all. It's great.
posted by amoeba at 3:41 PM on May 28, 2014 [2 favorites]

Honestly, I tried three different topical retinoids for acne several years ago (in my saga over the past 15 years where I have probably tried all the acne medications extant). Differin did nothing for me, either in terms of acne or in terms of side-effects. Then I used Retin-A for maybe a year, and then switched from that to Tazorac for maybe a year. Retin-A and (especially!) Tazorac gave me a really red sensitive face - it almost looked sunburned or chemical burned. I tried to wait it out in the hopes that retinoids would get better for me, but after a couple of years or so, I got to the point where I thought I would rather have the acne, so I stopped using it and went back to the dermatologist. I got switched onto Finacea (azaleic acid), which I have been using for a few years, and which has proven much more gentle for my skin. I do have generally sensitive skin that is prone to red, however. My advice would be to tread lightly, using the recommended pea-sized dose, pair it with products for sensitive skin (e.g. Cetaphil etc.), and be prepared to reassess if the side effects are beyond what you're happy with.
posted by ClaireBear at 3:51 PM on May 28, 2014

I didn't experience any "purging" when I began using a tretinoin gel just over a year ago, but holy hell, did I shed like a moulting reptile. It didn't look great, but it was fairly short-lived--two weeks in, and the flaking ceased completely. My derm did advise me to apply the tretinoin *after* prepping my skin with a fairly heavy moisturizer (CeraVe cream), and I've continued to do this. I also experienced increased sensitivity (face felt a little burnt) and some redness, but that went away as well.

If you don't have extremely sensitive skin, you can manually exfoliate your face with a washcloth or face brush in the shower to get rid of the flakes. If my skin feels tighter and drier than usual, I apply a layer of a bland hyaluronic acid lotion before the cream moisturiser.

Also, if you're not already using a mild, non-foaming cleanser like Cetaphil Gentle Skin cleanser or CeraVe hydrating cleanser, that may help reduce irritation as well. I've noticed that when I use a cleansing oil that contains Salicylic Acid for a few days in a row, my skin becomes quite red and hurty.
posted by peripathetic at 4:54 PM on May 28, 2014

It's definitely a YMMV thing. I didn't get any of the effects like peeling or an increase in acne when I started using tretinoin last year. Just remember to put on a thin layer only at night, and use sunscreen daily (which you should be doing in any case). Also, don't use it with cleansers or other treatments that contain salicylic acid or benzyl peroxide - that's overkill for your skin.
posted by Anima Mundi at 5:53 PM on May 28, 2014

I used Retin-A and the only side effect I experienced was increased sensitivity to sun. Wear sunscreen!
posted by BusyBusyBusy at 5:22 AM on May 29, 2014

Response by poster: Thank you all so much for your answers. My take-aways from this thread are:

1) How to actually apply the stuff
2) To work up to daily use (if desired) slowly and carefully
3) That it's okay to try gently exfoliating any peely bits the following morning
4) To wear sunscreen religiously, and reapply often
5) How long the peeling-and-redness phase is likely to last (I'm glad to hear that it's a couple of weeks, not usually months and months)
6) That this stuff actually does work, if given time and used properly.
posted by Flipping_Hades_Terwilliger at 8:44 AM on May 29, 2014

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