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Retinoids: Topical

Retinoids are truly the gold standard when it comes to knocking years off your skin’s virtual age (SVA) because they reverse and prevent the signs of aging.

When a retinoid is applied to the skin regularly, the vitamin A derivatives help to shed the cells of the outer skin layer (the epidermis) that have become flat and jumbled after prolonged sun exposure, replacing them with plumper, healthier, better-arranged cells. Underneath the surface, in the second layer of skin (the dermis), the retinoid normalizes blood vessels and stimulates the production of new collagen fibers and hyaluronic acid.

The new fibers replace at least some of the irregular, thick, clumpy, sun-damaged ones. The result is better texture, more even color, and increased radiance in as little as two weeks. After every month and year of a retinoid’s use, the improvement only continues. There’s even evidence to show that retinoids can stop (and possibly reverse) early signs of skin cancer.

Retin-A (tretinoin) has been around since the early 1970s as an acne treatment, but once dermatologists caught on to its anti-aging capabilities, it became very popular as a prescription item for skin aging. The company developed a few variations on the formula, such as Retin-A Micro, a less-irritating form of Retin-A, and Renova, a more moisturizing version, which are highly effective in treating sun damage.

Myth: If my skin isn’t red and scaly, my treatment product isn’t working.

Truth: The “no pain, no gain” approach is for marathon training, not skin care. Yet I still meet many women Who continue to have facials that leave their complexions looking angry, who insist on using harsh lotions, or who use their prescription retinoid so frequently that they make their faces burn and peel. They tell me that this is how they know the treatment is doing its job.

Here’s the real scoop: First, you don’t need an extra-strong product to make a difference in your skin, For example, studies show that the tried-and-true acne fighter benzoyl peroxide works just as well in 2.5 and 5 percent concentrations as it does in 10 percent concentrations—and the lower concentrations are far less likely to leave an unsightly crust in their wake. Second, by irritating the skin, you’re breaking down its protective outer layer which means that it can’t perform as efficiently as ft usually does. It also looks pretty crummy There are, of course, exceptions. In-office procedures like microdermabrasion, peels and certain lasers are designed to wound the skin mildly to promote collagen production. When you’re choosing a product to use at home, however the ones that feel fabulous going on will leave your skin looking even mote fabulous in the end.

Now the prescription retinoid landscape is crowded with more names, like Differin, Avage, and Tazorac. Each is available only by prescription, and each has its own pros, cons, and potential for irritation.

In general, the lower concentrations are gentler but less effective, and the gel forms are a bit harsher than the creams.

Differin is the least irritating of the group but might also be the least effective. A new 0.3 percent gel has recently been released, and I believe that it works better than the original 0.1 percent, for both acne and photoaging (the cumulative effects of UV exposure). If you are planning to use Differin to treat skin aging, I would recommend the higher concentration.

Avage and Tazorac are actually identical formulas under two different prescription names: Tazorac is typically prescribed for psoriasis, and Avage for acne. For most people, both are a bit more irritating than Differin but a bit less irritating than Retin-A. It’s best to ask your dermatologist which retinoid is ideal for you. Most will send you home with some samples to try. This way, you can be sure that you can tolerate a product before you pay for an expensive prescription.

You’ll notice that retinoids come in many different concentrations. Before automatically asking for the strongest one, remember that it’s far better to regularly apply a retinoid that your skin can handle than to choose one so irritating that you won’t want to use it at all. My basic rule is the following: to see the fastest, most dramatic improvement, you should use the highest concentration that your skin can tolerate without becoming red and flaky. That often means starting with a retinoid a few times a week, then working your way up to a stronger concentration.

The best time to apply a retinoid is before bedtime, at least five minutes after washing and drying your face. (If you still find the formula irritating, try waiting half an hour after drying your face.) By plying the formula at night, you’ll give it eight uninterrupted hours work its magic without any sun exposure. (Since retinoids make the skin sensitive to the sun, it’s best to avoid sun exposure soon after applying a retinoid and be even more obsessive than usual about wearing facial sunscreen while you’re using these products.)

Not long ago, a patient named Isabel told me that she adores her Retin-A; then she added that of course she stops using it during the summer in order to avoid excess sun damage. I’m always surprised by how many people believe that they’re helping their skin by doing this. Their motivations are admirable, but they’re actually making a big mistake by cheating themselves out of two or three months’ worth of SVA-lowering opportunities. Unless you are lying in the sun or performing activities in direct sunlight without sunscreen, using Retin-A at bedtime is perfectly safe.

To maximize a retinoid’s effectiveness and minimize irritation, wait at least five minutes after washing your face, then squeeze a pea-size amount onto your index finger; more is not better in this case. (Retin-A Micro now comes in a pump that dispenses the precise amount.) Place dots of even amounts on the center of your forehead, chin, and each cheek, then blend gently into the skin.

Keep in mind that the retinol you see in nearly every over-the-counter anti-aging product is not the same as prescription retinoids. Studies show that retinol has some of the same benefits as a retinoid, but it’s not nearly as effective. On the other hand, it’s also much less irritating, so for the few of you who cannot tolerate at least one of the prescription retinoids, you can use retinol with abandon.

Excerpted from "The Youth Equation: Take 10 Years Off Your Face", by Jeffrey Dover, M.D.

© 2009 Vivacare.
Last updated February 12, 2009.

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