How Not To Give Up On Retin-A
If you’ve ever tried Retin-A (or one of its many cousins: Renova, Avita, Tazorac, generic tretinoin, etc.), you know the usage downsides: redness, flaking, stinging. Some MDs will tell you to just push through the irritation period (and walk around with a flushed, flakey face for months)—or to wait thirty minutes after you cleanse to apply. However, I don’t know about you, but by the time I get around to washing my face at night, I'm beat. No way I’m delaying bed for another half hour.
On the other hand, nearly every dermatologist on the planet will tell you there is no better-studied, anti-aging cream than a topical vitamin A (a.k.a. tretinoin). It’s been clinically proven to speed skin cell turnover (keeping pores clear and skin smooth and radiant), suppress Melanocytes (the cells responsible for excess pigment) and stimulate collagen and elastin production (helping to plump fine lines and keep skin firm). So how can you get all those highly-desirable benefits without looking sunburned? Allow me to share what I’ve learned in the thirty-odd years I’ve been applying tretinoin creams, on-off-on-off-on.
I started using Retin-A as a teenager to clear up my acne. It didn’t help that much with the breakouts, but it did leave me red and peeling (not a pretty addition to the pimples). I vividly recall on one occasion at the orthodontist, after sitting with my mouth propped open for thirty minutes, the irritated, s-t-r-e-t-c-h-e-d skin around my lips started flaking off like shredded cheese. I stopped using Retin-A that night and swore it off until my early twenties.
My second go at tretinoin was only slightly more successful. I’d recently completed a six-month round of Accutane, which did erase my acne. Although my skin was clearer than it had been since grade school, my dermatologist wanted to put me on a tretinoin cream to ensure it stayed that way. Because I’d had such a bad experience with full-strength Retin-A, he prescribed Retin-A Micro, a new-at-the-time formulation that had been designed to deliver the active ingredient at a slower rate, thereby (in theory) diminishing irritation. While it’s true my skin never got as flakey as the shredded-cheese incident, I did still have a chronic flush, and anytime I applied makeup, it would grab the few flakes that were there, causing my complexion to look like a cracked egg. So I abandoned tretinoin, yet again, after six months.
In my late twenties, I made a third attempt. At the time, I was the beauty editor at CosmoGirl, then a startup magazine, and we were working very long hours (if I left the office before midnight, it was an early night). This showed up on my face in painful cysts. My then-dermatologist, Fredric Brandt, MD, knew about my unhappy history with tretinoin creams, so he gave me some samples of Avita, a new, gentler, topical tretinoin—and he told me to use it every third night rather than nightly. Breakthrough! My skin did still get a little flakey, but the level of irritation was drastically reduced from my two previous dalliances. Shortly thereafter, I met esthetician Sonya Dakar (as I recount here), and she introduced me to the idea of using a non-comedogenic oil, which I applied before the Avita and voila! even less redness and flaking.
My successful two-year run with Avita was interrupted by pregnancy and nursing (as most of you know, tretinoin is a BIG NO during pregnancy as it may up the risk of birth defects). By the time I could safely return to the Avita, I was also battling post-pregnancy melasma, so I switched to TriLuma, which is a tretinoin cream laced with hydroquinone to lighten excess pigment. I again applied it every third night, preceded it by an oil, and redness and peeling were minor.
Once the melasma faded, I stopped using a tretinoin cream for a few years, largely because I rarely suffered breakouts anymore. Then, in my late thirties, I started to see fine lines. As I recounted above, most dermatologists say tretinoin is the answer to everything, so back I went to Dr. Brandt, this time asking for an Rx tretinoin to fight against the signs of aging.
We settled on a generic tretinoin (not previously available) in the lowest strength, .025. Why I didn’t opt for a low-strength formula years ago, I have no idea. Maybe no one offered it? But I applied the .025 every third night, on top of an oil or moisturizer and dealt with just a few flakes.
Then, three years ago, I got rid of redness and peeling altogether (sound the trumpets!) when I met dermatologist Neal Schultz, MD. He convinced me to start using glycolic peel pads on nights I didn’t use the tretinoin, and that final step put an end to the remaining, pesky peeling. I love Dr Schultz’s Beauty Rx Peel Pads ($70; beautyrx.com), but have also found success with Dermadoctor Kakado C Intensive Vitamin C Peel Pads ($78; sephora.com) and Dr Dennis Gross Skincare Alpha-Beta Ultra-Gentle Daily Peel for Sensitive Skin ($88; sephora.com) .
Aren’t up for employing all my anti-irritation steps (low-strength Rx + an oil buffer + alternate with peel pads), but still want the anti-aging benefits of topical vitamin A? Then consider downshifting to over-the-counter retinol. Using retinol rather than an Rx tretinoin means you’ll have to wait longer to see results (as in six to nine months versus three to six), but you’ll also lower the risk of irritation.
Check out my OTC retinol picks (plus my favorite at-home peels) in Shop This Post, below.