Reduce peeling, redness, and rashes on your skin when using Retin A, Refissa, Renova, Differin, Tazorac, and Retinol

As many of you know, I am a strong advocate of daily retinoid use for most patients to prevent aging and correct existing damage. There is so much proven scientific data behind them that they are still the gold standard in topical anti-aging treatment. I have been using prescription retinoids and daily sunscreen for 30 years. If you come to see me as a patient, I will likely recommend that you start one of them as part of your anti-aging skin care program. And, of course, if I recommend it, you will do it.

Retinoids are vitamin A derivatives and include over-the-counter retinol, prescription Retin-A, Renova, Refissa, Tazorac, and Differin. Initially developed for acne, they were also found to increase collagen and elastic fiber production, diminish wrinkling, improve brown discoloration, and reduce roughness and pore size. Retinoids can be applied to the face, neck, back of hands, and forearms as these areas also show aging changes from chronic sun exposure. Apply a pea size amount to each area on completely dry skin in the evening. Most people can only apply it to the skin off the face every other night because of irritation.

The biggest drawback, and the reason people discontinue retinoids, is that early on, they cause peeling and some redness, a process called retinization. The key to success is to use the proper form and to use it correctly regularly, not intermittently. Instead, most people do it this way: they use the retinoid; they get dry and peel, stop until it gets better and then start again. In the meantime, the top layer of skin builds up, just in time to peel again when you restart treatment. That is the wrong way to do it. If you do it that way, your skin never adjusts, and you will keep peeling every time you start treatment. If you use it regularly without starting and stopping, after about two months, your skin will stop peeling. You may have occasional episodes of peeling after an environmental insult to the skin, but much of that can be prevented.

Most, but not all, people who have had problems using a retinoid can use it successfully if they do it the right way. I often start patients off every other or every third night and work up to every night, but consistently. You can start with the least irritating retinoid and move to the more irritating product. Older gel formulations are more drying and irritating than creams, although the newer microsphere gels are not. Retin-A Microgel (Tretinoin Gel Microsphere), Refissa (if you get it as it was sold to a proprietary company and is not usually available in pharmacies), and Renova (again difficult to get) are the least irritating, then Differin cream, then standard Retin A (tretinoin cream). Finally, Tazorac (tazarotene) is the most irritating. For myself and many of my patients, I have switched to generic tretinoin gel microsphere 0.04% in recent years, as the other less irritating retinoids are hard to obtain. Unfortunately, name brand is outrageously expensive. It has worked for me.

Another strategy that I have recommended for many years but is now getting "buzz" is when starting treatment to do retinoid or retinol sandwiching. In this technique, you apply moisturizer to towel-dried skin and let it soak in. Then you apply the retinoid or retinol product and let that soak in. Finally, apply another layer of moisturizer on top.

Alternatively, you can do what I call "an open-face retinoid sandwich," in which you apply the moisturizer before application (if you are having redness, itching, or irritation) or after (if you are just dry). And if you have an episode of dryness and peeling later in treatment, you can always return to this regimen for a few days. Our Antioxidant Enzyme Peel is great for removing the peeling skin without abrasion.

Mild stinging, redness, peeling, and flaking may occur during the first several months and on occasion. This is normal; soreness and irritation are not. Anything you use on your skin that abrades the skin will cause more redness and peeling. The most common culprits are washcloths, synthetic cotton balls, makeup brushes, or granular exfoliants. The infomercial technique of applying mineral powder in a circular scrubbing motion with a special brush is the most common cause of retinoid intolerance in my clinic.

Discontinue retinoids 5-7 days before waxing, bleaching, peels, microdermabrasion, acne surgery, hair removal, and laser treatments, or you will be sorry. If you wax an area treated with a retinoid, strips of skin will come off with the wax when it is ripped off. Yikes! Other procedures may burn the skin if you don’t stop retinoid use before the procedure. That is why the instructions we give with the prescription go over this. If you didn’t read your instructions and have an “unfortunate accident,” start with a non-fragranced moisturizer and apply it 3-4 times a day to the area where the skin was ripped off. I like our Facial Moisturizing Cream, Aquaphor, or Cetaphil cream. Don’t put toner or active skin care products (glycolic acid, salicylic acid, etc.) on it until it has healed. Don’t scrub or pick. As soon as the skin has healed (pink, not open, crusted, or oozing), wear broad spectrum UVA/UVB sunscreen with an SPF of 20 or higher every day, whether you usually do or not. Avoid sun exposure over the next several months to help keep the area from darkening over time.

Retinoids make you more sensitive to the sun, and you should use sunscreen every day, year-round, or you are just undoing what you are trying to do. We used to tell patients that they could not use retinoids if they were in the sun, but now we know that, within reason, you may use them if you use sun protection. Of course, I know you are already wearing your sunscreen every day because you know that it is an essential part of an anti-aging skin care program. If you go to the beach, lake, or skiing, discontinue retinoids for a few days before exposure.

To recap:

How to reduce peeling and irritation with Retin A, Differin, Tazorac, and retinol

• Use it on a consistent schedule—every day, every other day, every third day, not on and off. Work up to every day.

• Choose one of the less irritating and drying formulations listed above.
• Use the retinol sandwiching technique (moisturizer - retinoid - moisturizer) or the "open-face sandwich" technique (moisturizer underneath to reduce irritation or moisturizer over to reduce dryness.

• Don’t use mineral powder with a brush; use a sponge.

• Don’t use a washcloth or granular exfoliant.

• Stop retinoids 5-7 days before waxing or laser hair removal, or chemical peels.

• Wear sunscreen.

Retinoids are very effective as part of your anti-aging skin rejuvenation program. It is worth working with them to be able to use them successfully.