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Reduce peeling, redness and rashes on your skin when using Retin A, Refissa, Renova, Differin, Tazorac and RetinolHow to use Retin A without your skin peeling off

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 25 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. Originally developed for acne, they were found to also increase collagen and elastic fiber production, diminish wrinkling, improve brown discoloration, and reduce both 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 skin that is 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 right form and to use it correctly on a regular basis, not intermittently. Most people do it this way: they use the retinoid; they get dry and peel so they 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 again. If you use it regularly without starting and stopping, after about 2 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 are able to 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 up to the more irritating product. Gels are more drying and irritating than creams. Refissa and Renova are the least irritating, then Differin, then Retin A, and finally Tazorac is the most irritating. On the other hand, Tazorac gives the most improvement in pore size and acne scars. Another strategy when you are starting treatment is to mix them with moisturizer to dilute them, apply 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 dilute them again 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 that 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 a granular exfoliant. The infomercial technique of applying mineral powder in a circular scrubbing motion with a special brush is the most common cause 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 that has been treated with a retinoid, strips of skin will come off with the wax when it is ripped off. Other procedures may burn the skin if you don’t stop retinoid use prior to the procedure. That is why the instructions we give with the prescription goes 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 Aquaphor, or Cetaphil cream. Don’t put any 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 single day, whether you normally do or not. Avoid sun exposure over the next several months to help keep the area from darkening over time.

Retinoids do 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 are going to the beach, lake, or skiing, discontinue retinoids for a few days before exposure.

To recap:

How to reduce peeling and irritation with Refissa, 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 a cream not a gel.
  • Start with Refissa unless you have oily skin and acne. Refissa is in a moisturizing base, is stronger than Renova, and usually the easiest to tolerate. I use Refissa.
  • Apply moisturizer underneath to reduce redness and irritation.
  • Apply moisturizer over retinoids 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, 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.

18 comments

Posted on January 01, 2015 by anti aging

Pretty nice post. I just stumbled upon your blog and wanted to
say that I have truly enjoyed surfing around your blog posts.

After all I will be subscribing to your rss feed and I hope you write again
soon!

Posted on January 01, 2015 by Dr. Elaine Cook M.D.

Thanks! I appreciate it.

Posted on March 03, 2015 by jane

Thank you ! This is the most clear and complete instruction that i’ve ever read.

Posted on March 03, 2015 by Dr. Elaine Cook M.D.

Thanks Jane! It is a problem that we see all the time and it seems that few physicians goes over the steps that you need to take to use retinoids successfully with the patient. Most of my patients can use them successfully if they follow these instructions.

Posted on April 04, 2015 by Maha

Hello Doctor! Thank you for the informative post. I recently started using Biacna ( Tretinoin 0.025%) and my doctor did not provide me with any instructions except for using it everyday. My skin is peeling and flaky and I was wondering if it would still be effective if I cut down to every other day instead?

Posted on April 04, 2015 by Dr. Elaine Cook M.D.

Hi Maha, yes you can start with using it every other day and then when your skin is tolerating it better, try to move to every day. It usually takes about 2 months for your skin to get used to it. If you can’t move to every day, then keep doing it every other day and you will still get benefits. Be sure to follow the other tips in the post. And it is better to do it every other day, than every day for a week or so until you get flaky, then stop for a week or so. If you stop for a while the surface layer builds up again and then when you start again, it all peels off again. So yes, go every other day, but consistently.

Posted on April 04, 2015 by Maha

Thank you again! Over the past week I have noticed that although my skin is still slightly flaky, the initial stinging and heat I was experiencing is almost gone. I think my skin is getting accustomed to the everyday routine. I will try and continue sticking to that but if it does not work, I will switch to every other day.
I was hoping to ask you another question. Almost every week or so, I get a pimple which ends up being huge, goes away after a while but leaves a dark mark. I am guessing its the way Retin-A works and it is part of the purge?

Posted on April 04, 2015 by Dr. Elaine Cook M.D.

It is not uncommon to have some increase in breakouts in the first couple of months of using Retin A, or any retinoid as the treatment unplugs previously plugged oil glands and pre-existing acne lesions rise to the surface. It usually calms down in a couple of months. Of course, acne in adult women is very common and often starts in mid-30’s or later, even if the patient has not previously had acne.

Posted on April 04, 2015 by Maha

Thank you for all your help Doctor!

Posted on April 04, 2015 by Dr. Elaine Cook M.D.

You are welcome Maha—keep at it!

Posted on May 05, 2015 by Karin

Hi Doctor,

The clarity of your post is so helpful !!!  I started four days ago with retin A,  0.1.  I believe the concentration is strong for begginers, but I give it a try any way. I was wondering if the retinization was avoidable or a sign that your skin can not tolertate the product, but after I read you I understand all.  I v seen a lot of videos on youtube about it,  but your post was the ost helpful.
I would like to ask your opinion about the streng that I am using.  Iv been puting it for two times now and its ok,  little bit red and soft peeling,  I don tknow if I must live the skin in peace or take off the skin that is peeling.  seem to me that it is better to moisturize and let it be.. 
Well,
Thank for your post.

Posted on May 05, 2015 by Dr. Elaine Cook M.D.

Hi Karin,
Thanks for your kind words.
Retin A 0.1 is the strongest strength available (comes in a cream and Retin A Micro Gel). If you are already having a little redness and peeling after two applications you may want to work into it by applying some moisturizer before you apply it which effectively dilutes it, or starting with every other day. When you wash you face, some of the peeling will come off naturally, other than that it is usually best to not try to scrub it off or remove it with an exfoliant etc. You are correct that it is usually best to just apply extra moisturizer to counteract the peeling. Good luck!

Posted on June 06, 2015 by Karin

Thanks to you for answering. 
I would like to comment with you that after a month with tretinoid 0.1 my skin is startng to get used to it,  but arround my mouth, (not in the corners) and my chin Iv got this constant red undertone that make all my dark spot more noticeable and make my face look darker in the lower part of it.  I know that redness in this part of the face is very common because of the special sensibility of this skin,  I did every rhing to make the cream more soft to that place,  mix it with moisturizer,  put moisturizer before….

There is any other option that do not involve to stop using the cream on this part of my face
thanks again.

Posted on June 06, 2015 by Elaine Cook M.D

Hi Karin,
It is almost always that area that causes the most issues with tolerating any retinoid. You are doing the right things by putting moisturizer under it, mixing with with moisturizer and putting moisturizer on top of it. Be sure that you are not rubbing around your mouth when you wipe your face with a napkin, use a soft napkin and blot like a lady don’t rub the food off like a truck driver. When you brush your teeth be sure that you are not dripping toothpaste water down your chin. Sometimes in that area you can’t ever build up to using it every day, you just use it every other or every third. And you might want to mix it with even more moisturizer than on the rest of your face to dilute it a little more.

Posted on September 09, 2015 by Shana

What is a good calming cleanser to use to wash my face prior to retin -a? And is the Mia gentle circular brush ok? Or better to use my hands to clean face?  Thank you.

Posted on September 09, 2015 by Dr. Elaine Cook M.D.

Hi Shana, I use our Facial Cleansing Lotion and it works great with retinoid treatment, because it actually adds moisturizer to your skin.  Our patients with oily skin or acne do great with our Clear Skin Wash. You can use any gentle facial cleanser that doesn’t have scrubbing beads, and that your skin tolerates. I am not a fan of using any cleansing brush with Retin-A if you have dry or sensitive skin, and at least not at first if you have normal skin. Some patients with oily skin can get away with using a gentle cleansing brush.

Posted on November 11, 2015 by Bianca

I use a retinol product every 3rd day. I went up in concentration recently, and I’ve been getting mild peeling (no redness or irritation). I’ve been told not to use moisturizer on the nights i use retinol, that it will negate the benefits of the treatment. Is that true? Also, thanks for the tip about not using a washcloth!

Posted on November 11, 2015 by Dr. Elaine Cook M.D.

Hi Bianca, I don’t agree that you can’t use moisturizer on the off nights. I think you can, without negating the effects of a retinoid product. Using moisturizer will reduce the exfoliation, but won’t affect the cellular renewal process and that is really what you are trying to do, not just get a temporary exfoliation.

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