Retin A and Acne– What Cleansers and Moisturizers Can I Use?

I got a great  email from a 16 year old  who  is using Retin A micro  for acne control.  Like most of us, she got the prescription with little or no advice about   how to use it.  She wanted to know what  scrubbing grains, toners and moisturizer I would recommend.  She was concerned about the redness and peeling and wanted to avoid these problems with additional  skin  care products

Retin A  was actually originally  developed and approved for acne  management.  This vitamin A derivative helps the skin to empty  pores clogged with debris, shuts down overactive oil glands and helps skin turnover to reduce discolorations from old acne eruptions.   This process includes flaking off old dry keratin that is contributing to blocked pores and breakouts. Some peeling and flaking is necessary and actually good.  However   you need to keep it under control to avoid too much redness and irritation.

The  solution  is to allow  Retin A to do what it does best. Twice a day use an extremely gentle  oil-free cleanser such as Cetaphil Gentle Skin Cleanser and apply with damp cotton pads. Rinse off with handfuls of lukewarm water. Even a washcloth can be too rough in the first months of Retin A treatment   Start by using Retin A every other night and gradually, over three weeks, work up to an every night routinue.  

 In the early months of using Retin A  its very import ant to avoid additional irritants such as scrubbing grains or pads, toners and even alpha hydroxy acids ingredients  such as glycolic acid.  It certainly takes  a leap of faith to abandon these tried and true acne aids and simply   trust Retin A to clear your skin– but  that’s the best way to succeed.  These products and ingredients  are  simply too irritating to be used at the beginning of Retin A therapy and can make the skin so red and sore that  people abandon Retin A treatment. 

Using a moisturizer  to control the peeling  can actually  lead to additional breakouts.  If your skin becomes too irritated and flaky,  use a tiny dab of oil-free moisturizer and take a two day Retin A holiday.  In the morning make sure  to use an light fragrance-free oil  sunscreen such as  Aveeno Ultra Calming Daily Moisturizer SPF 30.  Retin A  increases sensitivity to sun damage and its ESSENTIAL to use a sunscreen each and every day– even when its cloudy.    

After six months, you skin will  become comfortable, even bored with Retin A.   At this point you can amp  up the impact by adding exfoliators such as 3M Buf Puf Pads or  my beloved Clarisonic cleanser.  Toners and peels with glycolic acid can   provide additional  benefits  for acne-prone skin.   But if irritation and flaking  reappear,  cut back on the extras and focus on Retin A.

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Milia – those annoying white bumps under the skin

Its amazing what you can learn at a medical conference.  At a lunchbreak at the recent Mount Sinai Derm meeting, I sat down next  to two young dermatologists.  They were  talking about milia, those little white bumps under the skin– sort of faux pimples. ( In the picture below my milia is under my eye). Milia are formed when a pore becomes blocked with dead skin cells.  They are more common as we get older,  the result of slower cell growth.  Unlike the garden variety pimple, they do not contain oil or bacteria  so they don’t become red and inflamed.   Milia  just sit there. Forever.

Another important difference, milia are actually  in the dermis and if you try to  remove them yourself, you  can do real  damage to the skin. Seriously, you can get infections and even  scar the area.  Case in point:  Even when I had my milia removed by a physician, I got a shiner! 

Sitting next to the derms I learned two new facts:

1) The best way to deal with milia is to exfoliate regularly with Retin A,  dermabrasion or glycolic peels.  Milia tend to come back in the same area but since I have been using Tri-luma  ( which conains Retin-A), I  have been milia-free.

2) Its an old wives tale  that  rich face creams promote milia.  Good to know  since I use a moisturizer under my eyes every night. 

I’d love to hear about  your experiences with milia.  Where  do they appear?  How do you handle them?

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Reversing Summer Aging– The Plan Begins

As I  progress in this anti-aging journey, I’ve discovered two things about myself:(1)  I really want to look good; (2) I want to look good really  FAST.  The little home  DDF Revolve Exfoliator  delivered on both accounts.  My skin looked fresher and healthier and it took only one minute.

The small hand held Revolve 400X is ultra easy to use.  It comes with two types of heads– a brush for deep cleansing and a sponge that’s used with a gritty gel.   The instructions are short and simple.  Squeeze out 1/2 teaspoon of the gel onto the sponge head.   Wash face as usual but don’t dry.   Push the grey button and press the vibrating sponge agaist your face for one minute.  I also aimed the exfoliator at my neck to tackle  that dull, bumpy skin.  Then I rinsed off my face throughly  to remove the gritty bits.

The difference was clear and immediate.  My skin had such a healthy glow I didn’t  want to cover it with foundation.   I was especially impressed how it gently cleared the pores on my nose. But don’t take my word for it.  In these before  (top)and after  (below) pix you can see a pinker, brighter color after using  home microdermabrasion.

But the benefits of the DDF Exfoliator are not without rules and regulations.   This  cute curvy machine  cannot be  used more than twice a week– and not on skin that is using glycolic acid ( moisturizers or peels) or Retin A.  That is not good news. 

Current recommendations are to avoid retinoids and glycolic peels for 48 hours before laser or IPL treatments.  I’m going to  adopt those guidelines  for home microdermabrasion.  Its going to take a bit of juggling to get the benefits of both retinoids and microdermabrasion.  Have you had to coordinate using two different skin treatments?    Any suggestions?

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Anti-Aging skin Care: The Teenage Years

There is a gorgeous  buffet of choices  for acne care including gels, pills, antibiotics, lights, retinoids,  lasers, hormones, peels and wipes.  There is even an i phone app that offers an acne-fighting light that has good science behind it!  This plan looks at  a way to integrate standard acne fighters with anti-aging protection. 

In the Morning:

* Wash face with oil -free cleanser such as Healthy Skin Anti-Wrinkle Anti-Blemish Cleanser ( Neutrogena, $7.99) and Clean and Clear Continuous Control Acne Cleanser ( Johnson and Johnson, $6.99).   Wet your face and rub a dab into your face.  Massage  gently and rinse thoughly with warm water.

* Apply a treatment  product  that contains acne fighters such as benzoyl peroxide which deals acne causing bacteria in  the pores or salicylic acid which dries up blackheads and small blemishes. 

* Top with oil-free moisturizer/ sunscreen such as Oil-Free Moisture, SPF 15 ( Neutrogena, $10.99)

Nighttime Care

* Wash your face with oil-free cleanser ( see  selections for daytime)

* Wait for 30 minutes before applying a  heavy duty treatment product such as an antibiotic gel  like Clindamycin( prescription only)  or a Retin A formulation for acne  such as Tazorac.  Start using them three times a week to allow your skin to get used  to them and work  up to every night. 

Once a week  use a home glycolic peel.  My current favorite is Exfoliating Glyco Peel System   from Patricia WexlerMD ( $60).  Glycolic acid  is awesome!  It takes off the top dead layer of skin cells that encourages healthy skin growth.  It is a valuable acne fighter as well as a great anti-aging tool.  In fact, for twenty somethings, glycolic acid  becomes   the first line anti-aging  tool.

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