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Posts Tagged ‘Tretinoin’

FrecklesIts back on shelves!  Tri-luma, the turbo powered skin lightener is now available after a more than an 18 month disappearance.  There was no FDA recall or explanation from the company.  Nothing.   I discovered that compounding pharmacies could make it up for individual prescriptions, but that option  was just not widely  available.  Then,  without fanfare  or explanation,  Tri-luma  was back– and I’m delighted. 

 How Tri-luma Works

This prescription- only skin lightener  contains three active ingredients:

1.  Tretinoin ( aka Retin A) is famous for its ability to speed up cell growth and exfoliate darkened areas.

2. Hydroquinone which prevents melanin production and is considered one of the most effective  weapons in the  anti- hyperpigmentation tool  kit

3.  Mild corticosteroid to keep  things calm.  Both Retin A and  hydroquinone can be irritating.  Enter  a  mild steroid.  It allows the skin brighteners to do their job  while keeping the skin calm and comfortable

While Tri-luma can be used over the entire face, I needed it mainly  to lighten my dark under eye shadows.   Plain Retin A  is too irritating to be used on delicate under eye areas but mixed with a steroid it can  address  skin darkness without causing more  problems.

Tri-luma was one of the first anti-aging tools I used and I loved the way it lightened  my long standing  dark shadows.  However while plain RetinA can be used continuously for years, most  doctors recommend using  Tri-luma  only for three montha at a time.   The treatment period  should be followed by a three month  Tri-luma holiday and then the  product can be used again for another three months.  To keep it fresh and effective, pharmacists recommend keeping it in the refrigerator.

There is a whole buffet  of skin lighteners including kojic acid, arbutin and soy extract, but Tri-luma  is often the product of choice.   It represents the new thinking about  medical treatment.  Rather than a single  solution to a problem , researchers are looking at different targets  for treatment.  In the case of  hyperpigmentation,  some skin lighteners like retin A a can help the skin shed darkened skin cells while  while ingredients like hydroquinone  can break up existing  melanin.  Combining them in one product can be much more effective than used spearately.  Since Kojic acid seems to prevent melanin production, I would love to see a  product  that combines all four ingredients.  There are so many me-too  products, it would wonderful to see a formulation that uses all of the science  we  now have about treatmenting dark patches and spots.

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layer cakeI just spent   four days at three different   beauty conferences.   There were probably over 100 vendors with  lines of at least twenty products each.  So  many products, only one small face.   At many of the counters,   I was urged to use  4-5 products at a time, each one promising   different benefits.  

But the skin is not like a layer cake with each new layer adding  more and better flavors.   The reason  that  the body is covered with skin is to protect the internal structures  like the  heart, muscles and  brain.  It is designed  to keep stuff out, including  dirt, bacteria, mold, insects and toxic chemicals.  Indeed  when the integrity of the skin is broken from a cut or burn, we all know its important to clean the wound  and cover it to prevent infection.  Its very difficult for most ingredients  to pass thru the upper layers of the skin and  arrive at the growing, lower  levels.  Applying  any product, be it  a  lotion, serum or moisturizer, makes it  much much more difficult for the next product  to  pass through the skin layers to get to the area where is can actuallydeliver results.   

So What’s Girl Have  To Do to Look Good?   

Different ingredients offer different benefits. For example  antioxidants  protect  skin  structures from UV damage while hyaluronic acid  is an uber moisturizer that draws and hold  water in the skin.  To get  as  many benefits as possible you have two options:

1. Combination  products

Rather than using a serum with antioxidants, a moisturizer with hyaluronic acid and a sunscreen with zinc oxide,  look for a product that contains all three.  Mixing the molecules  together in one  product  gives all ingredients equal access to your skin.  Even better, it’s  a great  way of stretching your  beauty budget.

2.   Alternate Skin Care

I’m often asked how  to use Retin A, a moisturizer, a sunblock, and an antioxidant serum.    Short answer, not all at the same time.   For example, at night you can use Retin A and a moisturizer on Tuesdays, Thursdays, Saturday and Sunday.  On Monday, Wednesday and Friday nights  use the antioxidant serum topped by the moisturizer, and skip the Retin A.  This alterrnative application will allow  even sensitive skin to use a  full strength Retin A .  In the morning use a moisturizer with sunscreen under  your make-up.   To make things even easier  you can use  a BB or CC  cream which offers a  combination of hydration,   antiaging ingredients, sun protection  AND foundation.  You can get  the benefits of four products at the price of a  single  item.  Cool.

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QandA3Question:  I’ve had acne since I was a teenager, but now  I’m  37  and its still a problem.  I wanted my doctor to give me Retin A, but she insisted that Differin would work better.  Its not covered by my heath plan and I can buy  Retin A online for a lot less.  Any advice?

Answer: Its sad but true  that acne can remain a problem long past high school.   Differin ( adapalene)  is actually the newest form of Retin A  ( aka  tretinoin).   This new kid on the block  has several advantages than its older cousins.  It is less irritating than traditional  Retin A, yet can be more effective  preventing   blocked-pores.  It also acts both to reduce inflammation and helps the skin shed old dead skin cells.  But what makes adapalene   an anti-acne rock star is its ability to get along well with  other acne fighters.  Both benzoyl peroxide which kills acne causing bacteria and clindamycin  which reduces  inflammation,   reduce effectiveness of  Retin A.  By contrast,  Differin ( adapalene)  works beautifully with other acne medications.  You can layer all three at night and  then use the benzoyl peroxide and clindamycin during the day.  To round out dynamic acne care, wash your face with an oil free cleanser like Neutrogena  Oil-Free Acne Wash   and  be sure to use an oil-free  physical sunscreen  such as  SkinCeuticals Physical Fusion UV Defense  SPF50 during the day.  Keep in mind that  Differin like the original Retin A  increases skin sensitivity. 

This triple threat program is the current  gold standard for acne care and you should see  big improvements in 2-3 months. If  things  don’t get better, you probably have some form of hormonal acne  and will need hormonal therapy.   I agree that its outrageous that most  healthcare plans refuse to cover any form  of tretinoin  much past adolesence.  Retin A is now available in less expensive generic form while newer Differin is  still under patant. Despite the increase in costs,  I think your doctor  made a good call.

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Costs seem to explode when daily skin care meets anti-aging.    Brand name tretinoin ( eg Retin A) clocks in  at $300 for a tube that lasts  six months.   Generic Retin A drops to about $200.  Upscale anti-aging  brands with  effective levels of retinol are lower at about $100, but still a  significant bit of change.  And then there are the luxury department store brands  like La Mer and Perricone  that will cost more than $300 a  jar– and thats   just for one product in the recommended routinue.

There are  anti-aging products  that don’t   cost much, but they  don’t do much either.  The challenge is to find affordable   anti-aging  forumlations that  deliver  real results.   I believe that   when a  low cost  cream or mask  doesn’t  deliver,  you are still wasting your  money, albeit less of it.

Glycolic Acid– cheap and effective

The search for  acessible anti-aging skin care starts with  deciding what you want from them.  As the  years go by skin growth slows down, dark spots pop-up  and   our  healthy glow  is replaced with  a sallow, dull skin tone and textrue.  That’s the bad news.  The good news?  Glycolic acid and vitamin C, either singly or in combination  were born to deal with skin aging.  These  two super age busters  are also among the most inexpensive ingredients used in  skin care  products.

Glycolic acid will remove the top layer of dead skin cells and stale  oil and encourage  the growth of healthy hew collagen.   Within a  month of use,  pores will shrink and  rough dull  surface  will be replaced  with a fresh healthy glow.  Think of glycolic acid as “Retin A  light”.   It will  produce real results without irritation– and at about 80% lower cost. Two of my favorite glycolic acid rejuvenation  products are:

Alpha Hydrox Enhanced Lotion ( 10% glycolic) $12- for dry skin

It contains active levels of glycolic acid but forumlated for thin,  dry skin.  Available in pharmacy chains like Duane Reade and online.

Alpha Hydrox AHA wipes ( 14%) $17 for  normal and oily skin

 These wipes are super easy to use  and can be added to  almost any cleansing routinue.   They will  help control breakouts  while stimulating  healthy skin formation. 

Vitamin C– an oldie but goodie

Vitamin C  is  one of the most studied AND effective anti-aging ingredients– and available for literally pennies a day.   Vitamin C  works in three ways– it is essential for  the growth and repair of  healthy collagen, can lighten  dark spots and splotches AND is a powerful antioxidant that protects the skin from UV rays.  But  vitamin A is uber  fragile and takes  careful hadling to avoid oxidation.  When this happens, the vitamin C loses much of its power and potency. 

There are a few  wonderful commercial vitamin C  products  ( eg Cellex C and Ski Ceuticals)  that will deliver  full strength benefits.  But they are expensive and if  you want to stretch your beauty dollar, you can make a  truely effective vitamin C serum without  special ingredients or equipment.

DIY Vitamin C Seum

I tried  six different formulas before  adopting  this  one from Gorgeously Green by  Sophie Uliano.  I could find all the ingredients at a local health food store and  had all the tools I needed in my kitchen.  While DIY  products are so tempting, some formulas  can involve ordering special chemicals and tools, eg scales and thermometers.  These add up and the bottom line here is to save money.

Budget Busting Vitamin C Serum

Ingredients:  2 teaspoons, water (  boiled and cooled), 2 teaspooons vitamin C powder in the form of L-ascorbic acid ( $10 for 4 oz.)  , 2 teaspoons vegetable glycerin ( $10 for 4 oz.), dark brown bottle with eye dropper.  These ingredients  will last three months at the cost of  $1.60 a week.  Seriously.

Directions:  In a little bowl, mix the water and vitamin C until the powder is dissolved. Mix in the glycerin.  Using the eye dropper, transfer  the mixture  to the dark brown bottle. It will stay active for a week.  If you have any leftover, discard it and  mix up a fresh batch.

To  use, shake the bottle well and  put two  drops on fingertips.  Rub in a bit on the  hands then apply to the face.  Repeat  for neck and chest.  And that’s it.  You might feel a  sight tingling that will fade in a moment.  Unlike glycolic acid which  show almost  immediate results, vitamin C takes  time to see benefits.  The changes are  internal but in a few months  you should notice  fewer dark patches and  a radiance that only comes from treating your skin correctly.

In the summer I like to use vitamin C serum under my mineral sunscreen.  In other seasons, I alternate glycolic acid wipes with vitamin C serum  as my bedtime routinue.   Let me know  how you  like to use this home made age buster.

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Last month I was dealing with a hair trigger skin  that seemd to develop red splotches at the slightest  provocation.  It went on for weeks until I tried Metrogel and the problems ended  overnight.  This was obviously great news but  it set me thinking– “how long should it take  to get results from a skin care treatment?”

The answer  obviously depends on the problem and the cure:

1.  Tretinoin ( aka Retin A) — Tretinoin is approved for both acne and anti-aging, but the time frame is significantly different.  Its no secret  that I am a big fan of tretinoin and  I feel that its the foundation of an anti-aging plan.  It clarifies  the surface, fades dark spots, encourages collagen growth and stimulates circulation.  Used 4-7x/  week, you may start seeing benefits after  3 weeks.  By six weeks, most women should see  a pinker, softer skin.  It will take  two months  to start seeing a change in hyperpigmentation and three  to six months to notice a lessening of fine lines.Current guidelines recommend using tretinoin nightly for 48 weeks, then 2-3X/week for maintenance  to preserve gains.

For acne management, Retin A  is a very different timetable.  At first,  many people report that acne worsens for at least the first month.  But  by three months, if this is the right treatment for you, the acne should be under control.  It may  take  another 3-4 months for acne discolorations  to fade.

Skin Lighteners–  Ingredients like  hydroquinone, Kojic acid, snd Lumixyl are all proven to lighten skin discoloration, but they are not quick.  They act by either blocking melanin production or by slowly breaking down existing melanin deposits.  Its necessary to wait until the melanin-rich skin cells grow old and drop-off, to see a lighteing hyperpigmentation — and  the skin growth cycle is 6-8 weeks.  To deliver results, the skin needs to be treated  nightly with skin lighteners and protected each day with a 50SPF sunscreen.

Glycolic Acid-  Found in sugar cane, glycolic acid has both  short term and long term benefits for the skin.  An  office based 50-70% glycolic peel dissolves  and removes the dead dry skin cells and stale oil that coat the skin.  Five to ten minutes  on the skin, followed by a neutralizer and rinsed off, the skin feels soft and feels fresh.  For about 24 hours, you’ll look  amazing making glycolic peels a great tool for  special events.  ( ie a reunion where you’re likely to see your ex who is coming with his new girlfriend).  A series of five peels provides a big long lasting change, but it can be pricey.

Moisturizers, pads and home peels with 10% glycolic acid can provide lasting benefits that include  skin lightening, younger firmer collagen and thicker skin.  You” start to see freshening within two weeks– and a maximum of benefits within three months.

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Question:  I’m concerned that  that Retin A Micro .o4% will irritate my skin.  Can I mix it with  my moisturizer before  applying it?

Answer:    I’ve received this type of comment  so frequently I think it deserves a post of its own.  Mixing  Retin A ( aka tretinoin) with a moisturizer immediately reduces its concentration and  impast on the skin.  If you take a pea size dab of  .04% tretinoin with an equal dab of moisturizer, the concentration is now .02%– lower than any other prescription grade  tretinoin.  If there is more moisturizer than tretinoin, then the concentration is even lower  and the action on the skin will be very limited.  Then there is the issue of cost.  Retin A  Micro .04% runs about $300/tube.  If you dilute it to .02%  you will get more  for  your beauty dollar if you buy  .1% Retinol from Skinceuticals which clocks in at $100.

There are tried  and true  methods of reducing  risk of   redness and flaking with tretinoin products.  Start by choosing  a mild cleanser like Cetaphil and  wait  at least 30 minutes between washing your face and applying  tretinoin.  Ease into a tretinoin regimen  by applying it every other night for several weeks gradually working up to an every night routinue.  If redness develops, stick  with using it only three times a week.  Make sure  you avoid  other products that could cause irritation  including microdermabrasion, glycolic acid peels, exfoliating pads or grains and alcohol based toners.  At night  use a  moisturizer like CerVe PM ( which is brimming with ceramides and hyaluronic acid) over tretinoin to prevent irritation.   Commit to using  at least a 30SPF sunscreen  each and every  morning.  Tretinoin increases sensitivity to the sun  and you can get red and flaky even from sunlight through a window.  It will take at least  six weeks to produce a noticable difference.  Don’t be impatient and stick with the program.  I believe that tretinoin is the foundation of a stong anti-aging plan.  What ever else you do, tretinoin will  supply a daily  boost to skin cell growth that refines the surface and boosts collagen production-  all good things.

One final thought.  I also  hear from women  who apply their tretinoin OVER a moisturizer.  Please don’t do that.  Tretinoin is  one of a handful of ingredients that can actually pass throught he layers of the skin to  provide  real benefits to the lower, living layer of the skin.  Applying a moisturizer just blocks access to the skin and inhibits all the good that tretinoin can do.

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I have been using Retin A Micro for several months and I’m thrilled  with the results.  There are also several other types of  Retin A products ( available only by prescription) that you should know about.  In addition I’m going  to decribe  two new types of  retinoids  that   have different features that could be of value.

1.  Retin A — This is the granddaddy of anti-aging products and has volumes of research behind it.  Its now available in a generic version that costs less than $30 online.  By comparison the drugstore price for the brand name Retin A is about @$120/tube. This is one of the strongest  forms of Retin A and you  should follow the rules  very carefully to avoid irritation– its worth it and the savings are amazing.

2. Retin-A Micro-  This is the form that I currently use.  It has  two strengths–.o4%  and .1%.  It is made up in a slow release formula to make it less irritating .

3. Renova—  This is a particularly mild form of tretinoin.  It comes in a .02% concentration in a rich creamy base.

4.  Refissa —  The only fragrance-free tretinoin, Refissa  is the newest  form on the market.  It i a very creamy formulation  with a .05% concentration.

5. Differin — This product has a different retinoid called adapalene.  There are two strengths– .1% cream and .3% gel.  Adapalene is  milder than  Retin A, but  not quite as effective.  Its an excellent choice  for people who cannot handle Retin A, but still want to deal with aging/sun-damaged skin.

6. Tazorac — This product contains   tazarotene, another type of retinoid.  It is available in .1% concentration  in both a gel and a cream.  Doctors report that can be more effective than Retin A, but also more irritating

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