Topical retinoids are medications that are derived from vitamin A.
They are the drugs of choice in people who have comedonal (blackhead and whitehead) acne, and they are also helpful in clearing inflammatory acne (papules and pustules, also known as “zits”).
How do these medications work?
Retinoids work by making the skin shed more easily so that hair follicle plugs don't build up and form blackheads and whiteheads.
In addition, retinoids help “plump up” the skin and make large pores less obvious.
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How should I apply these medications?
Apply small, thin, pea-sized amounts of the medication to clean, dry skin once a day, usually at bedtime or as otherwise instructed by your health care provider.
Apply the medication to all affected areas as well as to places that are acne-prone.
How long do they take to work?
Within 6 to 8 weeks, you should notice improvement if you have been using the retinoid continuously. The peak of improvement most often occurs by 3 to 4 months, so give it a real chance to work.
How do I deal with side effects?
All retinoids can cause some skin irritation during the first few weeks of use. You may have some discomfort, such as stinging or burning, and sometimes may experience mild redness and scaling of your skin. These reactions are to be expected, and they are an indication that the retinoid is working.
After several weeks, your skin generally gets used to the medication and the discomfort eases.
If you are sensitive to the retinoid that your health care provider prescribed for you, you can take a number of steps to help ease the irritation:
Start off gradually. Begin by using it every other day, or even less often, until you get used to it. If you have extremely sensitive skin, try applying the retinoid for short periods, such as leaving it on for a few minutes and then washing it off. You can put it on for as little as 2 to 5 minutes. This tends to make it more tolerable, and it still will have positive effects as long as you stick with it. As your skin becomes accustomed to it, you can gradually increase how frequently you use it and how long you leave it on. Eventually you may be able to apply it every day and leave it on all day or overnight.
Use a moisturizer. If you develop scaly skin, apply a moisturizer generously in the morning. The moisturizer should be applied over any medication you apply at night or in the morning. (If you also use a sunscreen, apply it over the moisturizer.) Effective moisturizers are Oil of Olay, Nivea Ultra Moisturizing Creme, and Eucerin creams.
Use only emollient, nonirritating cleansers to wash your face when you're using a topical retinoid.
Tips
Despite the common misconception, there is no flare of acne in the first few weeks of treatment; rather, the “flare” is either caused by irritation from the medication or from the natural progression of your acne, so try to “ride it through” unless the irritation is really severe—at which point you should call your health care provider.
Retinoids may produce sun sensitivity. It's true that the retinoids can make you become somewhat more susceptible to sunburn; however, this problem eases after the drug has been used for a month or two.
Applying the medications at bedtime is added insurance against your having problems with sun exposure the next day.
If you're using a retinoid in sunny conditions, particularly if you have fair skin, just take simple sun-protective measures, such as avoiding the midday sun, applying a broad-spectrum sunscreen or sunblock (over the medication), and wearing a protective cap or hat.
Recommendation: Do not use retinoids during pregnancy or breast-feeding.