Dr. Fulton answering a question about retin-a
I am using Retin A® but I do not seem to clear up.

When I developed Retin A® in 1969, it was quite an irritating formula. The more the skin peeled the better the acne would respond. However, during this peeling phase all the acne impactions are coming out so there may be an appearance of flare up of the acne condition as all of the impactions are being evacuated. Once all the pores are clear, the acne is under control and not visible . Also, if a patient is considering Retin A®, they should use the Retin A® gel and not the Retin A® cream. The Retin A® cream contains isopropyl myristate, which is an aggravator of the acne condition and sometimes patients will get worse because the formulation of the Retin A® cream. There are also new formulations of the Retin A® on the market, such as Micro Retin A® that are better formulated creams than the previous product. The key is to keep the skin visibly peeling in order to get a rapid clear up. If there is no peeling whatsoever, your particular formulation is not working very effectively on your skin. You should see at least a little peel once a week to know you are at the right therapeutic level. Also, you may need to work with your physician or esthetician during this early phase to help extract out all the acne impactions that are coming to the surface. This will lead to a more rapid resolution of the problem

hope this helps a feel people, maybe you guys ahve read it.
Particularly interesting part is that he wants deliberate irritation (visible peel) for acne to rapidly clear up.

Topical retinoids are very effective anti-acne AND anti-aging products. They transform your skin cells over time, speeding up the rate at which skin cells form and making them less "sticky". Retinoids also increase collagen production. Long-term retinoid use results in smoother, more even and glowing skin. Topical retinoids are not effective spot treatments, but are meant to be used all over your face, and on a regular basis.

A lot of people get started with retinoids but give up quickly -- usually because they have not been properly taught about how retinoids work, and what to expect in the early weeks.

Here are some key things to remember:

1) IRRITATION

Topical retinoids are irritating to the skin, and you MUST ease into them gradually. Here is a general schedule that I suggest people follow when first starting out:

Week 1: once every 3 days
Week 2: once every 2 days
Week 3: 2 out of 3 days
Week 4: daily

Pay attention to your skin! Red, sore, "sunburned"-looking skin and excessive peeling are signs of irritation. If you experience either, STOP using the retinoid until your skin has gone back to normal. Then pick up the schedule where you left off.

Moisturizing with emu oil (or just adding it to your favorite moisturizer or sunscreen) will help to reduce redness, dryness and inflammation.

2) INITIAL BREAKOUT

Retinoids work by forcing the comedones that are clogging your pores to come to the surface. It takes about 3 months for your pores to clear, and during this time, you will probably see some breakouts. Blackheads may appear larger and more noticeable as they surface; small hard bumps may form; and if you are prone to inflammatory acne, you will probably get pimples. (A short course of antibiotics can help people with inflammatory acne get through this initial breakout, but I do not recommend taking antibiotics for more than 2-3 weeks.)

3) SKIN FRAGILITY

Retinoids make your epidermis thinner and more fragile (don't worry, though, because they actually thicken and strengthen the underlying dermis). DO NOT PICK AT YOUR SKIN! Trying to squeeze out a blackhead can leave you with a red mark for weeks. Be patient.

Be sure to use a very mild cleanser with no other active ingredients while you are getting accustomed to the retinoid, and cleanse your face with lukewarm water no more than twice a day. Once is probably better. Retinoids compromise your skin's barrier function, and excessive washing is going to result in dehydrated skin. You can reinforce your epidermal barrier and reduce dehydration by supplementing your diet with fish oil and moisturizing with emu oil.

4) PEELING SKIN

Some peeling is normal. Not only are your skin cells regenerating very quickly, but they are not sticking together as cohesively, and you will see surface peeling. Gentle exfoliation can help get rid of the shedding layer of skin; you can use a soft facial brush or a silica microbead scrub. BE GENTLE! You can do a lot of damage if you aren't.

5) SUN SENSITIVITY

Retinoids increase your skin's sensitivity to the sun. Wear sunscreen during daylight hours. If you are getting laser or light treatments, be sure to tell them you are using topical retinoids; you may need to avoid product use for a week or so before a treatment.

6) PRODUCT APPLICATION

You should apply retinoids to clean, dry skin and wait at least 10-15 minutes before applying moisturizer. Many retinoids degrade in sunlight (Differin is an exception, as it's not a true retinoid), so it's best to use them at night.

If you are also using benzoyl peroxide as part of your regimen, do not apply it and the retinoid at the same time, as BP oxidizes retinoids. Usually, you'll want to use BP in the mornings, retinoids at night. Differin (adapalene) is an exception to these rules.

Salicylic acid and retinoids work very well together. (SA loosens comedones; retinoids push them out.) You can use SA in the AMs, retinoids at night, or you can layer the products at night. If you are layering, the general rule is to cleanse; apply SA liquid or gel; wait 30 minutes; apply retinoid.

If you want or need an acne prescription, see a doctor and get it legally. If you get prescriptions illegally online you could easily hurt yourself or waste your money.

- Independent studies have been performed on the sale of Internet-bought prescriptions. Often the prescription contains no active ingredient, little active ingredient, or in a worst case scenario toxic amounts of active ingredient.

- Drugs bought without a prescription can actually be a completely different compound from what the buyer intends.

Acne.org prohibits the illegal trade of any form of drug or prescription drug. If you see a post from someone selling a prescription, please report it immediately. Thanks.

Time to call in the real expert!

LabGirl ... could you please explain, in your usual awesome level of detail, what goes on with people's skin during the initial 3 months on retinoids?

There has been quite a bit of discussion about this lately ... someone actually went so far as to call the initial breakout a myth. She basically said that any pimples that show up during that time were going to show up anyway. Do you think that is true?

Also, do you think the severity of the IB (assuming it isn't a myth) correlates to the severity of the acne someone had going into the treatment?

Any and all information would be much appreciated ... thanks, hun.

(I am not entirely sure this thread belongs in the Research section, but I'm reasonably certain of finding you here.)

So I just went to the derm a few days ago and he put me on Clindamycin lotion twice during the day and Tretinoin Gel 0.25 at night.

My question is, should I wash my face before applying the Tretinoin? I just wasn't sure if the Clindamycin needs to be washed off or not first.

Today is day 96 using retin-a .025% gel. For the first time in a long time my skin looks amazing. I have one and ONLY one tiny blemish on my chin right now that isn't even noticable. This is huge improvement from the hundreds of blemishes on my face 3 months ago. So I really encourage everyone who uses a retinoid to stick it out for at least 3 months. I'll be honest, it really sucks getting there, but when you do, its great. My skin hasn't been this smooth since I was eight years old!

Haven't been on in a while but was looking around for a new acne fighter to try and was thinking about trying Epiduo.. does anybody have any info or results from using this ?

Also was looking at Skin ID does that stuff work??

Hi,

I'm wondering what would be a good facial cleanser to use while I'm treating my skin with Isotrexin (isotretinoin 0.05% + erthromycin 2.00%). If someone else who has used a similar gel could let me know what face wash you used, I'd really appreciate it!

Also has anyone here used a salicylic acid face wash at the same time as one of these gels? I was recommended the Neutrogina 2-in-1 visibly clear wash, but I am a bit concerned that the combination of the salicylic face wash and the reinoid gel might be a bit much for my skin. I'm currently using a face wash called 'Freederm facial cleanser' - maybe someone has experience of using that in conjunction with a retinoid gel?

Sorry for all the questions but I'm a curious person

Thanks in advance

So, I'm on RetinA 1% (have been for a while) I was wondering does anybody (on any topical not just retinA) use a toner? Or do you leave it out of your regimen purposely?

If you do use one please tell us which one..thanks.

I went on Clindamycin and Retin-A Micro about a year and a half ago, and since then I have had problems with facial flusing. Never had this issue before. But it really bothers me because I have fair skin and it is noticable. It happens when I get too warm or embarrased. I feel this hot flush hit my cheeks and sometimes my ears and chin even gets red. Then it stays that way for a while, sometimes over an hour or so.

Anyone else ever have that problem?

Or can it just rub off on your pillow while you're sleeping. Cause that would make the prescription pretty point to use a night.

Hi there. I was recently prescribed retin-a, antibiotics and another topical that inst a retinoid to treat my acne. I just have a quick question. My dermatologist told me to apply retin-a in the MORNING, however, I have been reading different posts and forums and it appears as though everyone uses it at night. So I guess what I am asking is, should I continue to use retin-a in the morning or switch to using it at night?

Thank You for your HELP!!!!:)

Background: 27 year-old female, mild acne during high school, worsened during undergrad, annoyingly persistent since. Would classify as mild to moderate with pustules. Post-inflammatory hyperpigmentation has always been an issue. Breakouts became increasingly inflammatory with cystic lesions on chin. Family history of acne, and severe scarring.

Past products: Salicylic acid (pads, gels, and every other form), benzoyl peroxide (ProActiv, etc.), AHA's, series of facials, exfoliation, tea tree oil, sulfur-based treatments, birth control pills. I've tried gentle, I've tried aggressive. I've tried washing my face multiple times/day, and I've tried leaving it alone.

What I hadn't used: anything prescription.

Now onto the good stuff...

OBAGI Nu-Derm: Recommended by an aesthetician at a medical spa. Pricey, indeed, but so was the collection of products I was using. Consists of 0.05% Retin-A, 4% hydroquinone, and AHA's.

Here's the regimen (I was very compliant with this-- never missed anything, no matter how tired I was! I was super dedicated to fixing my face.) AM: wash, tone, hydroquinone, AHA, SPF35. PM: wash, tone, hydroquinone, Retin-A.

Weeks 1-2: Peeled like crazy! Tried to work shorter hours, avoided going out because I was peeling so badly.

Weeks 3-4: Redness and breakouts galore. When I went in for my 4-week follow-up, they thought it a bit unusual that I would have this reaction this late into the treatment. They were expecting a significant improvement. My skin is stubborn, oh well.

Weeks 5-6: A bit better, not much. Went in for red/blue light treatments, and my skin started to turn around. Unsure if it was due to the lights or the treatment finally taking a turn for the better.

Weeks 7-8: Fewer breakouts! Finally!

Weeks 9-10: Even fewer breakouts, hyperpigmentation starting to fade and even out. Is patience finally paying off?

Other lifestyle changes: consistently exercising (cardio 3-4x/week), eating better (more fruits and vegetables, less processed stuff), multivitamin/omega-3/birth control pill daily.

Photos can be found here: . (If this link doesn't post, which I'm not sure it will, it's under my galleries... it's the only gallery I have.) I realize that they are not the best quality (webcam) and it's not consistent on the lighting. I also realize that I didn't start at the beginning of my treatment (started at about week 4), but I wasn't feeling like taking self-photos while I was mega-peeling. Despite all this, I think the photos do show the improvement.

Cover-up: I love makeup. Period. I've been using mineral makeup since it's better for your skin, and less comedogenic. Was using BareMinerals for the past 2 years, now using CoverFX, and would recommend it. BareMinerals has more titanium dioxide (read: sunblock), but I'm using SPF35 moisturizer anyway. CoverFX has better color, less splotchy. Also, to counteract the redness, used a green primer (using Smashbox Photo Finish Primer in green).


...I'll continue to post. Heck, if no one reads it, it's cathartic anyway, and I figure it'll be good for me to document my own progress. Good luck to all!

Ive been using Ziana for about 2 months, my acne is not too bad right now, a few sortaa active pimples...not too bad, but quite a bit of red marks all along my checks, which makes it look pretty bad.
So.

(1). Ziana is considered a retonoid, right? but its a low concentration?

(2). How long did it take to start to really clear up. I keep hearing 3 monthsish, but is that just to start seeing the very first results?

(3).Would it be beneficial to incorporate 2.5% bp in the morning for an extra "kick" Ive been on Ziana for 2 months and i havnet had really any irritation problems, i started off once every 3 days and within 2 weeks i was using it once a night. I had a little peeling the first 2 weeks or so, but after that nothing (just redness)

(4). My last question would be. What is responsible for most of the clearing from Ziana, the antibiotic or the tretoin? and may it just take a higher concentration of tretoin to work for some?


haha im just starting to get curious since ive been on it for 2 months now. I feel like its getting better, i just dont know.

Just wondering if anyone was on Atralin and how it's worked for him or her...

Background: I had mild, very persistent acne starting when I hit 19...I did a six-month Accutane regimen after trying other solutions that didn't seem to work (including Retin-A Micro, although I didn't use it consistently or for very long...the IB upset me so much). I went on Accutane at age 21, about two-three months after I went off it I started to break out again. It wasn't enough to get me back on the Accutane, so I kept it at bay using Green Cream, BP 2.5-5%, SA, etc. Nothing really, truly cleared me up.

I'm now almost 24; I went to see the derm a few months ago and she gave me a ton of Atralin samples...I finally decided to commit to using it though I was super afraid since Retin-A Micro made my face red, greasy(er), and I broke out worse than ever. So far I've been on Atralin for a few weeks and my forehead (my biggest trouble spot) is covered in these flesh covered bumps that makes my forehead all bumpy. My jaw also has a bunch of bumps, and I've had a couple of whiteheads here and there. I'm trying to stick with it this time. I use it every night easily; I was on Level 6 Green Cream every night and my skin is pretty resilient.

I was just hoping to hear from anyone who's used this product and liked it.

i read somewhere that if it gets yellow...that it is like expired. my expiration date says march 2010 but i did get it a while ago..... the color of mine is like and off white...yellowy tinge (but barely and yellow at all lol)
please help....
maybe this is why its been 3 months and i am still unhappy with my skin????

Hi!

I've heard that Retin-A also are being used against sun and pigmentation damage. Probably by decreasing the amount of melanin in the skin.

Is this true? Does Retin-A (or Differing for that matter), give you a lighter skin color?

I'm satisfied with my skin color, and gets a tan pretty easily. I'm therefore worried that it will give me a lighter looking skin.

And does it give you a thinner skin permanently, or just only while being used?

Any ideas?

I am on the .5 Taz for the past 2.5 months- still breaking out on jawline and side of face. should I up the dose? Anyone care to share positive stories on if this will end soon?

retin a does absolutely nothing for me, if anything it makes my acne worse, is this common?

Hey i was on Dans Regimen for about a month and a half....it works great but i can just tell it wont work very well against the scarring,I dont want to be left with red marks on my face. its getting rid of the pimple but leaving red marks. Anyways i'm switching back to retin a, i've used it in the past and it works wonders it completely fades the pimple and scar after 2 or 3months of treatment....i was just wondering..will it be ok to moisturize with Dans moisturiser while using reting a..?

Hey everyone I went to the Derm on the 16th (Monday) and he also gave me Epiduo with a prescription of Doxy 75mg once a day. When I got home I quickly went online and started reading posts on how horrible the IB is when using retinoids so I tossed it in drawer with no intent in using it. I didn’t know that Epiduo was a new topical. I didn’t think it was any different than any other retinoid topical. Has anyone had any luck with this stuff? Should I start using it?

I was just wondering if its a good idea to use .3 differin gel daily with the regimen because my dermatologist reccomended differin. what do u guys think?

Hi all!

I have been on tretinoin .1% and eryacne (a topical antibiotic gel) for about 2 months now. I only have acne on the lower area of my face so I haven't applied the medication to my forehead. And now the lower area of my face is bright red! As you can probably imagine it looks really weird having one half of your face normal skin color and the other half looking like a tomato. Now I'm already using a moisturizer for 2 weeks 2 times a day but that hasn't done much. So I really don't know what to do now.
Should I stop applying the meds for a week or something like that? And if I do that will that mean I will really fuck up the progress?
Thanks!

This is my first time posting on any type of on-line forum. I feel like information from the members on acne.org has been so beneficial and I hope someone will come across this forum if they are considering Retin A.

I have oily, sensitive skin with moderate acne. Having sensitive skin really limits the number of products you can try and tolerate. I was really at my wits end... I have limited funds, so I can't see a dermatologist and try expensive products. After reading up on different forums/reviews I wanted to try Retin A. The reviews scared me, but I was desperate. I was able to get a prescription from my doctor and she prescribed Tretinoin Cream 0.05%. She gave very basic instructions, BUT they are so important to follow.

I've had only minor skin irritations from Retin A and for someone with super sensitive skin, that is pretty amazing. For starters, I use jojoba oil as a moisturizer at night after I shower and jojoba oil with lavender oil (3 drops of each) in the morning as a moisturizer. I don't mind the oiliness at night because its moisturizing to my skin. In the morning, lavender oil prevents it from being extremely oily to start, but I still need to blot my skin throughout the day, so its something I can't avoid. At night, right before I go to bed, I put on the Retin-A using my pinky finger, with the minimal amount that they recommend. Be aware of your skin conditions... if your skin got a little too much sun that day or is starting to show irritation from Retin-A applications from before, give it a days break. I even stopped the lavender oil for a day when I found it made my skin more irritated. I might be diluting the effects of Retin-A by having jojoba oil on my face, but its worked for me and I haven't experienced the extreme irritation that other people have. I can tell my skin is tolerating the Retin A much better now. I did have minor irritations that lasted a week or two tops. I had minor peeling and redness, but nothing anymore. If my skin takes a downwards spiral, I will be honest and post something to update.

As weird as this may sound to some people who aren't familiar with it, I use jojoba oil to wash my face. I apply the oil and use my fingertips to gently exfoliate, then I wash it off with the acne.org cleanser. Other products that I have really come to NEED in my routine include milk of magnesia mask (buy the original flavor; generic brands work fine), which I apply after a long day. It helps with the oiliness without overdrying. I apply a thin layer and sometimes leave it on for a whole hour before I gently remove it by applying the jojoba oil (which I shower with on), then wash with acne.org face wash. I also NEED to drink apple cider vinegar diluted in water (1/2 a teaspoon with a 12 oz of water, about) around lunch and maybe dinner. You have to figure out how much of the taste you can tolerate. If you need to dilute it more, then do, because if it taste bad, your not going to want to drink it. I drink it with a straw and cold water taste better. I just recently started Manuka Honey mask, which I do once in a while. You hear so many great things about honey face mask, but I never saw or felt results until my sister introduced me to Manuka honey. And with Retin A, you NEED a good sunblock. The Neutrogena Ultra Sheer 35 SPF is an affordable and effective sunblock for my skin type. Using a gentle shampoo/conditioner may be beneficial, especially if you have long hair. I like Earth science fragrance free shampoo, which is relatively affordable on vitacost. I use Dr. Bronner's body wash. Don't do try all these things at once, but I would recommend getting a regular skin routine down before you try Retin A... so you know how to take care of your skin when you do get minor irritations.

Where am I now? I still get a few pimples. I had a huge zit on my right temple just a few days back, but the timing between a arrival of a new pimple has become longer, that I am no longer so preoccupied with my skin. I was at a point where I seriously thought I would be stuck with adult acne the rest of my life and I'd better start looking for some make up ( which I don't do well with because it always breaks me out even more). Nobody is going to look at my skin and say "Wow you have amazing skin" but I'm just glad that I am at a point where I feel like I won't get noticed for having acne. And maybe one day, I'll look at my skin and think "wow, I have amazing skin". The thing is I'm not in a rush to cure my skin overnight, but I am really happy with the results of Retin A. Its important to think holistically, like I exercise, drink lots of water, and have a pretty healthy diet (I'm pescatarian). But at the same time, I did all those things and still had acne, so Retin A has really been the only thing that has worked to stop new pimples. I would still consider other things like stress, or if you have a very limited, poor diet. I'm also on birth control, which I have been for a long time.

Other things that I have tried but would NOT recommend: applying apple cider vinegar topically, apply lemon juice topically, calamine lotion (does minimize redness from pimples but wouldn't you rather just be done with getting new pimples??), vitamin B5 (i was on this for about a year to prevent oiliness and I started to get pustules on my cheeks. I don't know why I didn't stop sooner, but I wanted a cure for my oily skin. I went the cheap, inexpensive way of buying vitamins from healthfood stores. I feel like the Milk of Magnesia mask and drinking apple cider vinegar has actually helped with my oiliness), proactive, Benzoyl peroxide, sulfur soap bars... these things may work for other people, but it did not work with my skin type. I've been told that I have Candida and the Candida cleanse pills did work but only temporarily. I think it worked some because acne can be related to your digestive system. My sister works for a well-known natural/preservative free skin care company that sells at Sephora. They have good products, but I still had acne. Right now, I have an inexpensive skin routine going that works for me and I'm not curious about other products that only lots of money can buy.

Good luck and learn to listen to your skin, so you can figure out what works for you and what doesn't. Don't look for overnight cures.

So I started using Taz a little over a week ago. So far I have only used it four times and am only using it once every three days (i.e. Sunday, Wednesday, Saturday...). I put it on over my moisturizer as directed by my dermatologist. So far I have not noticed any redness, peeling, itchiness or anything at all, really. Does this mean I should start using it more frequently because my skin can obviously handle it....or should I just stick with this for a couple weeks to possibly avoid a horrible IB? Any POSITIVE experiences with Taz are very welcome.

Quick history about my acne...I've always had mild to moderate acne ever since I first started college. I have tried ProActive, Murad (bad reaction), Exposed Skin Care System (worked great for 4 months), and the occassional drug store fix. About a month ago, my face was breaking out extremely bad so I headed down to Dillards and spent almost $70 on the Clinique 3 step system! After about 3 days of use, my face got extremely dry, flaky, itchy, and broke out even worse. I tried to stick with it, but my face felt like it was melting off. I was fed up and decided to go to the dermo once and for all. I don't have insurance (thats why it was a last result). She prescribed me this Epiduo gel and CeraVe face wash and moisturizer. She said to only use the gel once every other day and I tried that but my face was getting really oily, so I've probably made a bad choice and have been using it twice a day but I don't really have any dryness or burning going on. Also, she prescribed me Minocycline 100 mg 2xday. I am now about to hit the 2 week mark in 2 days and my face is STILL broken out. At first, it looked like it was getting better after a couple days and now its way worse again. Can anyone else relate? Did your skin get better after the 2 week mark? I'm just tired dealing with acne, I'm 23 years old and thought I wouldn't have to deal with this anymore.

Can I use both together? AHA has been working very well for me but my dermatologist wants me to use Retin-A Micro at night. Should I just give up on using the AHA or can I continue using it in the morning?

So, I've been faithfully using Tretinoin Cream o.1% for the past thirteen weeks. My skin has gone from not-so-bad to a volcano-eruption-in-face-form, with no end in sight. I know that tretinoin can take up to 6 months to work, but I recently found out that this cream contains Isopropyl Myristate.
Is it possible this comedogenic ingredient is causing the tretinoin to not work at all for me?

I'm going to my derm in exactly a week, and I want to ask him to prescribe me Retin-A Micro gel o.04%. I have a quick question: will switching to gel cause another IB? Although my face is already a train wreck, I don't want to have to deal with more scarring after wasting my time for 3 months!

is the gel supposed to be lumpy?

so my pores are hideous. like, makes my everyday living a burden.

I hide in my house until night time.

I'm a guy and sumtimes try using makeup to cover my ugly pores on my nose. on front, and sides. its disgusting.

they get worse weekly, and even if i drink alcohol, the next day..eugh.

so i complained to my derm and she noticed some "acne" on my cheeks...that actually was coming (and did)

but, Epiduo she presicribed me...little samples. and WOW.

it took a few days to work, but the lil samples i used on my nose since it is the only real problem i have...i wish i could explain how much my pores hold me back in my life.

so, my pores litterally close up and dissapeared!!!!!

but, sometimes, i would add lotion after showering cuz it had like, soft little flakes on top of the old pores taht were noticable up close.

but wow! what a difference.!

but , i ran out of samples for a week, and my pores returned.


shame. but, i just got my prescription and starting again.

its great --it lets me know that htey only show so hideous cuz they are congested and full of gunk~!

but, it has not helped with my rediculous oil production. oh well, i can care less, id take oil over holes on my nose anyday.




EPIDUO! life saver!

i got 3 refills and the tube will last forever sicne im only usin on nose.