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Starting With Tretinoin - Help Please!

tretinoin 0.01% blackheads whiteheads oily skin initial breakout sunscreen tretinoin cream stieva-a

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#1 gxtirby

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Posted 17 January 2013 - 01:33 AM

Part I: A New Hope?

A couple of weeks ago I went to my doctor for a referral to a dermatologist and she prescribed me Stieva-A cream 0.01% (Tretinoin) in the meantime. I'm 19 years old, and have suffered from acne from the age of about 12. In my earlier teens, I had extremely oily skin, moderate acne, and many blackheads. The past few years, my acne has fluctuated between mild and moderate, but my skin is still quite oily with huge pores, blackheads, and discolouration. I've tried quite a few products to get rid of blackheads and whiteheads around my t-zone, but only salicylic acid has helped to a degree (reduced their appearance a bit, but hasn't removed them).

For about 3-4 months before seeing the doctor, I suddenly starting getting deeper larger (cystic?) pimples in and around my t-zone, which, unlike my previous acne, take a long time to heal and leave deep scars. Even though I've only been getting 1-4 of these at a time, they've made me even more depressed than usual about my skin and it finally occurred to me to see the doctor.

I've read about the initial breakout with tretinoin, so I've started with applying it every 2 days and will eventually up it to every night. Application 1 didn't appear to have any effect, except maybe a bit of peeling on my nose but my nose is always peely! I'm concerned about the fact that I have the cream- my doctor told me that she was prescribing the gel because my skin is oily, but I believe wrote it down wrong. I plan on asking the dermatologist for the gel, but it could be months before I can get an appointment. Could this make my acne/congestion worse? Should I worry about the IB, since 0.01% is so low?

Also, does anyone has any recommendations for moisturizers with spf in them? I've tried Neutrogena spf 30 and cetaphil oil control spf 30, but both make my skin really oily.

I'm very nervous, so any advice would be much appreciated!

Today was application 2 (aka Day 4). My face tingled for a couple of seconds after putting it on. I've noticed that it almost immediately makes my face very oily, which doesn't really matter before bedtime I guess. It also makes my blackheads look more prominent than usual :(

#2 Garrettryan

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Posted 17 January 2013 - 01:41 AM

The cream isn't really meant for acne prone skin, its usually prescribed for people that are older and have more wrinkle prone skin. If there is anyway you could just call your doctor and say that she wrote down your prescription wrong, she would probably have the pharmacy called for you and the problem corrected! I know personally that the cream just made my skin feel oily, and I eventually switched to the gel which I'm on right now (0.025%). Also you have to watch for the cream having the comedogenic ingredient "isopropyl myristate" this can clog your pores and make acne worse. I would seriously try to get your hands on the gel, give your doctor a call, if she made a mistake I'm sure she will correct it for you.

As for the peeling, it started for me after the 3rd application, believe me, its coming ;p and you are right to start out slowly, and see how your skin reacts to it... if you find you aren't getting enough peel, then you should bump up to the 0.025% gel, and then see how that goes. With tretinoin you should be frequently getting a small peel on your face to know its working.

If you have any question at all, feel free to ask, or message me if you like!

Hope this helps (:

#3 gxtirby

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Posted 17 January 2013 - 02:25 PM

Thanks so much for your input! I go to school in a different province so I doubt that I'd be able to fill a new prescription here. I'll probably just hold tight with the cream for another month and a half until I can see the dermatologist - maybe the cream will prepare my skin for harshness of the gel?

Week 1, Day 5 is still somewhat anti-climactic. Woke up with an extremely oily face from the cream but still almost no peeling.

#4 tracy521

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Posted 17 January 2013 - 03:16 PM

i am surprised you aren't peeling the 0.01% is the strongest stuff! i used to peel like crazy with that and the 0.05%. I am now just starting to use the 0.025% so i hope that my skin will be ok with it. i think you will get good results with the stronger one though thats for sure!

#5 gxtirby

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Posted 17 January 2013 - 04:25 PM

Actually, I think the 0.01% cream is the weakest one available. The 0.1% is the strongest stuff!

#6 tracy521

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Posted 17 January 2013 - 09:39 PM

hmm i didnt think there was anything lower than 0.0025% but i could be wrong.

Edited by tracy521, 17 January 2013 - 09:39 PM.


#7 gxtirby

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Posted 20 January 2013 - 10:49 PM

I didn't realize there was a 0.0025% as well! I think 0.01% is the lowest Stieva-A cream available.

Week 2, Day 1 - Was perplexed to find two tiny red scaly patches in opposite corners of my face this morning. I put cream on them and they seem to have gone away. I've had a big cyst on my forehead for at least a week now that won't heal. The tretinoin flattened it out but it's darkened and I'm worried it will scar. Also scars from blackheads and pimples on one side of my face are slowly healing. Still no visible difference to skin texture or blackheads - guess it's too early.

I'm planning to move up to every other day because I'm not seeing much effect. Any suggestions for a non-greasy moisturizer with 30+ spf? Anyone?

#8 gxtirby

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Posted 23 January 2013 - 11:40 PM

Week 2, Day 5 - I started peeling yesterday and decided to start applying every other day next week.  I woke up this morning with three smallish pimples around my mouth (very odd place to get them) and one on my cheek.  The timing is pretty terrible, since I have a wedding to attend this weekend, but they at least don't seem to be cystic.  Haven't worn sunscreen the past two days, which I know is really not a good idea with tretinoin.  I just can't bear to when it's -30 degrees celsius outside and snowing.   



#9 gxtirby

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Posted 27 January 2013 - 12:16 PM

Week 3, Day 1 - I've started peeling around my jawline and the right side of my face near the hairline.  The right side is also kind of red and irritated with a few small pimples - I'll try to avoid this area for a bit when applying the tretinoin because I've never broken out badly there before.  I've also been putting cetaphil moisturizer on those areas before the neutrogena spf 30, in an attempt to counteract the peely-ness.  Otherwise, not much change to skin texture or blackheads.  Maybe my skin feels a little more fragile?  The bump from the huge cyst on my forehead (appearing approximately two weeks ago) is still refusing to go away... definitely abnormal.

 

If anyone is curious, my daily routine goes something like this:

Morning

Wash with Cetaphil gentle cleanser

Gently exfoliate t-zone and peely areas with Olay 2-in-1 Daily Facial Cloths (the ones for combination/oily skin)

Apply Cetaphil DailyAdvance Ultra Hydrating Lotion

Apply Neutrogena moisturizer, spf 30 (most of the time)

Evening

Wash in shower with Cetaphil gentle cleanser

Wait 30 minutes for face to dry and apply tretinoin 0.01% cream

or, on nights when I don't use the tretinoin, I just apply some Cetaphil Lotion to the dry areas of my face



Also, I should admit that I wear foundation, which I know is bad for my skin and probably contributes to the breakouts.  One of my main goals in using tretinoin is to stop wearing foundation every single day.  Not only does it most likely make my skin even more oily and congested than it already would be, it makes me feel like an imposter.  Ultimately, I am hoping to a) have clear enough skin to not need foundation and b) stop caring caring about my skin enough to not need foundation.  In fact, either one would be great.


Edited by gxtirby, 27 January 2013 - 12:08 PM.


#10 gxtirby

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Posted 30 January 2013 - 09:35 PM

Week 3, Day 4 - I've moved up to applying the tretinoin every other night.  My face is now incredibly oily upon waking up!  I've also had some pretty intense peeling on my nose- if nothing, I will come out of this treatment with a kind of ralph fiennes/voldemort look, complete with patchy reptile skin and lack of nose. I think the peeling is somewhat reducing the pores/blackheads on my nose but the oilyness is undoing all this good work.

 

Finally got an appointment with a dermatologist.  The bad news is that it's a month from now.  I plan to persevere with the cream until then, assuming that its effects will at least provide some clue about my skin problems.



#11 gxtirby

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Posted 04 February 2013 - 10:34 PM

Week 4, Day 2 - Not as much peeling going on right now, probably because I've been heading it off with moisturizer.  Since I switched to applying every other night, my skin has felt a bit fragile and sensitive, and maybe a bit smoother in some areas.  I can feel a really big cyst emerging on the side of my face, and a couple of small ones have popped up in the middle of my face.  I've been a lot better about not touching/picking at my face this week.  Some days are better than others in terms excessive worrying about how bad my skin looks, especially with the oiliness.



#12 gxtirby

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Posted 11 February 2013 - 01:17 AM

Week 5, Day 2 - Everything in general is still okay but my nose is quite red and irritated by the sporadic peeling.  I also have peeling patches around my mouth and jaw that defy all moisturizers.  Some small-moderate pimples have appeared that don't seem to culminate in anything but just slowly die away, leaving red marks.  I'm increasing my applications to every night from now on, so bracing myself for some more intense breakouts/results!



#13 gxtirby

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Posted 24 February 2013 - 01:33 PM

Week 7, Day 1 - It's been a while since I last posted.  I'm starting to see some definite improvements, especially in the enlarged pores around my cheeks.  The constant splotchiness that I've had in this area also seems to be reduced.  I haven't had a single cyst for at least a week now! 

 

On the negative side, my forehead has been breaking out with medium-sized bumps that don't come to a head, and hence don't go away.  I also woke up yesterday with a couple of red scratch marks on my face that are slowly healing - my face is so fragile now that I must have done it while unconsciously itching!  The largish blackheads on my nose are definitely much smaller now, but still dark and visible enough to bother me.  I'm planning to ask the dermatologist for either a higher % of the cream, or to switch to the gel.  If I get the cream, it still might not clean out my blocked pores as well as the gel and continue to make my skin oily, but I'm worried that the gel will be very irritating.  I definitely don't want to go back to square one.



#14 skinnie

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Posted 02 March 2013 - 11:17 PM

You should read this: http://www.acne.org/...g/#entry3253334

 

These are my tips for using Tazorac, which is a retinoid like retin-a. If I were to post a fleshed out answer to this thread, it would say exactly what I've already written. So if you want my advice, read the post above!

 

BTW, I have oily skin too (really oily), but I had more success with the cream. Retinoids dry out your face like nobody's business. They are vitamin A derivatives in a topical lotion or gel form -- accutane is oral vitamin A. Retinoids like retin-A and Tazorac are usually the option right under accutane. Does that put it into perspective as to their strength? 

 

I've been using Tazorac for a year to treat cystic acne, and I have had great success with it, with few initial breakouts! The key is to go slow and be gentle. 

 

Good luck! 

 


Edited by skinnie, 02 March 2013 - 11:20 PM.


 Current Regimen: 
AM: 

Olay Foaming Cleanser for Sensitive Skin 

DHC Water Base Moisture  (A LIFE SAVER for Chicago winters!!!) 

1 pumps CeraVe PM

Aczone or Tazorac (alternate days) 
Olay Age Defying Daily Lotion for Sensitive Skin, SPF15

MAC Studio Sculpt in NC42

 Night 
Swipe with Neutrogena Rapid Clear Treatment Pad or Paula's Choice 2% BHA Liquid

Wait 30 minutes to a couple hours 

Olay foaming cleanser for sensitive skin 

DHC Water Base Moisture

1 pumps CeraVe PM

Dan's BP (every other day) - pea size

 

 

 
 

#15 gxtirby

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Posted 20 March 2013 - 07:34 PM

Episode II: Attack of the Comedones

 

Week 10, Day 4 - It's been almost 10 weeks since I first started using tretinoin.  Sorry for the lapse in updates - I've been swamped with school work.  Unfortunately, I started breaking out about 2 weeks ago, with some huge pimples on my cheeks and even on my nose, which is unusual.  There are also a couple of bumps on my cheeks that aren't inflamed but won't go away.  Of course, now that I'm breaking out, the cycle of picking at my face and then breaking out has started again.  Ack! 

 

I saw a dermatologist, as opposed to my usual doctor, for the first time right before this breakout and she prescribed me 0.1% Differin gel after barely looking at my face.  I've decided to stay with the 0.01% tretinoin cream at least until the end of the month because 1) I want to give the tretinoin the full 12 weeks in case any new improvements emerge and 2) I'm terrified that the initial breakout will be bad, especially considering that it's a gel rather than a cream.  Does anyone have any advice about switching retinoids?  My face is really oily so the gel might be a better option.  I also have some hyperpigmentation from the pimples that keep appearing on my cheeks.

 

Thanks for your advice, Skinnie!  If I start with the differin, I'll definitely go slowly.


Edited by gxtirby, 20 March 2013 - 07:40 PM.


#16 gxtirby

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Posted 23 March 2013 - 12:13 PM

Week 10, Day 7 - My latest breakouts have all started out as noninflammed smallish bumps on my cheeks.  If I even so much as look at them, they get kind of irritated, turn into small pimples but then rapidly turn into HUGE scabs.  Now I have a lot of big shiny red marks on my cheeks where they're healing.  I also have a couple of weird crusty rashy spots that feel kind of sore.  I can't even tell whether underneath all of this there's been any improvement to my skin texture.  Had to really force myself to leave my apartment the past few days....



#17 gxtirby

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Posted 29 March 2013 - 12:47 PM

Week 11, Day 6 - The redness from breaking out all over my cheeks is fading pretty quickly- maybe the work of the tretinoin finally?  I still have a ton of brown marks where the pimples were and some still seem to be inflamed underneath the scabs. Ugh.  I really do think the tretinoin is helping reduce/shrink the blackheads on my nose.  Also, I've decided to ask for a higher concentration of the tretinoin cream next time I go to the doctor, as opposed to going on differin.  The cream seems to be working for me, but not fully unblocking the pores on my cheeks and nose. 

 

Please, can anyone recommend either a moisturizer with spf or a sunscreen?  My skin tends to be oily so something light would be nice.



#18 gxtirby

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Posted 13 April 2013 - 09:23 PM

Week 13, Day 7 - I'm praying that this breakout is finally over, though I did wake up with another pimple on my cheek.  I still have red marks and some brown ones (PIH, I'm guessing?) from several weeks ago.  It's especially frustrating, as I'm used to acne marks healing pretty quickly from breakouts because of how oily my skin is.  I've been using lemon juice to try and lighten the discolouration, which seems to be helping.  Even the tiniest clogged pore is leaving a mark that lasts for weeks! 



#19 gxtirby

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Posted 22 April 2013 - 11:04 AM

Week 15, Day 2 - My skin seems to be clearing up from the breakout, with only one active pimple (I've completely resisted touching it so hopefully it won't leave a mark).  The marks on my cheeks are healing, albeit very slowly.  Last night, I slathered a lot of tretinoin on my face but it actually seems to have tolerated it well because my face felt really smooth when I woke up this morning.  Overall, then, I have a load of PIH and red marks on my face but there may or may not be some general improvement with texture/pores?  Tretinoin is such a tease.