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LionQueen

Info about retinoids and the initial breakout

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Is it ok to use tretinoin every other night, replacing it with triamcinolone every other day? Or should I just choose one?

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1. What effect, if any, does the weather have on the efficacy of the drug (i.e., humidity, seasonal changes, etc.)?

Personally, the onset of autumn has always been accompanied by breakouts while on Tazorac, even after months and months of clear skin during milder months.

2. Is it possible for the body and, more specifically, the skin to develop a tolerance/ resistance to a retinoid?

Despite tremendous success with tazarotene in the past, the last few go-arounds have ended in disappointment. Currently, I am going into my 8th month on Tazorac, and things are only getting worse. In my experience, this is far, far too long (typically 8-10 weeks). If it worked so well in the past, shouldn't it follow that it would continue to work indefinitely? This is the reason I ask about the possibility of resistance.

The only thing I can find on retinoid 'resistance' with regards to efficacy (there are references out there on retinoid tolerance with regards to irritation)

are discussions of retinoid resistance as cancer treatments. I mentioned earlier in this thread that I believed the method in which retinoids exhibit an anti-cancer/antiangiogenic effect is through expression of RAR-alpha.

The anti-acne/comedolytic effect of retinoids is mostly mediated through RAR-gamma instead. As RAR-gamma is the most prevalent receptors in skin tissues, most believe that RAR-gamma binding of receptors is responsible for the comedolytic and anti-aging effects of retinoids.

Point is, there are many accounts of women who have been using tretinoin since teen years who have very little to no wrinkles in later years. This suggests that efficacy of retinoids (through RAR-gamma) does NOT decrease over time.

However, skin is NOT static. It changes over time. Retinoids can only do so much, their actions don't really change (they bind to receptors, they're simply RAR agonists).

For example:

A woman who's been using retinoids successfully for say 10-20 years will one day notice that she has new wrinkles even though she specifically remembered having erased fine lines a few years back.

Her skin changed over time, retinoid usage cannot possibly stop aging in its track, it can only help whatever the condition the skin is in at the time. This woman can't simply say that her retinoid stopped working because she can't get rid of these new wrinkles as easily anymore.

Now, in the case of acne, that can easily fluctuate depending on mood, weather, and yes, season. The onset of autumn means there's less sunlight. P agnes is sensitive to the blue of the light spectrum. Acne is commonly improved in the summer when there's more sunlight.

What this may mean in your case is that your skin is sensitive to seasonal changes that is independent of the tazorac. But tazorac can't work 100% in all of your skin scenarios.

Meaning, it's probably working, but it has more to deal with during your less-than-ideal conditions.

To answer your question more bluntly....

The weather/humidity does not affect the efficacy of retinoids, but those external factors DO affect your skin.

If I were you I would examine all the factors that may be contributing towards your acne.

Are you female? If so, have your hormones perhaps changed (have you gone on or off bcp)?

Are you wearing cosmetics (suncreen, makeup, moisturizer, maybe even hair products) that may be exacerbating your acne?

Do you use a different cleanser during winter than one during summer months?

Are you more stressed during those times when you break out?

etc, etc..

That's my layman opinion.

Is it ok to use tretinoin every other night, replacing it with triamcinolone every other day? Or should I just choose one?

You can use tretinoin as much as you can tolerate. It's better to err on the safe side though and start slow and conversatively first (think every 2 nights) before increasing frequency.

What I'm more concerned about is your usage of triamcinolone.

Corticosteroids are NOT to be used regularly, certainly should not be part of a routine that alternates with tretinoin "every other night".

Steroids should be used only when needed (ie. skin inflammation), NO MORE THAN THAT.

Long-term regular usage of corticosteroids attribute to skin atrophy.

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Is it ok to use tretinoin every other night, replacing it with triamcinolone every other day? Or should I just choose one?

You can use tretinoin as much as you can tolerate. It's better to err on the safe side though and start slow and conversatively first (think every 2 nights) before increasing frequency.

What I'm more concerned about is your usage of triamcinolone.

Corticosteroids are NOT to be used regularly, certainly should not be part of a routine that alternates with tretinoin "every other night".

Steroids should be used only when needed (ie. skin inflammation), NO MORE THAN THAT.

Long-term regular usage of corticosteroids attribute to skin atrophy.

Uhhh...ok, I had no idea about the Triamcinolone...my derm didn't even tell me it was a steroid, wtf. Thanks for telling me, I've been using it for like a year...should I be worried about that?

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Wow, abbylee, that was incredibly helpful. You made a number of good points and have given me a lot to think about. The idea that it is my skin that is changing and not the efficacy of the Tazorac makes a lot of sense. Knowing that the Tazorac will always do what it's intended to is reassuring. Now I need to look into those external factors you mentioned. I've tried to replicate the regimen that, in the past, was successful. Unfortunately, I haven't been able to reproduce the same amazing results. Back to the drawing board.

I'm off to the derm tomorrow, and I will certainly milk him for as much info as possible. Of primary importance is whether or not I should continue with the Tazorac, despite the setbacks.

Thanks again.

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Waits in anticipation...

Good Morning!!!!!

I just woke up so I'm a little groggy......I'll try my best but I have way more info at work (I'm relying solely on what's in my head).

This is a really good question since many scientists still don't know exactly how retinoids work. Dr. Albert Kligman is the original patent holder on using topical retinoic acid to treat acne (he has done tons of research on this topic, and has 40 years of studies on acne, sebaceous gland function and retinoids).

Anyway. A retinoid is any molecule capable of binding to and activating a retinoid receptor. There are many types of retinoid receptors, RAR-alpha, RAR-gamma, RXR (retinoid-X receptors), and their activation does all different things (cis-13 retinoic acne or Isotretonin acts on the retinoid-X receptor, and can inhibit cellular proliferation....especially of the sebocytes, where as trans-retinoid acid stimulates the other retinoid receptors...as well as the RXR and increases the proliferation of keratinocytes.)....it's not really that simple and the retinoid receptors actually interact with eachother and form heterodimers that control various types of cellular proliferation in epithelial tissue and also in other types of tissue.........

Okay so in the first few weeks of treatment with topical retinoic acid (or other topical retinoid), the skin cells begin to proliferate rapidly. This really only takes a few days to have an effect, but you don't see the effects instantly (although you may feel them). As you already know a retinoid makes skin cells proliferate and desquamate in only 5-6 days (it usually takes a month). This may be why.......but we don't know for sure ....

Physiological and retinoid-induced proliferations of epidermis basal keratinocytes are differently controlled

Within a couple weeks the epidermis thins out. This is when you begin to see the derided initial breakout. Is it really an initial breakout? Is the skin actually purging itself???.....well yes and no.....

You may see after about 2-3 weeks of treatment a bunch of tiny bumps (whiteheads, comedoes, clogged pores, etc). As the skin cells rapidly proliferate inside the pore ducts the microcomedo swells up. At the same time the stratum corneum is becoming thinner. It's usually 8-9 cell layers thick, but by using a topical retinoid it becomes only 4-5 cell layers thick. This happens to the entire epidermis. The granular layer is also smaller and the granules contain less keratin. The proliferating skin cells don't have the chance to become hyperkeratinized as they loose their nuclei and cytoplasm, flatten out and become enclosed in the cell envelope of the corneocyte.

Since the epidermis is thinner the comedoes (which actually form in the dermis), become visible through the thin epidermis.......this also makes you more sensitive to UV radiation.....so wear a good sunscreen...

So what about the inflammatory initial breakout? Some of the comedoes may become inflamed.....if you are prone to inflammatory acne. Retinoids do cause a bit of irritation, and this can induce inflammation. Sometimes the pores are so blocked up that it takes weeks to resolve the comedo, and the bacteria and sebum trapped inside, and the irritation from the retinoid make it a perfect opportunity for a pimple to form. The reason it seems like an initial breakout is because it speeds up the rate of cellular proliferation. Those may or may not have become pimples without the retinoid. But in the worse case scenario you will get about 15 months of pimples in only 3 months.

I have another theory about the initial breakout phenenmon. Since the retinoids thin out the epidermis they cause increased transepidermal water loss. Water in the skin is important to normal desquamation. Water is necessary for the destruction of the desmosomes and tonofilaments that hold the cells of the stratum corneum together. If there isn't enough water present in the skin, the cells don't desquamate properly.....this is why you get flakes .......the cells are stuck together in clumps.......this is bad if it happens inside the pores.......Dry skin is bad for acne, since abnormal desquamation inside pore ducts can cause the formation of comedoes.

An initial breakout can be controlled by using a topical or oral antibiotic in the first 12 weeks of treatment. After that you shouln't need as much bacterial control, since the pores aren't easily blocked and most of the comedoes will have resolved themselves. BP just irritates the skin and increases barrier damage. Moisturizing is crucial on a retinoid, since the epidermal barrier is compromised due to the thinning of the epidermis. A good moisturizer is one that contains about 3-5% glycerin. Glycerin is a great ingredient and really improves the barrier function of the skin, by filling in the extra-cellular matrix between the corneocytes ....and it promotes healthy desquamation of skin cells by drawing water into the skin from deeper dermal tissue and it is known to activate certain genes in the keratinocytes (just don't tell the FDA).

Okay when I get to work I'll look up some more stuff.........

I didn't even mention the effects topical retinoids have on the dermis........they reduce shallow scarring and wrinkles by stimulating the fibroblasts in the dermis to produce Collagen I and III.....which fills in shallow scars and plumps up wrinkles........another reason to stick with it even if the initial breakout makes you think that "this can't be good for my skin".....eventually it will be........

hi labgirl, I'm new here........

My doctor prescribed BP for acne and and Azelaic acid (20%) for the scarrs which I followed for a month .I have used retinoic acid before. I think it works better than azelaic acid.So I've started using retin-A cream now. Can u please tell me which one works quicker?

Do skin pores get clogged while using these creams?Whenever I use any of these I have initial breakouts which makes my skin look worse. How can I get rid of them?Will these go away naturally after a week?

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I just got some samples of Differin. Its been working well (so far. no I.B. [knock on wood]) and I just wanted to know:

I've heard it practically erases red marks, is this true? And how long does it usually take for them to dissapear?

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Hi.

I've used Retin-A .1% Cream last year for a few months but I stopped it due to me getting a lot of inflamed acne. 6 months ago, I started the CSR regimen but it didn't really work out for me because my skin stayed pink and irritated looking. Now, I went to my dermatologist a month ago for solutions and he prescribed me Retin-A Micro,1% and Torazac 6%(I believe this is a prescribed benzoyl peroxide gel). He told me to use Retina-A Micro every night and Torzac every other day in the morning.

Since a month ago, I used Retin-A Micro .1% every night. The first week was great because I didn't get any new pimples and my redmarks/scars were fading. After a few weeks, I started getting small pimples/clogged pores that sometimes became inflamed. Also, my skin was incredibly oily and my face was kind of pinkish on the areas where Retin-A Micro was applied. Because of this, I've stopped using Retin-A Micro for 4 days and only spot treated with Dan's BP gel. Most of my inflamed acne has died. So tonight, I decided to start using Retini-A Micro again. But this time, I'm in need of your help.

First of all, my skin gets really oily in just 3-4 hours from using RAM. The past few days when I stopped using RAM, my skin's oilyness lessened a lot. So I was wondering, to start off right this time, should I use RAM every other night for a week then use it every night from then on? When should I apply RAM, 30mins-1hr after washing my face or after 2 hrs of waiting(what i've been doing for a month)Also, should I apply moisturizer when I use RAM? If so, when should I apply it, like 30mins-1hr after using RAM, and which kind of moisturizer would best suit with RAM without causing irritation or reducing its efficiency? On the other hand, should I ask my derm to reduce the RAM concentration from .1% to .05? Btw, I haven't actually used any Torzac though since my dad hasn't bought it for me yet.

Thank you all for reading and putting in your time. I just want any answer or solution to my problem. Please don't hesitate to input comment or give tips.

Thanks again!

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I've got a question about retinoids...

Just read that retinoids make your skin-cycles (or whatever they're called) go faster. Which means that acne could come faster in the beginning (initial breakout) [up to approx. five times as fast?]. But won't the red marks fade out faster as well?


Oh look! A cute little kitten. Come here... Squash, Caboom. MUAHAHAHAHAHAHAHA


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This is probably the best thread I've read thus far on this site. :clap: Thanks so much LabGirl and abbylee, this was by far the most imformative summary anyone could hope to assemble about retinoids. It's making me want to ask more questions, but I know this is an old thread, so I won't bother... I'll be back at school soon anyway so I'll have better access to reading materials.

So cool. Can't wait to learn more! :dance:

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Moisturizing is crucial on a retinoid, since the epidermal barrier is compromised due to the thinning of the epidermis. A good moisturizer is one that contains about 3-5% glycerin. Glycerin is a great ingredient and really improves the barrier function of the skin, by filling in the extra-cellular matrix between the corneocytes ....and it promotes healthy desquamation of skin cells by drawing water into the skin from deeper dermal tissue and it is known to activate certain genes in the keratinocytes (just don't tell the FDA).

I'm just about to start a course of Differin and am wondering if anyone is using moisturizer and maybe even one that contains glycerine as mentioned above by labgirl.

A couple of questions:

1. what brands do people use?

2. i have differin gel to be applied at night, do i then wash my face in the morning and then apply moisturizer?

Thanks.


Accutane - 4 months @ 40mg per day. Finish in June

Morning - Murad Correcting Moisturizer SPF 15 (Redness Therapy)

Night - Eucerin 10% Intensive Treatment Lotion


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