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OTC topical retinoids are a great alternative to prescription retinoids (Retin A, Tazorac, Differin) for people with mild/moderate acne who find the prescription products too irritating to their skin.

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:


Topical retinoids are irritating to the skin, even the OTC formulations, 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.


Retinoids work against acne 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.)


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 single blackhead can leave you with an ugly 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.


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 the surface layers peeling off. Gentle exfoliation can help get rid of the shedding layer of skin; you can use a soft facial brush or a silica microbead scrub each morning to prepare your skin for the day. BE GENTLE! You can do a lot of damage if you aren't.


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 your consultant you are using topical retinoids; you may need to avoid product use for a week or so before a treatment.


Most OTC retinoids need time to absorb into your skin and do their work. You should apply them to clean, dry skin and wait at least 30-45 minutes before applying moisturizer. Many retinoids degrade in sunlight, so it's best to use them at night.


Retinoids can work really, really well in tandem with AHAs or BHAs, but I don't recommend trying to introduce both at the same time. Your best bet is to start with the AHA or BHA product, and when your skin is fully accustomed to it (in other words, you can use it daily with no drying or irritation!), then start gradually introducing the retinoid. I would recommend using the AHA or BHA product in the AM and the retinoid at night.


Green Cream (my personal favorite) is a retinol gel that comes in three concentrations: Levels 3, 6 and 9. Level 3 is quite mild, and is intended for people with highly sensitive skin. Most people with normal skin can start out with Level 6. Level 9 is quite strong and probably not the best one to start with. I didn't start using Level 9 until I could tolerate Level 6 twice a day. GC is pretty expensive, about $45 - $55 for a one ounce bottle (this will last a month or so, depending on how often you use it). I have bought from www.lindasy.com, www.dianayvonne.com, and www.amazon.com. More information and a message board are available on the product website, www.greencream.com.

Diacneal is made by Avene. It's retinaldehyde-based, which some people prefer to retinol, and contains 6% glycolic acid as well. More readily available in Europe and Canada than Green Cream is.

The Vivant Vitamin A products are also very highly regarded. Check them out at www.betterhealthyskin.com.

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