Adult acne is usually more inflammatory than teenage acne. Medicated cleansers and drying agents irritate the skin, and for many women the side effects aren't worth pushing through and leave them unhappy with their skin. What makes adult acne different? Older skin. Teenage skin, though oily and reactive, is more resilient than adult skin and tends to tolerate harsher treatments.
Typically adult acne is brought on by a sudden hormonal fluctuation. This triggers excessive sebum production. The pores get clogged quickly for one of two reasons. They either aren't large enough to let the impaction through or a slowed cell turnover rate leaves dead cells in the follicle, which makes a clog inevitable.
Adult acne and teenage acne are both caused by excess sebum, but you wouldn't know it from looking at the surface of the skin. Because the oil is trapped inside the follicle instead of lubricating the surface of the skin, many women mistake dehydration or a damaged barrier function for a dry skin type. Moreover, many women have dry, flaky patches scattered amongst their papules and pustules.
Assuming that acne imposters aren't at fault and that we've handled the necessary lifestyle factors, adult acne deserves a special plan of attack. Benzoyl peroxide and overcleansing can accelerate damage and add to irritation. This often makes acne even worse and damages the barrier function.
I've posted an article on anti-aging tips, which you can check out at the link below:
Top Ten Anti-Aging Tips for Acne Prone Skin
Another option is available only by prescription and is highly successful in boosting collagen production while treating comedonal acne. Retin-A (tretinoin) comes in several strengths and formulas, which can be determined by your doctor. Developed in 1967, this miracle drug is loved for its cosmetic benefits, as well as its effectiveness in managing skin disorders. However, Retin-A is available by prescription only. Other brands use similar-sounding ingredients, but no product available in stores affects the skin like tretinoin does.
As with any prescription, you should always follow your doctor's instructions precisely, which may differ from what I discuss below. Your doctor may also decide that Retin-A is not best for your particular acne or combine it with another medication.
Unfortunately Retin-A is often misunderstood, causing many to have negative experiences with the medication. When used correctly, it is generally well-tolerated, although side effects can occur--especially at first. However, some people with delicate skin cannot tolerate this treatment.
Your doctor will instruct you on how you should use the specific product he or she prescribes. The routine I describe is based on my own experiences and is consistent with the general guidelines for proper use. You may also look over the FDA's literature by clicking here.
Retin-A is essentially Vitamin A. More specifically, it's a topical version of retinoic acid, which is what differentiates it from the Vitamin A you see listed on moisturizers. For some bizarre reason that scientists don't fully understand, retinoic acid accelerates the rate of cell turnover on the skin. Since an abnormal cell turnover rate is often responsible for the congestion at the root of acne, this can solve the acne dilemma with diligent, careful use. Retin-A is not a spot treatment, and it doesn't fix your skin overnight.
You must be patient with Retin-A. Many people give up too soon. Your skin will not clear for about six to nine weeks of treatment, and the first two weeks are unpleasant for some. During your appointment, your doctor may be willing to perform an in-office procedure like a cortisone shot(s) to jump start results. Regardless of whether you elect for any immediate results, Retin-A will help you prevent future acne and clear any congestion inside the follicles.
Retin-A can cause drying, flaking, redness, and irritation as the skin begins to shed itself. Moisturizers can help reduce symptoms, but Retin-A must be used very specifically to even be effective.
Unlike AHAs and BHAs, retinoic acid actually redesigns the structure of the skin, making it look and act younger. In addition to a rapid cell turnover rate, Retin-A also stimulates fibroblasts in the dermis to produce more collagen. This provides firmness to the skin, as well as wrinkle reduction. The dryness you experience upon initial use is usually temporary. Often oilier skin are unaccustomed to depending on moisturizers, but don't resort to heavy creams. A water-based fluid with calming ingredients is often sufficient.
It is also imperative that you discuss any beauty services you plan on receiving with both your doctor and those actually performing them. Many facial treatments cannot be used on Retin-A clients or will need to be customized for you. Waxing services are notorious for causing damage to Retin-A users because the top layer of the skin is known to come off along with the unwanted hair. It is not uncommon for you to be asked to stop your medication 48-72 hours before receiving an esthetic service. This disruption may affect the outcome of your treatment.
Sunscreen is not considered optional while using Retin-A. Daily SPF is required, and you must remember to take extra precautions when spending time outdoors. Sunscreen must be reapplied every two hours, and protective clothing often is also necessary. If you experience a sunburn of any kind while using Retin-A, you must wait for the skin to heal before resuming treatment.
Though redness is a commonly reported side effect, you should report it to your doctor if your skin feels tender and irritated. Some people do not recognize an actual burn they're experiencing within the first few weeks.
Unless you have been instructed to do so, you must stop all other acne medications when you begin Retin-A. For many, this means throwing out the old products and starting from scratch. If you want to customize your routine, partner up with your doctor to do so. Aside from the damage misuse of this medication can cause, it is a shame to make careless choices with your skincare that could change the product's effectiveness. Retin-A is chemically unstable. The active ingredients found in most other acne medications or exfoliators will make the medication ineffective.
It is best to begin your Retin-A treatment slowly because otherwise the skin can become so irritated that you must discontinue use. Typically clients begin incorporating Retin-A into their nightly routine three nights out of the first week. If well-tolerated, Retin-A can be used every other night during the second week. Your particular treatment may vary, but most dermatologists suggest starting slowly until you can comfortably use the product nightly.
Some doctors recommend using Retin-A both morning and night, but this is decreasing in popularity--especially with female patients. I personally have witnessed better results from nightly applications in myself and others, but I don't write the prescriptions.
Retin-A should be applied to clean skin. Only use a mild, nonmedicated cleanser during your nightly routine because a plethora of common ingredients are contraindicated. Most dermatologists suggest using Cetaphil, which is readily available. However, many clients complain that Cetaphil does not provide a sufficient cleansing for them. Substituting other cleansers is more problematic than you may think because many botanicals, menthol, and AHAs/BHAs are not options. One client of mine asked for alternatives she might use that do not contain sulfates, and I had to rule out over fifty "mild cleansers" before I found some she might like from the Sephora website. (Literally fifty.) A few that I have found include:
- First Aid Beauty Face Cleanser
- Laura Mercier Flawless Skin One-Step Cleanser
- Laura Mercier Flawless Skin Oil-Free Foaming One-Step Cleanser
- Kinerase Gentle Daily Cleanser
Using a toner during your nightly Retin-A routine is a waste of time, in my opinion. I suggest using a cleanser that is designed to function without one. Combined with a good makeup remover, your cleanser should rinse easily with warm water and leave behind no residue. As you are rinsing, you may want to switch to slightly cooler water to enjoy a more freshening effect.
Pat skin dry with a clean towel, then wait a minimum of twenty minutes before applying the Retin-A. Some dermatologists suggest waiting even longer. This sounds silly to most people, but it's an essential direction. Your skin must be completely dry before you use Retin-A and oily skins especially cling to more hydration that you can't feel. Moreover, the friction of cleansing can often stimulate blood flow that can make you more prone to a reaction. Set a timer if you have to, but don't rush to the next step.
Wash your hands with soap and water immediately before applying Retin-A. Aside from being hygienic, you don't want to destabilize the product. Apply no more than a pea-sized amount to evenly cover the face and onto the neck. Retin-A is not a spot treatment, and you always want to lean on the side of caution. Unfortunately some tubes dispense out more than needed, so always look at how much product you're using. Resist the temptation to overmedicate. This is the number one Retin-A mistake. Unless your doctor tells you otherwise, you should never reapply after you've dispersed the product. The product should feel weightless and look invisible.
I suggest dotting the product onto the forehead, cheeks, and neck, then spreading to the rest of the face. Avoid the eye area, and be sure not to get inside the lips or nostrils. You should also use as little as possible on the chin and upper lip because this area is the most prone to irritation. (This is why I don't recommend dotting the product onto the chin area.)
Wash your hands immediately after applying. Ignoring residue on your hands may result in accidentally wiping more product than desired on the skin or (worse) getting the product into the eye.
Leave the product on the skin for one hour before applying any moisturizer. Again time is important. And check the ingredients. Many acne sufferers don't need to moisturize, but even some of the oiliest skins may face some dryness. Anti-inflammatory ingredients like aloe, chamomile, and green tea can help soothe redness and irritation.
Hydrating at night will also make flakiness less apparent during the day. Choose an oil-free product unless instructed otherwise.
Your morning routine isn't nearly as strict. Your doctor may recommend using another topical product or chemical exfoliant at this time, but any morning routine must include another cleansing and sunscreen without exception. Blue Lizard, Bullfrog, Dermalogica, Clinique, DDF, Neutrogena, and Coppertone all have sheer broad spectrum SPF 30 products specifically designed for the face. Apply your sunscreen as your daily moisturizer to minimize that greasy feeling sunscreens can leave. You may want additional hydration if dryness or peeling are bothersome.
After using Retin-A for several weeks, most people's only side effect is flakiness. Some flaking is inevitable, since Retin-A causes the skin to literally shed. This is normal and is not the same as dryness.
Many people find that a gentle physical exfoliant cuts down on the flaking. Only introduce a scrub once your skin is no longer inflamed from acne or irritation. My personal top choice is Kinerase PhotoFacials Daily Exfoliating Cleanser. The granules in this product are rounded and almost melt into the cleanser, but it provides consistent results that you can use in the shower every morning without irritation. Dermalogica, Shiseido, Clarins, and Clinique all offer other options with microbeads in various strengths. Avoid scrubs that contain seeds with uneven edges or anything that feels scratchy.
A facial cleansing brush like any of the popular Clarisonic models can also help remove any visible signs of the shedding process. I suggest using the "delicate" brush head if you choose to use this method of cleansing.
Some say that Retin-A causes an initial "purging", but this is often misconstrued. You should not experience any new lesions after the first few days of treatment. (Within the first day or so is coincidence.) Retin-A will push the clog to the surface, so some blemishes may appear larger than before you started your treatment. You may also notice congestion you might not have been able to see as easily before, but any bumps covering large areas are not normal and could be a reaction if seen within the first few week. Though you may be less satisfied with your skin's overall appearance during the initial side effects, the acne itself should not worsen. Swelling or redness may fool the eye, so concentrate on soothing any inflammation instead of attempting to spot treat the lesions.
New breakouts could also occur from suddenly stopping other acne medications that may have been starting to work. Ask your doctor for instructions on stopping other treatments.
Those with very sensitive skin may need to use Retin-A less frequently. Some doctors suggest applying Retin-A to the skin for only fifteen minutes, then rinsing it off when first used nightly. Discuss this option with your doctor if leaving it on overnight is too uncomfortable.
Retin-A stands apart in the treatment of adult acne because unlike other acne treatments, it gives you beautiful skin in addition to curing your breakouts. Whether you choose Retin-A or not, your adult acne deserves more than kid stuff, so partner up with a dermatologist or esthetician to conquer that complexion.
Retin-A tips anyone?