What are the most frequently asked questions about topical retinoids?

I often prescribe retinoids in my Dermatology practice in Bangalore. Retinoids are my personal favorite as I consider them the game changer in Skin care. Retinoids have the potential to not only help in short term management of pimples but actually revitalize a patient’s face. In this article, I discuss frequently asked questions about retinoids 

Q1) What are retinoids? 
Ans- Retinoids are a group of molecules that are derivatives of Vitamin A or Beta carotene. Stronger retinoids such as tretinoin are prescription medicines, while milder ones like retinol and adapalene are also available over the counter. But to say it, they are a derivative of natural vitamins and hence not a ‘chemical’.

Q2) How do they work and what is their mechanism of action?
Ans- Retinoids have their receptors inside the nucleus of the cell. They bind receptors in the cell nucleus and alter gene expression, changing how the cell behaves. All the changes like acne, pigmentation involve altered signaling in our cell nuclei. This dysfunction is improved or rather regulated by retinoids by changing the DNA of the cell. In a way the results are longer lasting and hence I call it ‘gamechanger’ Following changes happen under your skin when you use a retinoid

1. Decreased inflammation. It is inflammation which is responsible for breakouts, premature ageing and pigmentation.

2. Increased collagen synthesis which has anti-ageing benefits

3. Decreased melanin synthesis

4. Improvement in the blood flow to the skin

Q3) What are the indications of using topical retinoids?
Ans- Topical retinoids can be used for following purposes

1. Acne or pimples

2. Acne scars or Spots left behind by the pimples

3. Pigmentation like melasma, dark spots

4. Fine lines, wrinkles

5. Open pores

6. Premature ageing of the skin

Q4) What do I need to know before using topical retinoids?
Ans- Your Dermatologist has prescribed you a wonderful medicine but it has a journey before it really makes you happy. Retinoids cause flaking of skin, dryness and sensitivity in the first few weeks of application. Hence it is important to follow these steps to manage your skin better-

1. Use a gentle cleanser or face wash as recommended by your dermatologist

2. Avid harsh scrubs or soap for washing face

3. Avoid toners and astringents

4. Avoid vigorous scrubbing with towels or wash cloth.

5. Short Contact Therapy

   • Dab the topical cream and do not rub it on your skin

   • Use a pea sized amount only

   • Dab on the affected area or pimples in the beginning for 5 minutes and then wash off with plain tap water.

   • Observe if any irritation persists in the morning. If your skin looks fine with not much peeling or redness, gradually increase the contact period to 15 minutes. 

   • Increase every three to four days depending on your skin ‘s tolerance

   • Gradually you can keep it overnight as well.

   • After 6 to 8 weeks, dryness usually settles as skin adapts, and benefits continue to build over several months.

   • The benefit is seen even if you do not notice dryness or flaking.

   • If the skin feels too dry, try the Sandwich method where you apply a moisturizer (as prescribed) before you apply the ointment and after washing it off as well.

   • In most of the patients the flaking is manageable with prescription moisturizers.

   • Do not use topical retinoids immediately before the bed. Apply around 7 pm

   • It makes the area under eyes and around the mouth drier, please use a moisturizer in these areas’ multiple times.

   • Avoid under eye area and area around the mouth 




6. Always use a Sunscreen

   • As the skin actually becomes flaky, you may become more sensitive to the sun

   • Apply sunscreen in the morning daily

   • Always apply topical retinoid during the evening hours

   • You can use a sunscreen after applying moisturizer

 

 

 

Q5) How long should I Use the topical retinoid before I see the result?

Ans- As I said Retinoids take minimum 6 to 8 weeks to show results, it is wise to use it continuously. Do not leave it midway as best results are seen after 4 weeks only. 

Q6) Even after using topical retinoids, I can see my breakouts appearing?
Ans- Topical retinoids are helpful to prevent scars which is the side effect of pimples or acne. However, if the skin continues to break out despite using topical retinoids on full face, your Dermatologist will add oral treatments like antibiotics, chemical peels or oral isotretinoin. Acne is multifactorial and can be due to hormonal changes as well. The topical creams will still prevent scars and hence should be continued. They cannot treat the underlying hormonal imbalance which needs to be managed along with. Topical retinoid is the backbone on which other treatments can be added.

 

Q7) Do I see a ‘purge’ of pimples before I see results?
Sometimes on usage, pimples may become bigger before they become better. It is a part of the acne clearance phase. If it is severe, your Dermatologist will prescribe you oral antibiotics to prevent the inflammation. This is not a ‘side effect’ but an expected effect.

Q8) Are they safe to be used while we are planning family or breastfeeding?
Topical retinoids though have not shown any side effects as it is an application. But for patient safety, even topical retinoids are best avoided as oral retinoids can cause birth defects. If you have accidentally conceived while you were ‘applying’ retinoids, do not panic and stop them when you discover your pregnancy. 

Q9) Is it safe to be used for my teenage son/daughter?
Absolutely! It is very important to treat blackheads/ whiteheads to prevent open pore like scars later in life. It can be used in adolescents as advised by a dermatologist, and helps treat blackheads and whiteheads that may otherwise contribute to scarring. We prefer micronized formulations.

Q10) Can I continue using topical retinoids for a longer period of time?
Of course! Topical retinoids are a powerhouse. It will also improve color and decrease pigmentation or brown spots left behind by pimples. It also helps in tightening the skin and has anti- ageing benefits. They are generally well tolerated for long-term use, but should be paused if you become pregnant or if your dermatologist advises. 

 

Q11) what is ‘retinoid holiday’ as you talk about it?
During winters or when you are planning a trekking or beach trip, you can stop topical retinoids for a week to 10 days before. They can make your skin a bit sensitive to sun and also cause excessive dryness in extreme winter.  During this break apply plenty of moisturizer and sun protection. Restart them with ‘short contact therapy’.

Q12) Can topical retinoids be helpful in melasma and pigmentation?
Topical retinoids cause exfoliation of the upper layers of the skin and also decrease melanin synthesis. In a middle-aged patient or the one who has signs of premature ageing, retinoids will give more benefits compared to conventional skin lightening agents. Retinoids can be a useful adjunct in melasma, usually combined with other agents under dermatologist supervision.

Q13) Please tell if any additional precaution can be used?
If you are planning a medifacial, chemical peel or laser treatment, you can stop the creams one week before as excessively dry skin can experience side effects and does not tolerate procedure well. 

Please consult your Dermatologist or/and her team to discuss the benefits and achieve a flawless, radiant skin which is pimple and blemish free. Patience and Persistence is the key!

I often prescribe retinoids in my Dermatology practice in Bangalore. Retinoids are my personal favorite as I consider them the game changer in Skin care. Retinoids have the potential to not only help in short term management of pimples but actually revitalize a patient’s face. In this article, I discuss frequently asked questions about retinoids 

Q1) What are retinoids? 
Ans- Retinoids are a group of molecules that are derivatives of Vitamin A or Beta carotene. Stronger retinoids such as tretinoin are prescription medicines, while milder ones like retinol and adapalene are also available over the counter. But to say it, they are a derivative of natural vitamins and hence not a ‘chemical’.

Q2) How do they work and what is their mechanism of action?
Ans- Retinoids have their receptors inside the nucleus of the cell. They bind receptors in the cell nucleus and alter gene expression, changing how the cell behaves. All the changes like acne, pigmentation involve altered signaling in our cell nuclei. This dysfunction is improved or rather regulated by retinoids by changing the DNA of the cell. In a way the results are longer lasting and hence I call it ‘gamechanger’ Following changes happen under your skin when you use a retinoid

1. Decreased inflammation. It is inflammation which is responsible for breakouts, premature ageing and pigmentation.

2. Increased collagen synthesis which has anti-ageing benefits

3. Decreased melanin synthesis

4. Improvement in the blood flow to the skin

Q3) What are the indications of using topical retinoids?
Ans- Topical retinoids can be used for following purposes

1. Acne or pimples

2. Acne scars or Spots left behind by the pimples

3. Pigmentation like melasma, dark spots

4. Fine lines, wrinkles

5. Open pores

6. Premature ageing of the skin

Q4) What do I need to know before using topical retinoids?
Ans- Your Dermatologist has prescribed you a wonderful medicine but it has a journey before it really makes you happy. Retinoids cause flaking of skin, dryness and sensitivity in the first few weeks of application. Hence it is important to follow these steps to manage your skin better-

1. Use a gentle cleanser or face wash as recommended by your dermatologist

2. Avid harsh scrubs or soap for washing face

3. Avoid toners and astringents

4. Avoid vigorous scrubbing with towels or wash cloth.

5. Short Contact Therapy

   • Dab the topical cream and do not rub it on your skin

   • Use a pea sized amount only

   • Dab on the affected area or pimples in the beginning for 5 minutes and then wash off with plain tap water.

   • Observe if any irritation persists in the morning. If your skin looks fine with not much peeling or redness, gradually increase the contact period to 15 minutes. 

   • Increase every three to four days depending on your skin ‘s tolerance

   • Gradually you can keep it overnight as well.

   • After 6 to 8 weeks, dryness usually settles as skin adapts, and benefits continue to build over several months.

   • The benefit is seen even if you do not notice dryness or flaking.

   • If the skin feels too dry, try the Sandwich method where you apply a moisturizer (as prescribed) before you apply the ointment and after washing it off as well.

   • In most of the patients the flaking is manageable with prescription moisturizers.

   • Do not use topical retinoids immediately before the bed. Apply around 7 pm

   • It makes the area under eyes and around the mouth drier, please use a moisturizer in these areas’ multiple times.

   • Avoid under eye area and area around the mouth 




6. Always use a Sunscreen

   • As the skin actually becomes flaky, you may become more sensitive to the sun

   • Apply sunscreen in the morning daily

   • Always apply topical retinoid during the evening hours

   • You can use a sunscreen after applying moisturizer

 

 

 

Q5) How long should I Use the topical retinoid before I see the result?

Ans- As I said Retinoids take minimum 6 to 8 weeks to show results, it is wise to use it continuously. Do not leave it midway as best results are seen after 4 weeks only. 

Q6) Even after using topical retinoids, I can see my breakouts appearing?
Ans- Topical retinoids are helpful to prevent scars which is the side effect of pimples or acne. However, if the skin continues to break out despite using topical retinoids on full face, your Dermatologist will add oral treatments like antibiotics, chemical peels or oral isotretinoin. Acne is multifactorial and can be due to hormonal changes as well. The topical creams will still prevent scars and hence should be continued. They cannot treat the underlying hormonal imbalance which needs to be managed along with. Topical retinoid is the backbone on which other treatments can be added.

 

Q7) Do I see a ‘purge’ of pimples before I see results?
Sometimes on usage, pimples may become bigger before they become better. It is a part of the acne clearance phase. If it is severe, your Dermatologist will prescribe you oral antibiotics to prevent the inflammation. This is not a ‘side effect’ but an expected effect.

Q8) Are they safe to be used while we are planning family or breastfeeding?
Topical retinoids though have not shown any side effects as it is an application. But for patient safety, even topical retinoids are best avoided as oral retinoids can cause birth defects. If you have accidentally conceived while you were ‘applying’ retinoids, do not panic and stop them when you discover your pregnancy. 

Q9) Is it safe to be used for my teenage son/daughter?
Absolutely! It is very important to treat blackheads/ whiteheads to prevent open pore like scars later in life. It can be used in adolescents as advised by a dermatologist, and helps treat blackheads and whiteheads that may otherwise contribute to scarring. We prefer micronized formulations.

Q10) Can I continue using topical retinoids for a longer period of time?
Of course! Topical retinoids are a powerhouse. It will also improve color and decrease pigmentation or brown spots left behind by pimples. It also helps in tightening the skin and has anti- ageing benefits. They are generally well tolerated for long-term use, but should be paused if you become pregnant or if your dermatologist advises. 

 

Q11) what is ‘retinoid holiday’ as you talk about it?
During winters or when you are planning a trekking or beach trip, you can stop topical retinoids for a week to 10 days before. They can make your skin a bit sensitive to sun and also cause excessive dryness in extreme winter.  During this break apply plenty of moisturizer and sun protection. Restart them with ‘short contact therapy’.

Q12) Can topical retinoids be helpful in melasma and pigmentation?
Topical retinoids cause exfoliation of the upper layers of the skin and also decrease melanin synthesis. In a middle-aged patient or the one who has signs of premature ageing, retinoids will give more benefits compared to conventional skin lightening agents. Retinoids can be a useful adjunct in melasma, usually combined with other agents under dermatologist supervision.

Q13) Please tell if any additional precaution can be used?
If you are planning a medifacial, chemical peel or laser treatment, you can stop the creams one week before as excessively dry skin can experience side effects and does not tolerate procedure well. 

Please consult your Dermatologist or/and her team to discuss the benefits and achieve a flawless, radiant skin which is pimple and blemish free. Patience and Persistence is the key!