Before entering the field of skin care, I was once told by a dermatologist that the two most important skin care products to use are sunscreen and tretinoin. Tretinoin is the scientific name for concentrated Vitamin A. Many physicians believe that tretinoin (as opposed to retinol, another form of Vitamin A) is possibly the strongest anti-aging ingredient currently available due to its ability to build collagen and even correct past cellular DNA damage. I have been using tretinoin for years, and recommend it to almost all of my patients (who do not have contraindications, of course). I have personally seen the difference it makes in my own skin and in the skin of my patients, and seeing is believing.
While tretinoin can do wonders for one’s skin, it is a tricky product to use. Because it is so concentrated and “active,” many patients experience some “backlash” from their skin in the initial days to weeks after beginning use of the product. Specifically, because tretinoin works to resurface the skin in a sense, it can cause skin flaking and irritation. In fact, what is actually occurring is the shedding of the outer layers of skin, but patients often mistake this to be simple “dryness,” and many stop using the product because of the initial side effects. Once a patient’s skin has a chance to get used to the product, the side effects will subside. It is important to continue using the product so that it can truly work and make change in the skin.
It is recommended to use tretinoin at night while the skin is in “repair mode.” Dr. Zein Obagi, world famous dermatologist and creator of the Obagi skin care line, was an advocate of twice daily usage of tretinoin, but many patients felt their skin could not tolerate this strong dose of Vitamin A. Most physicians believe that nightly use is optimal, but if patients can only use the product a few times a week (in the case of patients with extremely dry or sensitive skin), it is still able to deliver many skin benefits.
I often recommend patients start by using tretinoin every other night to begin with. If after a week side effects are minimal, patients may increase to using the product every night. If a patient cannot tolerate every other night, I recommend using the product every two nights, or even every three nights if extreme sensitivity occurs. Using moisturizer twice daily will also help combat side effects. In the morning, moisturizer and other skin care products may be applied as normal. At night, I recommend applying moisturizer first and waiting five minutes before applying tretinoin. This is to ensure the product is able to penetrate deep within the cells to correct damage and build collagen.
The amount of tretinoin used should be about the size of a dime. It is unnecessary to apply a large amount of product that will only sit on the skin surface without traveling through the epidermis to the dermis, and that will almost certainly cause irritation. A dime size amount is enough to get all of the benefits tretinoin has to offer.
It is very important to wear sunscreen on a daily basis, but even more so when using tretinoin. Because it thins out the stratum corneum (outer layer of skin), the skin’s partial natural barrier to the sun is decreased, making skin more susceptible to sun damage.
If you are interested in using tretinoin, make sure to consult with a licensed skin care professional for instructions on how to use the product. It is also important to consult with a dermatologist or physician first to make sure no contraindications are present.
