Topical Retinoids for Acne – Dr. Poole

Dr. Jeffrey Poole Metairie

By Dr. Jeffrey C. Poole, M.D., FAAD

Metairie, Louisiana 70005

Physician, Dermatology

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Topical retinoids (Differin®, Epiduo®, Retin-A®, Tazorac®, …. etc) are a must in most all acne treatment regimens.

They are part of the foundation for most acne treatment. All acne lesions start as a clogged pore (comedone), and effective acne therapy requires the removal of this clogged orifice (comedolysis). Retinoids continue to be our most effective topical medicines for this. Additionally, they have anti-inflammatory properties that further help to decrease the red pimples and pustules of acne.

The first 1-2 months of starting any retinoid will be an adjustment period for your skin. Most people’s skin will get dry, red, and mildly irritated. For some people, this can be quite severe. I tell my patients to follow these steps:

  1. At night, after brushing your teeth, wash your face and pat dry. Sunlight may breakdown retinoids, so they are best to apply at night. I find medicine spreads easier and is less irritating on moist skin.
  2. While your face is still moist, apply a small “finger tip” amount of medicine in small dots around the face, then spread over the whole face to a thin film. Be careful to avoid the sensitive skin under the eyes, next to the nose, and the in corners of the mouth.
  3. After rubbing the medicine in well, apply a moisturizer of your choice. Reapply the moisturizer in the morning, along with a daily sunscreen.
  4. If you find your skin becoming very irritated, hold the medicine for a few days, then start applying it only 2-3 times per week. Increase application by 1 day per week every few weeks as tolerated. For patients with sensitive skin, I often start them at this 2-3 times per week regimen.
  5. For some very sensitive skin, we may use short contact therapy. This means applying the medicine for 15 minutes before washing it off, and slowly increasing over time as tolerated.

Remember — this is medicine, not magic. Acne may initially get a little worse in the first 2-4 weeks of treatment. Continued improvement may occur for up to 4-6 months! So be patient and persistent!

Many people may become dry, red or peeling during the first 1-2 months until they fully adjust to the retinoid. This is a sign of the medicine working effectively. Be sure to moisturize regularly with a ceramide containing moisturizer (such as Cerave®, Cetaphil Restoraderm and Aveeno® Eczema Therapy).

Visit Dr. Jeffery Poole’s website at Poole Dermatology.