RX Retinoids: The Drawbacks
In the last article we discussed the benefits of retinoids, the remarkable prescription creams that can marshall your cells back into tip-top functionality. As usual, you don't get something for nothing. Payback takes several forms:
Irritation
Retinoids – and specifically prescription-strength retinoids, are often irritating. Compliance is a big issue with Retin-A because of this irritation, usually in the form of redness and flaking. There are several half-used tubes of Retin-A languishing in medicine cabinets all over the world. What often isn’t stressed to the patient is this ‘breaking in’ period will last about four to six weeks, and then will subside. Redness and flaking shouldn’t last longer than that, although light redness can persist.
The potency of prescription retinoids can be stepped up gradually. The patient can be started on a lower concentration, and use it every third night, then after a week, every other night, etc. It’s not always necessary or desired to jump right into the highest potency and frequency.
Increased Redness, Visible Vessels
Retinoids are stimulating, so much so that they can cause vessels to swell with the higher demand for blood. It’s not uncommon for patients to notice telangectasia – tiny vessels - to form while on a retinoid regime. Not a lot we can do about this, except recommend another treatment to zap the vessels.
Over- Eager Sloughing
In my experience, skin is a little more fragile on a retinoid regime – it breaks a little more easily, scabs form more easily (good picking deterrent, though) and waxing will take more with it than just hair, leaving a shiny pink patch.
Can’t Do It Alone
So retinoids deal with oil consistency, skin cell proliferation rate and ‘stickiness’, what acne-inducing villain has been left out of the equation? Gold stars fluttering down about you ala tickertape if you remembered bacteria. That’s why an anti-bacterial lotion or low-dose antibiotic is often prescribed with it.
Takes a While
Yes, results are eeked out slowly and undramatically over several weeks. Often too frustratingly slow for patients – and if going with a lower percentage retinoid, it may take even longer.
So as you can see, there are a few strikes against retinoids, but should be considered if the glycolic/salicylic/benzoyl peroxide route isn’t providing the results needed (as discussed in this article).
My general rule of thumb is this: for light acne to moderate acne, try the glycolic/salicylic/benzoyl peroxide route, for heavier acne, incorporate Retin-A into the regime, and for cystic acne, that is those deeply rooted, bigger and painful boil-like lesions, consider Accutane. Accutane is a systemic retinoid, and a whole other Oprah, as they say. It needs to be a carefully considered decision with a physician’s guidance. It is riddled with controversy (class-action lawyers are currently licking lips), but often gives wonderful results where all other treatments fail.
We’ll devote a whole article to Accutane soon, but first there’s something you should know about prescription retinoids– estheticians hate them and will not recommend them. More to follow...
