Lifestyle Choices

The effects of the sun can be seen on the skin of any present or former sun-worshipper in the form of wrinkles, dark spots, roughness, leathery skin texture and a sallow complexion, often with prominent bursts of blood vessels. Under the microscope this shows up as thickening of the outer layer of the skin, with extra grouped pigment cells, and in the deeper dermis, clumps of non-functional elastic tissue and loss of collagen.

All of these effects of photoaging are corrected by using retinoic acid cream or gel regularly for several months. Wrinkles decrease; dark spots fade; rough spots become red and irritated at first but then disappear (unless they are serious precancers or cancers); the skin becomes smoother, the complexion rosy (sometimes even shiny). The skin truly appears younger, not only to an observer, but also under microscopic examination: the outer layer of the skin is thinner; pigment cells are distributed evenly; there is less clumping of elastic tissue, and there is also regeneration of collagen!

However, these advantages are not without their price. The most common problem encountered with use of topically applied retinoic acid is dry, red, flaky skin — especially when first applied. Some people cannot use Retin A, even at a low concentration, because this reaction is so severe.

Retin A also increases the skin’s sensitivity to the sun. The user must use a high SPF sunscreen always, even with minimal sun exposure. The irony is that although topical retinoic acid corrects sun damage, if you do go into the sun unprotected by clothing and a strong sunscreen while using Retin A, you would suffer not only more blistering and severe sunburns, but more eventual photodamage, including the increased risk of skin cancer.

In fact, Retin A treatment makes your skin more sensitive to everything, especially to perfumes and cosmetics. Even products you may have used without problem in the past may sting or cause a rash. And anything that may be sun-sensitizing is even more sensitizing when you are using Retin A. When on topical retinoic acid, it is especially important to use a mild cleanser. If you have facial treatments or waxing, be sure to advise the beautician before your treatment so milder products and lower temperatures will be used. It is advisable to stop using Retin A at least four days before any such treatment. And never go to a tanning salon — especially if you are using Retin A.

How to use retinoic acid

Retin A is a prescription drug: it’s powerful stuff! Now that you have learned about its side effects, you can appreciate why it must be used only under a dermatologist’s supervision. There are six forms of Retin A: one solution (0.05% concentration), used primarily on the scalp since it is too irritating for the face; two gels (0.01 % and 0.025% concentration) which are especially good for oily skin but which can sting or irritate many individuals; and three creams (0.025%, 0.05%, and 0.1% concentration). The lowest concentration cream (0.025%) is most frequently prescribed to correct wrinkles; it is as effective as higher concentrations in treating photoaging, and is far less irritating.

To be effective in correcting wrinkles, Retin A must be used every night for at least two to six months. Under a doctor’s supervision, apply Retin A at night at least ten minutes after washing with a mild cleanser. You need apply only a pea-sized amount; dab a small amount of cream into all areas of your face, then distribute.

When first used, Retin A can frequently cause flakiness and redness; in such cases your dermatologist will probably recommend that you use it every second or third night instead of daily. You might apply it with a toothpick or a fine lipstick brush directly onto your wrinkles on days you do not apply it to your whole face. It is extremely important to consult your dermatologist if you have any acne flares or irritations, and until you establish the preparation and application schedule correct for your individual skin.

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