Retinoid Creams For Acne
Topical retinoids can be very effective
Retinoid creams and gels can be very effective at unblocking the pores of pimple spots and preventing new blockages from developing.
Retinoids are derivatives of Vitamin A. They can either be applied topically on the skin in the form of creams and gels or taken by mouth in the form of capsules such as Isotretinoin (e.g. Oratane, Roaccutane).
Retinoid creams can be continued for several years to help keep acne at bay.
While you can buy some creams containing retinoids over-the-counter at pharmacies, it’s a good idea to speak to your doctor first to make sure it’s the best treatment for you.
How do topical retinoid creams work?
Retinoid creams and gels can be very effective at stopping or reducing mild to moderate acne.
They can also be used as maintenance therapy to keep skin clear after successful treatment.
During the early days of therapy with topical retinoids, your blackheads will begin to dislodge.
Irritation can affect 10-20% of people when they begin using topical retinoid treatments. You may experience some redness, discomfort or peeling.
To minimise this you may be asked to apply your cream or gel every second night and then nightly as your skin gets better at tolerating it. Another tip is to use a light moisturiser before you apply the treatment.
After three weeks, you may see new acne appearing. This is normal but it will soon disappear.
After six weeks, there should be good progress and a noticeable difference in the amount of acne.
After 12 weeks, your acne should be under control and further improvement is still possible.
What types of retinoid creams are available?
Retinoid creams and gels include adapalene (Differin), tretinoin (Retin A, Re Trieve, Steiva-A) and tazarotene (Zorac).
There’s also two-in-one products. Epiduo gel and Epiduo Forte gel combines adapalene with benzoyl peroxide, and Acnatac that combines clindamycin (an antibiotic) with tretinoin.
For quicker inflammatory acne improvement and control, retinoids can be combined with an antibiotic at the beginning of treatment. This combination reduces levels of acne causing bacteria and directly reduces inflammation.
For women and teenage girls with acne, hormonal treatment in the form of the oral contraceptive pill, cyproterone acetate or spironolactone can be combined with a topical retinoid to help with longer term acne control. Your doctor will be able to advise you.
How to use topical treatments
- Cleanse your face no more than two or three times a day using a soap-free wash. Do not overwash. Pat your face dry without rubbing.
- Wait until face is touch dry (approximately 15-20 minutes) before applying the topical cream.
- Avoid applying to the corners of the mouth, nose, and eyes or on other sensitive areas.
- Apply at least half an hour before going to bed.
- If irritation occurs, oil free moisturiser used together may be helpful.
- If stinging and redness is extreme, notify your GP. Your doctor may suggest that you start treatment every second night so you get used to the new cream or gel.
Potential side effects of retinoid creams
Although retinoid creams are very effective at treating acne, like all medications, they can cause side effects.
It’s important to have regular check-ups with your prescribing doctor because they can tailor your therapy and give you more information on how to manage or prevent side effects.
Dryness
Retinoids work by reducing the size of sebaceous glands and the amount of oil they produce. So, one of the most common side effects is dryness which may appear as scaliness or skin irritation. This can be reduced by washing with a gentle soap-free cleanser and using an oil-free non-comedogenic moisturiser (preferably with sunscreen SPF 30).
When you start treatment with retinoid creams or gels, only apply a thin smear every second evening all over the face.
After several weeks, if you have minimal skin dryness and irritation, you can start applying the creams every night for maximum benefit. By this time, your skin will have partially adapted to the irritating effects, so the creams and gels will be better tolerated.
To help protect your skin, try to keep your showers shorter than two minutes and use lukewarm water rather than hot. Using a moisturiser on your face regularly will help keep the dryness under control. The best type of moisturiser is an oil-free face moisturiser for sensitive skin.
Dryness may be worse when you’re in air conditioning or a low humidity climate. If you wear contact lenses, you may also find it difficult to tolerate the lenses with higher doses of isotretinoin due to dryness. Eye drops (e.g. Thera Tears or Bion Tears) may be helpful.
Men with severe acne who shave should try both an electric and safety razor to see which is more comfortable. If you use a razor, soften your beard thoroughly with soap and warm water or you may want to shave using a moisturiser rather than a shaving cream or soap. To avoid nicking pimples, shave as lightly as possible. Shave only when necessary and always use a sharp blade.
Patients prone to eczema may need to increase moisturising their skin to prevent any flareup of their eczema.
Be aware that as your skin is more sensitive and fragile when using retinoids, minor skin trauma can be slower to heal such as cuts and grazes, especially when playing sport.
Flare-ups
When you use retinoid creams, it’s important to be aware that your acne may get worse about three weeks in. An antibiotic or anti-inflammatory may be prescribed in conjunction to try and prevent this. Don’t give up!
Some patients experience an initial flare-up which is minimised by starting on a lower daily dose. With continued therapy, acne flares generally become less severe, less frequent and shorter in duration, and in most cases the acne improves. If you are concerned about a flare-up in your acne after starting a new acne therapy you can contact your prescribing doctor for advice.
Sun sensitivity
Retinoids make skin more easily irritated by sun, wind and water.
Increased sun sensitivity leading to quicker sunburn is common in Australia, particularly in spring and summer.
It’s important to take extra sun protection measures such as wearing sunscreen, a broad-brimmed hat, protective clothing and trying to stay in the shade.
It’s a good idea to check the UV Index via news reports, weather updates or websites before you head outside.
Seeing a doctor for acne
When acne makes it difficult for you to enjoy your life, it’s definitely time to see a doctor.
