Is it Irritation or a Reaction?
By Peter T. Pacik, MD, FACS

We periodically receive e-mails from patients who are experiencing irritation or are having a reaction to MD Forte or Obagi Nu-Derm products. It is important to us that our customers understand whether their discomfort is irritation caused by skin care products or in fact, an allergic reaction.

About Reactions
A reaction is generally considered as an adverse response to a drug. In the case of skin care products, a reaction can be in the form of intense irritation, localized or generalized rash with or without itching, or in more severe cases (which I have never seen) difficulty in breathing (anaphylaxis). A reaction generally occurs if someone is allergic to a drug, or in the case of skin care, allergic to an ingredient in a particular product. Most people, who have a reaction to a particular skin care product, have this reaction when the product is first used, or at the beginning of a new skin care program. A reaction can also happen at a later time if a person becomes "sensitized" to the drug or product.

About Irritation
Irritation caused by skin care products is more common than actual allergic reactions. Signs of irritation include burning, redness, skin flaking, or actual peeling of portions of the skin and may be caused by using a concentration that is too high (i.e., Glycolic, Tretinoin, etc.), using too much of a product, or applying a product too frequently.

Irritation is usually noted during the course of applying topical treatments. Irritation can be normal; however, if the irritation is too intense, the skin care program may be too aggressive for your skin, or skin that has not been properly conditioned.

Testing for Irritation and Reactions
When starting any new skin care program, it is best to apply a small amount of each product to the undersurface of the forearm and observe the area for 24 hours. This area has sensitive skin similar to the skin on a person's face. If even a small amount of redness occurs, test the product in the same area with a slightly larger volume of the product. An intense reaction would be reason not to use the product. Most people would not notice any change.

When I first started using eye creams, I noticed too much burning and redness of the outer part of the lower lid, whereas the inner part was fine. I, therefore, used less volume and reduced the frequency of application to the outer eyelid. After a few months, this area became properly conditioned and I had no further problems with twice a day application. Reducing the frequency can mean just once a day or every 2-3 days, using smaller volumes or completely eliminating an area that is simply too sensitive.

The products that we sell are physician strength products that contain higher concentrations of ingredients than over-the-counter products or products available through spas. Some irritation may occur as the skin becomes conditioned because of the strength of the products. Sensitive skin is usually sun-damaged skin and can be improved by initially using small volumes of lighter concentration less frequently. I have seen many patients who converted from "sensitive" skin to "normal" skin using the Obagi Nu-Derm Skin Care Program.

The flaking noted during the first 6 weeks of the Obagi program is normal and can make it difficult to apply makeup. Further, the tretinoin (Retin-A) in this program may cause considerable sun sensitivity during these first six weeks of use. As with any skin care regimen, you need to be comfortable with the program, making it easier to maintain. Therefore, to enable the best compliance with the regimen, use the products in such a way that they are not too irritating. Gradually, as the skin becomes conditioned, you will be able to use the products as recommended.

I tell my patients that proper skin care is a marathon, not a sprint. You too will be a winner if you stay with a program that is working for you.