Peter T. Pacik, MD, FACS

Dear SkinCare-MD Customer,

Tretinoin (also sold under the brand Retin-A® and Renova®) is one of a variety of skin treatments classified as a Vitamin A antioxidant. Tretinoin helps rejuvenate the skin's deep collagen layer by improving it's texture and increasing it's blood supply. Since the collagen layer is essentially the framework for the skin's outer layers, these improvements help to reduce fine lines and wrinkles caused by toxins such as smoking and irradiation from the sun.

Tretinoin is an integral part of the Obagi Nu-Derm Advanced Skin Care System; however, it can also be used to supplement the MD Forte Advanced Skin Care Regimen, the Obagi-C Rx Complete System or the Kinerase Daily System. Tretinoin is generally used at night, and during initial use may cause sun sensitivity and peeling. Some individuals cannot tolerate tretinoin, and therefore need to use advanced skin care systems that do not incorporate tretinoin into the daily regimen.

Different Strengths of Tretinoin

Tretinoin is available in a number of different strengths and formulations. The more commonly used concentrations of tretinoin are 0.025%, 0.05%, and 0.1% creams. In my experience, I find that patients are usually best served by starting with the lowest strength (0.025%) of tretinoin, thereby conditioning the skin before advancing to the next concentration (0.05%). The exfoliation that results from the 0.05% in combination with hydroquinones is very helpful in the Obagi Nu-Derm Advanced Skin Care System because it helps to even out blotchy pigmentary problems. However, it should be noted that this higher concentration may be more difficult for some people to tolerate. We have seen considerable peeling in patients with sun damaged sensitive skin using only the 0.025% Tretinoin. As I have noted so often in the past, everyone’s skin is different.  0.025% Tretinoin is a fairly light concentration, and it is rare to see people who cannot tolerate this dose. We also have patients in our practice that need the 0.1% concentration to achieve desired results. The amount of product used also has a impact on the results. Generally, a nickel sized amount will do, though more or less may be used according to patient preference. I generally use more because in addition to my face, I apply the products to my ears, neck, hands and forearms.

Balanced Skin Care

With any advanced skin care regimen, it is important to find a happy balance — one that works by achieving the desired results of healthy, radiant appearing skin, without overdoing the beneficial effects, such as too much redness, irritation or excessive peeling. It is for these reasons that we start almost all of our patients on the 0.025% Tretinoin, followed by a reassessment of their program. We have had many patients make excellent progress on this lower dose, so much so, that we maintain this dose throughout their course and into their maintenance programs. The effectiveness of this lower dose has also been described in medical literature. As with any advanced skin care program, sunscreens are always a must, because the skin is more vulnerable to the harsh rays of the sun. Cessation of smoking is also important because of the toxic effects on the skin (not to mention heart and lungs).

Vitamin A Benefits:

• Improves density of dermal collagen
• Improves skin elasticity, tone and texture
• Smoothes skin surface and improves appearance of fine lines and wrinkles

For more information on Tretinoin (Vitamin A), please refer to our "Antioxidants, Anti-aging and Skin Rejuvenation" series in our Newsletter Section.

Contact Us With Your Questions

As always, we encourage you to call our office and speak to Dawn Mailhiot, our licensed Esthetician. Dawn is happy to talk to you about your skin type and condition and make product recommendations based on your conversation. Our MD Forte, Obagi Nu-Derm, Obagi-C Rx and Kinerase Advanced Skin Care Programs are all excellent for skin rejuvenation. Dawn can help you decide which skin care program would be best for you. She is available during office hours Monday through Thursday 9-4, Friday 9-3 EST at 1-800-640-0290 or (603) 669-0290.

Sincerely,

Peter T. Pacik, MD FACS
December 20, 2004

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