Start Tretinoin at Low Level
By Peter T. Pacik
Tretinoin to Restore Healthy Skin
 If I could recommend only one product in an advanced skin care system it would be tretinoin. Tretinoin, also known as Retin A, has been used successfully for many decades, has a high level of safety, and is known to be one of the most powerful topicals to restore healthy skin, and to give skin its radiant color. It acts on the deeper dermal layer of the skin, by bringing in more blood supply to this layer of skin, promoting new elastin and collagen formation. Variety of Strengths of Tretinoin Tretinoin comes in a variety of strengths from the weakest concentration of 0.025% cream to the mid-range of 0.05% cream and the highest concentration of 0.1% cream.
Start with Weakest Level of Tretinoin when Integrating into Skin Care Regimen The question arises as to which strength of Tretinoin should be used, and how stronger strengths can be integrated into an advanced skin care program. In our practice, we start all patients on the weakest strength after testing the weakest product on the forearm to be sure there is no adverse reaction to this drug. (Considerable redness or blistering would indicate a patient who should not use this product). It is well known that people respond differently to skin care programs. Some are very sensitive to almost anything applied to the skin, whereas others can tolerate much higher concentrations of drugs.  After one or more tubes of the weakest strength of tretinoin, our patients are then encouraged to try a stronger strength. We take into consideration the amount of flaking and reaction to the 0.025% tretinoin cream and how long this lasts. Some patients are not ready for the next higher strength until several tubes of the weaker tretinoin have been used, whereas others are ready after only one tube of the weaker strength, showing almost no reaction. Long-term excellent results are possible by using only the weakest strength for years; others get better results by moving to the stronger concentrations of tretinoin.
The next question is how one should move up in the concentration of tretinoin. We have tried a number of different ways and have found that when moving from a 0.025% tretinoin cream to the 0.05% tretinoin cream, it is best to alternate the 0.025% tretinoin with the 0.05% tretinoin. In this way, there is always some tretinoin on board even if it is the weaker strength. This steady state of application will help avoid the cyclical peeling that occurs when the product is used intermittently with one day on and one or more days off. A Sample Tretinoin Regimen Would Be: - On Monday, Wednesday, Friday, Sunday use the 0.025% Tretinoin Cream; on Tuesday, Thursday, Saturday use the 0.05% Tretinoin Cream. (4 times a week = 0.025% Tretinoin Cream and 3 times a week = 0.05% Tretinoin Cream)
- After a few weeks of the above regimen: On Monday, Thursday, Sunday use the 0.025% Tretinoin Cream; on Tuesday, Wednesday, Friday, Saturday use the 0.05% Tretinoin Cream. (3 times a week = 0.025% Tretinoin Cream and 4 times a week = 0.05% Tretinoin Cream)
- Again, after a few weeks of this regimen: On Thursday and Sunday use the 0.025% Tretinoin Cream; on Monday, Tuesday, Wednesday, Friday and Saturday use the 0.05% Tretinoin Cream. (2 times a week = 0.025% Tretinoin Cream and 5 times a week = 0.05% Tretinoin Cream)
- A gradual approach, as described above, will help you to condition your skin to accept the higher strength of Tretinoin Cream. Eventually, you use the higher strength of Tretinoin Cream every night.
The amount of reaction and flaking is the indication of how fast one can increase the concentration of tretinoin. In general, the 0.05% Tretinoin Cream is useful for many people, and it may not be necessary to advance to the 0.1% Tretinoin Cream. Some patients do not achieve any results until the 0.1% Tretinoin Cream is used, and again this points to the variability among patients. Tretinoin Used Before Skin Peels Patients who have considerable sun damage or the beginning of skin breakdown such as the development of actinic keratoses or skin cancers, are best advised to have a strong chemical peel. In these patients, we encourage the advancement to the strongest concentration of tretinoin that can be tolerated to get the skin ready for the peel. We always encourage the use of a full system of skin care whenever possible, because we have found the full advanced skin care system to be better than any of its individual components. Sunscreen an Essential Step with Tretinoin  The use of a broad spectrum sunscreen is an essential final step when using Tretinoin and an advanced skincare regimen. It is important to note that not all sunscreens are created equal. In fact, most do not block long UVA radiation. The term "broad spectrum," a term used liberally to describe sunscreen, actually means very little. The FDA is drafting more relevant labeling laws, but these will not be in effect for several years. The labeled SPF number is a measure of protection against UVB and only some short UVA, but not long UVA. These long UVA rays are now known to cause photo-aging and are likely to be involved in the more aggressive skin cancers, such as melanoma. The sunscreens that we sell on Skincare-MD.com already exceed the American Academy of Dermatology's recommendations to the FDA in regard to criteria for Broad Spectrum Labeling.
Pregnancy and Nursing Advisory In an effort to avoid injury to the developing baby, most skin care topicals have not been clinically tested on pregnant or nursing women; therefore, we advise that they not be used. Products containing benzoyl peroxide, salicylic acid, hydroquinoine and tretinoin or similar topicals such as products containing retinol should NOT be used when pregnant or nursing. You should also discontinue the use of skin care products containing these ingredients for at least one month before contemplating pregnancy. If in doubt, please refer to the product insert for further information and consult with your physician. Contact Us With Your Questions As always, we encourage you to call our office if you have any questions about Tretinoin or our skin care systems. We are happy to talk to you about your skin type and condition and make product recommendations. Our MD Forte, Obagi Nu-Derm, Obagi-C Rx and Kinerase Advanced Skin Care Programs are all excellent for skin rejuvenation. We can help you decide which skin care program would be best for you. We are available during office hours Monday through Friday 8:30 a.m. to 7:30 p.m. EST at 1-877-415-0600 or (603) 296-4920. You may also email us at info@skincare-md.com if you have any questions.
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