Topical Retinoids in the Treatment of Acne
What causes acne?
Multiple factors lead to the eventual development of acne. Acne begins with the abnormal regulation of skin cells within the hair follicle. This leads to the formation of a “microcomedone”, which blocks dead skin cells and oil from leaving the hair follicle. This is an optimal environment for the a bacteria that normally lives harmlessly on the skin. Under conditions of abnormal cell regulartion, Propionbacterium acnes (p. acnes) bacteria thrives, which leads to inflammation and ultimately causes inflammatory acne papules and cysts.
There are many prescription medications available for the treatment of acne. Topical medications include topical retinoids (ie. Retin-A Micro, Differin and Tazorac), topical antibiotics (ie. Clindamycin, Erythromycin) and benzoyl peroxide combination medications (ie. Duac, Acanya and Epiduo.) Oral medications for the treatment of acne include oral antibiotics (ie. Doryx, Solodyn and Azithromycin), oral anti-androgen medications (ie. Spironolactone, Yaz) and oral retinoids, such as Accutane.
How do topical retinoids work in the treatment of acne?
Topical retinoids are derived from Vitamin A. They increase skin cell turnover, therefore promoting the removal of the microcomedone from the follicle. Retinoids are therefore capable of treating and preventing both comedonal acne and inflammatory acne. Retinoids also have anti-aging effects and have been shown to improve the appearance of fine lines.
Are retinoids too irritating to use on sensitive skin?
Most patients are able to tolerate the use of a retinoid, if given proper instruction. It is important for the medical professional to take extra care in choosing the appropriate retinoid for a patient with sensitive skin, and for giving them the knowledge to be able to properly use the medication at home. For most patients, the application of only a pea-size amount is sufficient to treat the entire face. Retinoids can be combined with moisturizers, either before or after the application of the retinoid, in order to increase tolerability. Most patients start by using their topical retinoid only three times weekly or every other night. Eventually, the frequency of use may be increased to nightly applications. If you experience redness or peeling after using a topical retinoid, do not use the medication for 2-3 days. During that time, apply a gentle moisturizer and avoid other potentially irritating products.
Are retinoids available over the counter?
Most retinoids are available by prescription only; the milder form of retinoids, retinol, is available in over the counter preparations. Retinol is slowly converted to retinoid once applied to the skin, but in significantly lower concentrations. This means that the ability of retinol to treat acne is much lower and the results will be disappointing when compared to regular use of a prescription retinoid.