What Are Topical Retinoids for Acne?

Featuring Dr. Jan Dank, MD

Duration: 3 minutes, 18 seconds        

So topical retinoids are one of the most important medications used to control acne.  

They’re difficult to use, and so they often fail because people don’t know what to expect or how to use them. Topical retinoids are derivatives of vitamin A. So there are three common topical retinoids that are used to treat acne: adapalene, tretinoin and tazarotene.  

All of them are usually applied to the skin at night. They’re applied to the region you get acne, not to the spots themselves, and they have to be used on a consistent basis to work.  

Topical retinoids take a while to work. They can take up to two month to work, so people get impatient and give up on them too soon. They also tend to have side effects before they work, which is also discouraging if you don’t know how long it takes for them to work.  

The way they work is that they influence the skin cells that are getting sticky and plugging up the oil gland and the hair in the hair follicle so they’re less sticky, opening up the pore and reducing the likelihood that the pore is going to become acne.  

The medications need to be used at night to the region of acne, not to the spots, and on a very consistent basis to work. Early on, when you’re using them, the most common side effect is that they tend to dry out or cause chapping in the skin.  

In the first month is when you see most of this, and in the second month it usually improves. Additionally, they force out some of the sticky cells first – so people will often, somewhere between three and six weeks, have a temporary flare in their acne before they get better. If you don’t know this is going to happen, you’re saying, why am I using a medication that’s making my face look worse?  

And people quit on the verge of success. So a week or two after that initial flare, they see the good results – but too many people have quit the medicine before they see that. So it takes about two months for this medication to work, then you see clearer skin.  

Another major pitfall is stopping the medicine when you clear up. Acne is something we control, not cure. If you stop the topical retinoid, you’re good for a while, and about three or four weeks later the acne flares, and it takes two months to get better again.  

If you’re having problems with tolerating topical retinoids, there are some easy tricks to get them to work. Put them on in a very thin layer at night before bedtime.  

Don’t put on too much. Two green-pea-sized drops is enough to cover your whole face and your neck. If there’s areas of irritation, use the medication at first every other day, not every day, in those areas and you’ll have less dryness and slowly get used to the medicine.  

Remember, it’s most drying in the first month, and that gets better. To avoid irritation and dryness in the skin, put the medicine on dry skin, not damp skin.  Wait 15 minutes after washing the skin to put the medication on if you’re experiencing problems with dryness.  

Remember that topical retinoids are prescription medications. You’ll need to have consulted with a physician to start the medication, and if you’re having problems tolerating it, you should talk to that physician. 

Video shot in conjunction with Dr Dank and //www.dlcnw.com/

Presenter: Dr. Jan Peter Dank, Dermatologist, Bellingham, WA

Local Practitioners: Dermatologist