Clinical Procedures and Topics

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Erythema (superficial skin redness), usually in patches, is a common side effect of using retinoids in the treatment of photoaging and the most frequently cited reason for their discontinuation, however deriving maximum clinical improvement from retinoids need not be at the cost of injuring your skin.

To minimize and avoid erythema from retinoids:

Avoid the use of glycolic and ascorbic acid (Vitamin C), and any other ingredients such as essential oils which irritate your skin, unless you are already able to use them without provoking sensitivity.

Lipohydroxy acid, salicylic acid and sulfonic acids are suitable anti-inflammatory alternatives if you require additional superficial exfoliation.

If you have dry-prone, sensitive skin, avoid the use of foaming facial cleansers, or at the least those which contain sulfates.

Products containing niacinamide (such as Nia 24 and PCA Skin Hydrating Serum), ceramides (such as Kinerase Pro+, Replenix Dermal Restructuring Therapy PM) and cholesterol (RevaleSkin Day Cream) also seem to help reduce side effects.

Start by applying only a small amount of a lower-strength retinoid such as Alyria Intense Wrinkle Correction (0.1% Retinol), Neova Retinol ME 0.15% (0.15%) or Biomedic Retinol Cream 15 (0.15% Retinol) every third night.

After 2-3 weeks, increase use to once every second night, and after 3-4 weeks, increase your use to nightly, five nights per week (the maximum usage for many people).

Increase the strength of the retinoid you use over time if you have been able to tolerate a lower strength with little to no redness or irritation.

Ideally, you will need to acclimate your skin to the point of "Highest Strength Retinoids" and more potent options, as outlined below, although you should not persist with any strength which elicits considerable or prolonged erythema or dermatitis. With a measured approach, even individuals with extremely sensitive skin are able to benefit from the most potent and effective retinoids.

Lowest Potency Retinoids

Alyria Intense Wrinkle Correction

Biomedic Retinol Cream 15

Neova Retinol ME 0.15%

Replenix Retinol Plus Smoothing Serum 2x

Mid-Strength Retinoids

Biomedic Retinol Cream 30

Replenix Retinol Plus Smoothing Serum 3x

Neova Retinol ME 0.3%

Higher-Strength Retinoids

Biomedic Retinol Cream 60

Replenix Retinol Plus Smoothing Serum 5x

Highest Strength Retinoids

Replenix Retinol Plus Smoothing Serum 10x

Skinceuticals Retinol 1%

SkinMedica Retinol Complex

Higher-Potency High-Strength Retinoids

Avene Retrinal Cream 0.05%

Avene Retrinal Cream 0.1%

There is a considerable jump in the efficacy and potential for erythema from the retinoids in this category compared with the prior categories.

Highest-Potency Highest-Strength Retinoids — Rx Only

Tazorac, Differin, Retin-A and Retin-A Micro, Renova, Tri-Luma, Isotrex, Avage, Atralin, Avita.

These prescription retinoids are approximately 20 times more potent than the "highest strength retinoids."

All the above listed retinoids are formulated and packaged so as to avoid oxidation which reduces potency — please avoid retinoids packaged in open-top jars, droppers and in formulations containing alpha hydroxy acids.

Ultimately (after approximately one year), application three or four times a week is sufficient to maintain improvement, providing antioxidants and sunscreen are used during the day for the duration of treatment.

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