Need prescription retenoid/tretinoin advice
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free skin care · Wed Mar 01, 2006 3:29 pm

This forum has been so wonderful and I have a burning question for all who use the prescription vitamin A's.

I used SC .5% everyday, never peeled and noticed it was generally a nice "skin balancer". I am working on acne and refined pores/fine lines/smoothness and that wasn't enough. I switched to PSF 1% and am using everyday. Still, no peeling. Notice my skin is softer and has a nice glow but still not changing the texture of my skin much, especially the pores. I was wondering if I need to go with the prescription strength and am about to go to the doctor's...the thing that makes me nervous about moving up is getting that "waxy" looking texture. I absolutely DO NOT want this!

How do I choose a prescription to ask for that will not make me look waxy?

Wed Mar 01, 2006 5:02 pm

You cannot "choose" a prescription. Your doctor will make this selection, based on your comments, and what she/he feels is appropriate.

free skin care · Wed Mar 01, 2006 5:13 pm

Doctors provide a service. They know if they don't please you, you can easily go elsewhere.

Another way to look at it. My doctors love it when I suggest a drug I'd like to try. (I'm on quite a few for various conditions) They know I've checked it out (good/bad/ugly) by asking me a few questions about it and why I want it. It saves them time.

pnw,I can't help you with your question. I don't understand what SC and PSF are. Also, something no one can answer for you even a doctor is how your skin will react. It's a guessing game. Also, some people never peel even on the strongest Retin-A. It does not mean you are not getting any benefit...count yourself lucky!

free skin care · Wed Mar 01, 2006 5:33 pm

thanks for your input,

actually my doctor always gives me a few options, then asks me what I'd like to try. I'd like to have an answer, which is why I am asking about other's experiences with their prescriptions.

I'd just like to know if there are any I should definitely avoid if I don't want a waxy look.

free skin care · Wed Mar 01, 2006 7:04 pm

I agree with Donnababe,

I went to my doctor for my annual checkup and to renew my migraine meds. I told her that I wanted to try a tretinoin product ... and I told her that I wanted to start out with the lowest percentage ... and said " .01%" in the alcohol gel base ... and that I wanted it for anti-aging purposes.

She said to me that she usually started people on the .025% but would check in her book ... and was surprised to discover that there was a .01% ... and duly wrote me the prescription.

We're not talking morphine here folks. Laughing

Tretinoin is something that, according to some experts, we should all be using regularly. It helps with the "turn over" of cells ... and is a powerful anti-aging "tool". It's far cheaper than the commercially available but less potent retinols.

If your doctor won't prescribe it ... then change doctors. It's not addictive ... and unless there's a very good medical reason for you not to use it ... there should be no problem.

The real problem with tretinoin is using it improperly. Start with the lowest concentration ... ease into using it on a regular basis ... back off for a few days if you start to get red or peel ... and gradually build up to using it nightly.

After a time, move up to the next concentration ... and do the same things that you did with the first one.

I don't know what you mean PNW by "waxy" looking texture ... but I don't think anyone would say that about my skin. Laughing

I must say that after 5 weeks of using the .01% I'm beginning to notice smoother skin ... and my pores are looking smaller ... and my lines are less severe.

Hope this helps.

Mary

free skin care · Wed Mar 01, 2006 8:11 pm

Mary,

You are a dear.

Thanks for taking the time to talk a bit about the percentages and how to go slowly. I am doing my annual check up as well so thought this would be a good time. I do not know of the different bases available, but you specifically asked for an alcohol based gel. May I ask why? And if I'm not being too personal, what is the name of the .01% you are using?

Thanks again, this is very helpful. Very Happy

free skin care · Wed Mar 01, 2006 9:16 pm

Hi pnw, I first started using drugstore retinol products a few years back with no problem, ie peeling, redness, etc. I then used Green Cream level 6, again no problems with peeling, dryness, etc., so after I finished the bottle, I decided to try the GC level 9. Still no adverse effects at all...except when I used a little around my eye area, which is the only sensitive part of my skin. I was starting to wonder, too, if my skin was at all benefiting from using these retinol products.

During the time I was using GC, I was cleansing my face with a gentle glycolic cleanser (MD Forte II) which, I was told, may have helped exfoliate any flakes and dryness that may have occurred while using GC. Occasionally, I would also do a scrub or peel, followed by a rich moisturizer or jojoba oil, which I guess would help with the normal dryness and peeling that comes with using retinol products. If you are using these types of products, that could be one reason why you're not seeing the flakies. Another reason could be that your skin is just not that sensitive Smile

.

FYI--I've since been using renova 0.050%--still no dryness or flaking, but skin is looking good. hth Smile

free skin care · Wed Mar 01, 2006 10:36 pm

donnababe,

SC and PSF are short abbreviations for the SkinCeuticals and Pure Skin Formulations lines.

Jala,
Wow! Yes, this helps tremendously! I am so happy you posted with a similar story. I was starting to feel weird

and was worried that I was wasting money on products I wasn't benefitting from. When I read your story, I think to myself that you have been blessed with very accepting skin, so maybe mine is too and we are both lucky!

All I have noticed from the retinols so far is a very nice softness. I think I am going to go ahead and ask my doctor for a prescription or for some samples. It seems if I just go a little stronger, I may get that smoother texture I am looking for. And thanks for the great tips in case I do run into the flakes!

free skin care · Thu Mar 02, 2006 7:04 am

Hi PNW,

There were two reasons why I chose the alcohol based gel.

It was suggested that the percentage of tretinoin was more effective in the alcohol gel [that goes for all the strengths apparently] ... the cream base works like a buffer and reduces the penetration of the product into the skin.

Also ... my skin doesn't do well with commercial cream formulations. Creams tend to clog my pores ... and I couldn't see the point in having medication designed to help my skin in a base that might clog my pores and make it more difficult for the meds to actually work on my skin! Laughing

Initially I was very worried that the alcohol gel base would be too drying for my skin ... but I've been surprised that hasn't been the case. Of course, you don't use much product ... and perhaps because I'm doing OCM, my skin has been soft, smooth and hydrated ... even on those nights when I use just the tretinoin!

I'm using the gel every night now ... but every other night, after the tretinoin has had a chance to sink in, I follow up with my night time moisturizer as well. Why do I do this? I don't know really ... Laughing

... I just decided that it was a good idea. Laughing

The brand name of the stuff I'm using is Stieva-A ... which is a brand that's made here in Canada. It was about $12 for a 25g tube ... and I've been using that one tube for 5 weeks now. In another month or so, I'll probably move up to the .025% or .05% ... but for now this is working quite nicely.

Mary

Thu Mar 02, 2006 12:36 pm

I use retin-A cream (NOT generic, my derm says the there is a noteable diff. between brand name and generic with this one) .1 - red tube.

I love what it does...I have to order it form Canada because no pharmacy in the us stocks the brand name anymore.

it is imperative that you use sunscreen EVERY DAY while on a scrip. stregnth reinoid. othewise, you are jsut wasting your time and money.....

free skin care · Thu Mar 02, 2006 1:15 pm

Hi rkai93,

I wonder what differences your doctor would be referring to?

I mean you have your "basic alcohol gel" or your "basic cream base" into which you have mixed a specific percentage of tretinoin.

There aren't a whole host of other ingredients in the stuff ... so where could the difference lie?

And the tretinoin in Retin-A is the very same as the tretinoin in Stieva-A ... and it's the tretinoin that is the "active" part of the product.

I would certainly question the specifics of any statement that said the "generic" was "noticeably different" from the brand name.

Just my two cents.

Mary

free skin care · Thu Mar 02, 2006 2:33 pm

Hmmmm, interesting. My doctor said they were exactly the same. Confused

free skin care · Thu Mar 02, 2006 4:08 pm

I would definitely like to know if there is a difference, as well.

Mary,

Thank you for your time to post all of this info and describe your routine. The .01% sounds very good to me to start with. I will ask about it at my appt.

I think you have cleared up one discussion I was having with laurabeth a while back. She was using Green Cream which she describes is a gel and I am using PSF which is a more creamy base. I was wondering how she was getting faster results with lower percentages. Then I thought it could be the delivery of the gel vs. lotion base.

free skin care · Thu Mar 02, 2006 4:28 pm

I love Tazorac. It works as well as Retin-A but is milder.

free skin care · Thu Mar 02, 2006 5:06 pm

Hi Sharky,

Can you describe it, %, base, brand name or generic?

Thanks!

free skin care · Thu Mar 02, 2006 5:17 pm

Hi Sharky,

I always thought that Tazorac was harsher than retin-A [or the generic counterparts!] Confused

See? You learn something new every day. Laughing

Interesting ... I'd be interested in hearing about percentages and bases as well.

Mary

free skin care · Thu Mar 02, 2006 8:55 pm

Okay, I'm a little confused hmm

...so would I be benefiting more from tretinoin in an alcohol based gel than in cream form as in Renova? I chose renova because it was winter at the time I started using it (last year) and my skin can always use a little extra moisture in the cold weather, but I do tend to get an oily t-zone in summer. Maybe I should switch to retin-a?? I'd also be interested in hearing about the %'s & bases. So Tazorac is milder than retin-a? Also, does anyone know what the difference is between retin-a and retin-a micro?? tia

free skin care · Fri Mar 03, 2006 12:18 am

I always thought taz gel is the strongest among prescription retinoids. I am using renova 0.02% every other night for 5 months. I still can use it every night or else my skin freaks out. While it is making my face very smooth and even, it hasn't helped with clogged pores.

Here is a good website with lots of info (courtesy of eurogirl from MUA)

http://janssenbeauty.com/us/skincare.html#4

free skin care · Fri Mar 03, 2006 7:30 am

My Tazorac is 0.1% in a cream base. It does not cause any redness or peeling on my face and I tend to have sensitive skin (light skin, blue/grey eyes, red/brown hair). It works. From MEDLINE it is as effective (or more effective) as Retin-A but with fewer side effects. I've been using it for about one year.

free skin care · Fri Mar 03, 2006 10:56 am

Hi again Sharky,

Okay ... so since you've been using Taz for about a year ... have you noticed any remarkable [or anything at all] reduction in fine lines, deeper lines and pore size?

I'm wondering if, when I go back to the doctor to increase the percentage, if I should go for Taz instead. Hmmmm.

Do you know if it comes in a gel base? I am really leary of any cream bases ...

Thanks

Mary

free skin care · Fri Mar 03, 2006 11:29 am

Wow! Mtview, this article is phenomenal, thanks so much for sharing, it has really cleared up alot of my questions. Here are a few quotes for others:

Quote:

Tretinoin and related chemicals, called retinoids, are some of the most important discoveries in dermatology. In addition to tretinoin, other retinoids are available for treating various skin conditions including adapalene (brand-name Differin) and tazarotene (brand-names Avage and Tazorac). Adapalene is used for acne, and tazarotene was originally used mainly for psoriasis and acne. Currently, there are no published medical studies on adapalene as a treatment for photoaging, but tazarotene has been shown to be effective for this, though it may cause more irritation than the tretinoin. See for example, "Tazarotene Cream for the Treatment of Facial Photodamage," Archives of Dermatology, 137(12), 1597-1604, 2001; and "Efficacy of 0.1% Tazarotene Cream for the Treatment of Photodamage: A 12-Month Multicenter, Randomized Trial," Archives of Dermatology, 138(11), 1486-1493, 2002 Nov (abstracts available on Medline). Results indicate that improvement with 0.1% tazarotene is comparable to 0.05% and 0.1% tretinoin. Tazarotene may work better than tretinoin for some people. Tazarotene is not yet available as a generic in the USA, and the brand-name products Avage and Tazorac are more expensive than generic tretinoin. Other studies may be done to compare the effectiveness of tazarotene to tretinoin for photoaging.

How To Use:

Quote:

Most of the studies showing skin improvement with tretinoin have been done with a 0.05%-concentration formula. However, many people find that regular 0.05% tretinoin cream initially causes peeling and redness. They often give up on tretinoin because of this. To avoid this possibility, it is best to start out with a tube of 0.025% cream. Initially, apply only a tiny amount to your face at night and check for peeling and redness the next day. You can use moisturizer during the day if necessary. Work your way up gradually to no more than a pea-size amount nightly for the whole face. Apply it evenly by first dabbing your forehead, cheeks, and nose. You can also apply a small amount to any other areas that have received a lot of sun exposure such as your ears, neck, chest, back, arms and hands. (Apply it only lightly to the ears or you will get a lot of peeling.) You can apply it to the fine lines around your eyes, but be careful not to get any in your eyes or it could irritate them (flush them with water if you do.) It is very important not to use tretinoin during the day because exposure to light, especially sunlight, will decrease its potency. You should apply it at least a half-hour before sleeping so it is fully absorbed and won't rub off on your pillow. Don't apply other products to your face at the same time, since they could inactivate the tretinoin.

free skin care · Fri Mar 03, 2006 11:34 am

Ok, Last one....I promise
Comparisons to Help You Choose:

Quote:

The regular tretinoin creams are appropriate for most people because they are very light, and don't contain oil. However, if you find the 0.025% cream too irritating, you can try Ortho's 0.02% or 0.05% Renova brand products, which are thicker, emollient creams for dry or sensitive skin. If you have no problems with the regular .025% cream, your doctor can next prescribe the 0.05% cream. People with more skin oil may be able to use the 0.1% cream or 0.1% Retin-A Micro, which is a special time-release formula usually used for acne. There is also a 0.025% gel that is more potent than the creams. The gel does not spread as easily as the creams, and it contains a significant amount of ethyl alcohol (or ethanol), which can be irritating. The gel usually works better than the creams to treat acne and clogged pores. A very potent 0.05% alcohol-based liquid is also available, but most people find it too irritating, and it is easy to accidently spill it.

free skin care · Fri Mar 03, 2006 12:26 pm

I got the taz for adult acne it works well as I've said I have never had any peeling or redness with it. It may have helped with fine lines at 51 I have only one line (laugh line on the left side of my mouth). This line has a 3/4 inch section of completely good skin in the middle compared to a complete line last year. I have been using Taz on it but I also use vit C, Glycolic, Matrixyl 3000 and a number of other things so what has worked is not certain. I do know that when I stop using the Taz I get pimples along my hairline (thought this would stop when I got this old!!!!).

I love the Taz and am getting a new prescription on Monday. I do not know whether it comes in a gel form (just looked up the WEB site says there is a gel in 2 strengths).

Fri Mar 03, 2006 2:13 pm

it was the carrier cream that my Doc. said was not same. i actually used the generic for a while, then switched to the brand name - I think it worked better, even though it's a pain to get it in US.

as for renova, tazorac, etc...My impression is that it is easier to get your insurance to cover the retinoid that can be used and classified for acne - insurance companies genrally don't cover scrips for wrinkles, etc. I have yet to be with a insurance company that covers Renova, Vaniqua, triluma - anything related to "cosemtic" stuff...but if you have one that does, god bless you - never leave them!

the renova was formulated specifially for wrinkles, hence the more emolliant base. retin-A micro - for oiler, acne prone skin - hence the gel base.

free skin care · Fri Mar 03, 2006 2:43 pm

Hi again,

I found another great article some of you may already have read. I won't post anymore quotes. This is a shorter and easier read, more like a magazine article, but explains clearly some differences among the brands we are discussing. What struck me most was that in the "beginning" when retinoic acids were being used for acne, a slew of women found that it helped with skin rejuvenation and started using it for that. Many of them with dry mature skin and producing less sebum experienced high irritation and flakies, which is why the ointment formulation came out. The toughy, and the category I fall into, is that they are still oily enough to cause acne in some like me who are mid-life with drying skin yet still acne prone. Rolling Eyes

Here is the article:
http://www.dermadoctor.com/pages/newsletter80.asp

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