How to Use Retin-A & Survive the Purge :: The Acne Experiment

Hey y'all! This is the final installment of my retinoid series, which means my 6 month Retin-A trial review will be coming up next (see it here). In this guide, I'm going to share with you what I've learned about Retin-A purging through tireless research or, more accurately, based on my own two tretinoin purge experiences.

What is a purge?

A purge is characterized by whiteheads / little bumps in the areas of your face where you normally break out. In the case of Retin-A purging, it is often accompanied by some fun flaking action and redness.

What does a purge looks like?

This is what mine looked like:

 

What doesn't a purge look like?

In general, purging does not involve inflamed acne. That doesn't mean you won't get zits while you're purging (faces are vindictive jerks in that way), but if you suddenly have a face of big painful cysts where you don't normally get 'em, something else may be going on. Also, if your skin is super raw, you might be using too much of the product. Ease up soldier.

How long should this last?

Retin-A purging can last anywhere from a couple weeks to a couple months (eeeeeee). Of course, this will vary from person to person. My "peak-purging" didn't last for more than about a week or so, beginning almost immediately after I started using it. Some lucky SOBs don't purge at all.

How long shouldn't this last?

While the full effects of tretinoin won't be seen until 6 months – 1 year (or more), if you're still having a lot of redness, irritation, peeling (etc) after say, month 3, you can try easing up on application frequency or concentration. Doctors/derms can be very helpful in determining what is normal, and what is not.

Is there a way to lessen the severity of a purge?

YES. Tretinoin can be very harsh on the skin, but you can mitigate irritation by essentially lessening the amount of tretinoin your skin is exposed to, then ramping it up if you're feeling it:

1. Use a teensy tiny bit of it. Like, pea-sized or less (I probably used half that amount to start). Even after you get through the purge, you may not need more than this.
2. Start with a lower concentration. Tretinoin comes in 0.025%, 0.05%, and 0.1%. 0.05% is the most commonly prescribed dose, but if your skin is sensitive, you may find 0.025% to be a better starting point.
3. Try the cream first. I've used both 0.05% cream and 0.025% gel, and I found the cream to be milder.
4. Wait 30 minutes after washing your face before applying Retin-A.
5. Buffer it with oil or moisturizer. You can do this by applying a thin layer of oil/moisturizer before you apply the Retin-A. Similarly, you can actually mix the two together in your hand before applying. If your skin is very sensitive, you can even layer then mix.
6. Don't apply Retin-A every night. Every-other night, bi-weekly, or even once-weekly application can be and have been done. You can also start out with 1-2 times per week application, them bump it up gradually.
7. If irritation is minimal, you can apply Retin-A to bare skin, then apply oil or moisturizer 15-20 minutes after. The moisturizer won't cut the tretinoin in the same way buffering it will, but it will help sooth your skin.

What can do before starting Retin-A to prep my skin?

1. Make sure you have a facial moisturizer or oil that agrees with your skin. This will be your Retin-A buddy. If you need to use a new product, test it beforehand to make sure it does not make you break out. // My recommendations:  Jojoba Oil / Tea Tree Oil (10:1 ratio -- I get both from Trader Joes), Neutrogena Combination Skin Moisturizer, Hemp Oil, Paula's Choice Resist Clear Skin Hydrator
2. Make sure you have a very mild, non-drying cleanser locked-and-loaded. Test new products before you start. // My recommendations:  See my full cleanser guide.
3. Wear plenty of sunscreen during the day. You should to do this while using tretinoin also, so it's a good habit to get into. Plus, there is no world where starting tretinoin with a sunburnt face is a good idea.
4. Drink plenty of water.
5. Cut back on chemical & manual exfoliation, or better yet, cut it out entirely a few weeks before you start.
   

How do I "Survive the Purge" as you say?

1. Moisturize like a maniac. I don't care if your skin is already oily. Don't argue with your mother.
2. Don't wash your face more than twice a day, and use a very gentle cleanser. If you wash your face too much or use something that is too drying, you could add to the irritation and make things worse.
3. Avoid all other potential irritants. Do you use chemical peels? Knock it off! Does your face wash have salicylic acid in it? Find a milder one! In love with your alcohol-based toner? Drink it instead. Need to wax your goatee? ackk  Wanna rub lemon all over your face? Please STAHP.
4. Don't manually exfoliate your face. If the flakes are driving you nuts, use a clean wet washcloth and very lightly/gently run it over your face – like one or two passes. Rinse, then dab your skin dry, and immediately apply your moisturizer or oil.
5. Avoid exposing your face to hot water. Tepid (lukewarm) water is fine, but I've actually found that straight up cold water works best to calm my skin.
6. Get a dog and pet its tiny head.
   

What do I do if my vindictive jerk skin is still breaking out after months of Retin-A use??

Guess what? -- Spoiler Alert -- I currently find myself in this situation. I took that as my cue to tweak my Retin-A routine.

You may need to alter application frequency or use a milder formulation (like Retin-A Micro). You may even need a stronger formula (ask your derm!). You may need to switch up some of your other products – cleanser, moisturizer, toner, foundation, hair products. You may need to add another active acne fighter to the mix, like antibiotic topicals or mild exfoliants. And, of course, you may find that Retin-A just doesn't work for you :(.

Where can I get Retin-A?

I know getting it from a doctor/pharmacy can be expensive, but here's what I figured out:

#1: Make sure your doctor is prescribing it specifically for acne. Insurance companies will not cover tretinoin for anti-aging/wrinkle treatment. (I've even heard that it can sometimes help to have your doctor say it's for back acne treatment, but don't quote me on that).

#2: If you can't get insurance approval, shop around at a few different pharmacies. You can ask for the price before they fill your prescription, and you may find a better deal somewhere else. I've heard that Costco has good prices (and doesn't require a membership at their pharmacy). GoodRx offers discounts as well.

#3: Even if #1 and #2 are no-dice, remember that a tube of tretinoin will last you a very long time. I've been using the same tube daily for the last 7 months, and I still have a some left. If I had spent $100 on it, it would work out to about $15 a month, which is a less than what I might have spent on an OTC retinol.

#4: Get the generic. Both Retin-A (tretinoin) and Retin-A Micro (tretinoin gel microsphere) are available as generics. Generics are virtually identical to their brand name counterparts. In the case of tretinoin, it is more important to choose the right inactive "carrier" (ie the cream or gel the tretinoin is in).

That's it for now, my friends. Good luck. God speed. Stop picking at it.

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This is Part 3 of my 3 part Retinoid/Retin-A Series:

Part 1:  A Beginner's Guide to Retinoids
Part 2:  10 Things to Know Before Using Retin-A
Part 3:  How to Use Retin-A & Survive the Purge

My Review:  6 Month Retin-A Trial (w/ Before & Afters !!)

ALL Acne Experiment Posts are listed at The Acne Experiment MOTHER HUB.

How to Survive the Retin-A Purge :: The Acne Experiment

10 Things to Know Before Using Retin-A :: The Acne Experiment

This is Part 2 of my 3 part Retinoid Series, which will culminate in a big bad Retin-A review very soon (woo see it here). If you want to learn a bit more about retinoids, and the 7 (!) kinds available for skin care use, read Part 1 of this series first. You can pop back over here if I haven't lulled you to sleep at that point.

Like chemical exfoliants, there are some things that are good to know before giving Retin-A a go. Obviously a doctor will offer up specifics to your situation, but it's always good to be proactive. This post focuses on tretinoin, but can be applied sparingly* to any topical retinoid:

1)  Get it from an MD if you can.

Am I being too heavy handed with this? Maybe, but I am not a doctor, so it's not my place to tell you that it's safe to get tretinoin without a prescription. Retin-A is more powerful than OTC retinoids like retinol. They can cause more gnarly side effects than other products, so they require a prescription in the US. That way, if you have a nasty reaction, your doctor tell you whether it's normal or not. Plus, if you get it from a doctor, they can help you hone in on the specific variety & concentration that will work best for your skin.

Now, even if you discount this – even if you say "I've got this Shay. Let me buy my Retin-A from this online pharmacy, you wiener," know that with the various insurance coverage I've had over the last decade, I've always gone through my doctor, and I've never paid more than 10 dollars for generic Retin-A (tretinoin). It's worth a shot if you haven't tried it yet and I will ride this gravy train until they boot me.

2)  Retin-A shouldn't be used during pregnancy.

First off:  Retin-A (tretinoin) does not carry the same risks as Accutane (isotretinoin oral). Accutane is a category X drug which is the worst rating for pregnant women. Retin-A is a category C drug, which means it has not been extensively studied in humans. It hasn't been proven unsafe for pregnant women, but it hasn't been proven safe either.

As a regular layperson non-doctor, my take is this:  if you are planning to get pregnant, stop using Retin-A a few months before, and don't use it while breastfeeding. If you don't have the luxury of pre-planning a pregnancy, just stop using it when you find out. For topicals, a much smaller amount of the active ingredient actually penetrates the skin when compared to oral medications, but it's still better to err on the side of caution.

PS:  Drugs no longer have the letter categories on the label, but it's way easier to compare two drugs succinctly with the old system.

3)  Retinoids are light sensitive.

Once a retinoid is exposed to light, it stops being as effective. So, you can't just squeeze some out of the tube into a container for travel or something. It'll lose its potency. This is also why it is recommended that it be used at night only.

Retinol is even more sensitive to light, heat, and air, so it's best to buy the products that come aluminum crimp tubes just like their prescription counterparts.

4)  Limit sun exposure when using Retin-A, always.

Tretinoin makes skin sensitive to the sun in the same way chemical exfoliants do. Retin-A thins the outermost layers of the skin, so the sun's UV rays have less to pass through and can do damage more quickly. This means sunscreen and hats should be your friends, especially if you're already prone to sunburns.

PS:  While Retin-A is light sensitive, and make your skin more sensitive to UV light, it is not phototoxic. (confusing right?) Clarification:  Tretinoin is not going to actually cause a chemical reaction in your skin cells in the presence of the sun the same way, say lime juice does. It won't damage skin in this way, just thin it.

5)  Because Retin-A makes the skin thinner, it also make it more susceptible to wounds.

If you are prone to accidentally injuring/scratching your face or purposefully picking at blemishes (hey, no judgments here), know that Retin-A will make it easier for you to break the skin. On the plus side, those wounds will probably heal faster than they would without the Retin-A. You may also bleed out of your face, like a Japanese horror movie (actually, maybe see a doctor about that). 

6)  Waxing Retin-A treated skin is not gonna work out well for you.

Waxing skin that has been treated with tretinoin is like waxing a sunburn. Even if you try to avoid putting it in the areas you wax (like your upper lip), know that products can migrate from where you first applied it. You can try it, but it's a risky game to play. I should know—I once gave myself a raw-skin moustache that later turned into a scab moustache.

7)  Retin-A takes time to work.

The time from first application to results is typically much longer than other non-retinoid acne treatments. You probably won't see improvements before 1 month, and most people start seeing real results at around the 2-3 month mark. Be patient. Full, more long-term effects (i.e. collagen boosting) may not be seen until 6 months of continuous use.

8)  The purge is real.

If you've read my Acne Experiment posts, you probably know that I have a specific definition of what purging is. It is my understanding that purging only happens for chemical exfoliants and retinoids because these two classes of products are the only ones strong enough to effect that kind of change in skin cells. Purging is exceedingly common for tretinoin use, but is still a crappy experience for a lot of people. I am putting together a "How to Use Retin-A" guide in which I'll share some of my own tips for riding the purge and how long it typically lasts, plus I'll have some purging pics to share with you. Yes, I experienced a real purge. Hold me. (It's done -- see my purging guide here.)

9)  Not everyone needs follow the same Retin-A routine.

The typical instructions for Retin-A are to apply a very thin layer (I'm talking a pea sized amount or less for the whole face) every night 30 minutes after washing your face. This can still be too irritating for some, even after the purging phase has passed. You can vary application frequency, you may need to buffer it with a moisturizer, and there are even certain parts of your face that may not tolerate it at all. These are things your doctor may not necessarily tell you, and you may only be able to figure out your ideal regimen with trial and error. It's helpful to know things may not go smoothly from the start.

10)  Retin-A is not for everyone.

Although retinoids are the "gold standard" when it comes to acne treatment & anti-aging skincare, it can be highly irritating. For some people that irritation can be too much – even in low doses, and even after the purging period is over. Retin-A is not recommended for people with rosacea or eczema, and like any topical product, there is always the potential for an allergic reaction either from the active ingredient, or one of the inactive ones. Also, if you're having luck with chemical exfoliants, the addition of Retin-A to your routine might be too much and cause more problems than it fixes.

In sum, see a doctor, apply sparingly, and be careful out there. You should always listen to your mother (that's me, I'm your mom).

*See what I did there? "Applied sparingly" like you apply Retin-A?? (I'll show myself out.)

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This is Part 2 of my 3 part Retinoid/Retin-A Series:

Part 1:  A Beginner's Guide to Retinoids
Part 2:  10 Things to Know Before Using Retin-A
Part 3:  How to Use Retin-A & Survive the Purge

My Review:  6 Month Retin-A Trial (w/ Before & Afters !!)

ALL Acne Experiment Posts are listed at The Acne Experiment MOTHER HUB.

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Sources:
WebMD / NCBI / NCBI / VeryWell / YouBeauty / NYTimes / Wikipedia

10 Things to Know Before Using Retin-A :: The Acne Experiment

A Beginner's Guide to Retinoids :: The Acne Experiment

I've been on a Retin-A trial for over half a year (!), but before I do a proper Acne Experiment review, I wanted to write a bit about retinoids. There is a lot of confusion surrounding this powerful skincare ingredient and – this is so embarrassing guys – I actually learned I was wrong about certain things. Don't worry, I atoned for my sins by watching 50 Shades of Grey exactly once.*

Because I simply love Q&A style formats, I'm going to do that for this article. Here we go!

What is a Retinoid?

Retinoids are a class of chemical compounds related to vitamin A. In the body, retinoids serve a role in vision, as well as cell proliferation/differentiation, bone growth, immune function, and tumor suppression. In a medical/clinical setting, retinoids are used to regulate skin cell growth, and some studies are even being done on retinoids for the treatment of certain types of cancer.

This means nothing to me. What is Retin-A?

Retin-A (aka tretinoin) was first developed in the 1960s as a treatment for acne; its anti-wrinkle properties were not officially capitalized on until the 80's. Tretinoin is a form of retinoic acid (aka vitamin A acid) which also exists naturally in the body. Retin-A was the first retinoid to be prescribed to treat skin conditions like acne.

How many kinds of Retinoids are there?

For acne treatment & anti-aging skincare, there are 7 varieties of retinoids (listed here from weakest to strongest):

Type of Retinoid	Where to Find It
1.  Retinyl palmitate	OTC: Derma E, Exuviance, Dermalogica, Mario Badescu (Note: a lot of products don't contain enough to be effective)
2.  Retinol	OTC: RoC, Neutrogena, Paula's Choice, etc.
3.  Retinaldehyde / Retinal	OTC: Avene, MyChelle, etc.
4.  Adapalene	OTC: Differin (a gentler alternative to tretinoin) Prescription: Epiduo (adapalene + benzoyl peroxide)
5.  Tretinoin	Prescription: Retin-A Retin-A Micro (gentler Retin-A) Renova (more emollient, ie best for anti-aging) + many others
6.  Tazarotene	Prescription: Tazorac & Avage (can treat psoriasis)
7.  Isotretinoin	Prescription: Oral: Accutane (discontinued in the US, but generic Isotretinoin is still available) Topical: Isotrex/Isotrexin -- UK only (isotretinoin + erythromycin)

There are 3 classes of Retinoids. With the exception of Tazarotene & Adapalene, all retinoids used for acne treatment are "Class One." Retinoids in this class are similar in terms of their chemical structure, but vary widely in their potency and potential for side effects. Tazarotene & Adapalene are newer "Class Three" retinoids; both are synthetic tretinoin. "Class Two" retinoids have been discontinued for skincare use because they were found to cause birth defects.

How do Retinoids work?

Retinoids work by binding to receptors in skin cells, causing cells to essentially "reset" themselves. The effects of this "reset" depend on the potency of the retinoid, but they can control sebum levels, increase cell turnover rates, and boost collagen & elastin. On the macro level, the result is (hopefully) skin that sheds & renews itself in a very aesthetically pleasing way, i.e. skin that is clearer, smoother, more evenly colored, and younger looking.

Is there any risk of my cells continuing to shed and renew until I become the X-Men water mutant?

Probably not, but if you're worried, why risk it?

What's the difference between Retin-A and Retinol?

Retinol is the most widely used OTC retinoid and can be found in a range of products. I always thought retinol was just weak Retin-A, but that's just not true. Unlike Retin-A, retinol is not already in retinoic acid form. In order for it to affect skin in a meaningful way, our own bodies must convert retinol to retinaldehyde, then to retinoic acid. If your skin doesn't have the right stuff to make this happen, retinol will not be effective for you. If your skin does have the optimal chemistry, retinol will function similarly to Retin-A.

So, how can you prevent retinol from being a total dud? You can't kid. Welcome to life.

Sidenote:  Retinyl palmitate is weaker than retinol because it must be converted to retinol before it is converted to retinaldehyde and retinoic acid. Basically, the wee chemical has less of a chance to survive the journey.

Gel vs Cream – Why you confuse me, tube?

Prescription strength topical retinoids come in a few different forms, most frequently gel & cream. The gels can contain alcohol, while the creams tend to contain emollient/moisturizing ingredients. As a result, gel retinoids tend to be better for oily skin, and cream retinoids tend to be better for normal to dry skin. That said, many people with oily skin prefer the creams because they are less drying. I'm in the cream camp, despite my oily face. It makes me greasy, for sure, but I find it to be less irritating than the gel.

What's the deal with concentration?

Topical retinoids typically come in different concentrations with retinoid content at a fraction of a percent. Retin-A comes in 3 concentrations: 0.025, 0.05, and 0.1 — 0.1 is pretty strong and a lot of people have to build up their tolerance with the lower concentrations before they use it. Some don't tolerate it at all. As it is with all skincare, a higher concentration of an active ingredient is not necessarily better. It really depends on what your acne responds most optimally too. Your perfect match might just be a lower concentration, and that's okay. You be you.

If I use the most potent stuff will I blast through the purging phase?

What are you, the Rocketeer?

Do I really need a prescription for Retin-A? Can't I just smuggle it from Mexico?

If you're interested in trying a prescription retinoid like Retin-A for the first time, I really do recommend getting it from a doctor. A doctor or dermatologist (which I am not) will be able to give advice regarding your specific skin situation, and help you choose the right product, concentration, and form. Retinoids are not for everyone, and skin can react differently to potent ingredients like this. I don't want your face to fall of.

Sidenote:  Isotretinoin (oral, aka Accutane) should never be taken without a prescription. Isotretinoin drastically shrinks your oil glands and "resets" your skin, so it results in some crazy dryness while you're on it (and not just on your face!). While it is incredibly effective, it can come with with a lot of severe non-skin-related side effects including depression & birth defects (doctors require that you be on the pill while taking it). Do not ever dabble with Isotretinoin without a doctor to guide you. Never ever.

*My 50 Shades of Grey takeaway:  WOAH 50 Shades of Grey guy has chest acne? These filmmakers can't possibly be so progressive that they would allow their main hunk to have lowly peasant skin. Well, I can't believe I'm saying this, I was wrong. Again. They were supposed to be scars from cigarette burns :(. I've atoned for my sins by watching Stranger Things. THIS SHOW IS WORTH ALL THE HYPE I LOVE IT.

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This is Part 1 of my 3 part Retinoid/Retin-A Series.

Part 1:  A Beginner's Guide to Retinoids
Part 2:  10 Things to Know Before Using Retin-A
Part 3:  How to Use Retin-A & Survive the Purge

My Review:  6 Month Retin-A Trial (w/ Before & Afters !!)

All Acne Experiment Posts are listed at The Acne Experiment MOTHER HUB.

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Sources:
Wikipedia / Skinacea / Skinacea / XOVain / Medscape

A Beginner's Guide to Retinoids :: The Acne Experiment