11 replies to this topic

[davpet]

I've heard a plastic surgeon (and a cosmetic dermatologist) say, that if you want to maximise the anti-aging benefits of Retin-A. You should use the 0.1% strength, and once you can tolerate it. You should apply it twice a day.

They say the results will be much better, than using an anti-oxidant (C E Ferulic) in the morning and Retin-A in the evening.
They also go onto say, that the increased sun sensitivity won't be a problem as long as you use a sunblock.

Your thoughts ?

Edited by davpet, 09 July 2008 - 11:58 AM.

[Fredrik]

I've heard a plastic surgeon (and a cosmetic dermatologist) say, that if you want to maximise the anti-aging benefits of Retin-A. You should use the 0.1% strength, and once you can tolerate it. You should apply it twice a day.

They say the results will be much better, than using an anti-oxidant (C E Ferulic) in the morning and Retin-A in the evening.
They also go onto say, that the increased sun sensitivity won't be a problem as long as you use a sunblock.

Your thoughts ?

Tretinoin is not stable in daylight. I believe it is the yellow light that breaks it down. That´s why older skin is vitamin A deficient, the daylight downregulates the RARs and destroys the retinoic acid (vitamin A).

But sure if you have rhinoceros skin you can apply a retinoid (preferably the synthetic ones, adapalene or tazarotene as theyre more stable) OVER your C serum. But there´s no studies that show greater effect beyond 0.1% once daily. Actually, 0.025% and 0.1% were equally as effective in one study.

The higher % will give results faster (and much more irritation), it will be more like a peel where you look awful for 7-10 days and then look great after you´ve "healed" your skin barrier. There´s a peel made by Skinmedica that combines retinoic acid with AHAs.

But over time 0.025 to 0.1% once daily is fine. Use to tolerance. If that´s twice a day for you, fine, but don´t use it instead of topical C, layer it in that case.

Edited by Fredrik, 09 July 2008 - 05:13 PM.

[Eva Victoria]

Agree with Fredrik. It is no point using Tretinoin twice daily.

I have used Tretinoin 0.05%-=.1% for 10 years now every night. In last August after consulting one of the foremost derms. in Scandinavia I used it am and pm (always on top of VitC serum in am!).
Used it until beginning of March. Totally 7 months). I did not see any improvement that could be down to the twice daily application of Tretinoin, however there was plenty of irritation to my face! Coarse and very dry skin which could not have enough moisture. My skin looked lifeless, dry and lines were appearing because of loss of vital moisture.
This was an experiment which I would not recommend to anybody! When I did it it was mostly "dark": the UV index was under 2 and used a very high SPF/UVA prot. additionally.

After returning to my usual 1/day (pm) application my skin looks lineless, fully hydrated and it has a glow that it always had.

I would rather recommend Tretinoin 0.05% usage every night after it is well tolerated, combined with a potent antioxidant serum and a photostable sunscreen with broad UVA protection during the day (moisturizer: optional).

[Fredrik]

Agree with Fredrik. It is no point using Tretinoin twice daily.

Oh my, it´s been a while since we agreed on anything Eva. Now I get this lurking suspicion that I somehow must be wrong.

Kidding!

Seriously, I´ve done the twice a day experiment also. I did it on a blazing hot summer and I didn´t get dry though, instead my skin got really smooth and shiny, like plastic. When retinoids are used for psoriasis some clinicians have observed what they call "sticky skin". It´s an overproduction of super hydrating mucin (maybe hyaluronic acid). It wasn´t a flattering look on a guy. I think women can look "dewy", we guys just look shiny and sweaty.

[davpet]

From : http://archfaci.ama-...nt/full/5/2/145

Skin Rejuvenation Regimens

A Profilometry and Histopathologic Study

John D. Rachel, MD; Jasmin J. Jamora, MD


Arch Facial Plast Surg. 2003;5:145-149.

ABSTRACT
Objective To quantitatively examine the effects of skin rejuvenation regimens in treating photodamaged skin.

Methods Fourteen patients with photodamaged skin were considered for analysis. Skin rejuvenation regimens were as follows: (1) 10 weeks of treatment with topical 0.05% tretinoin emollient cream, (2) 10 weeks of treatment with 0.05% tretinoin emollient cream and topical ascorbic acid lotion, (3) 6 superficial trichloroacetic acid peels, and (4) a combination of the topical treatments and superficial peels. Comparisons of the treatments were analyzed using profilometry and histologic findings.

Results Profilometry analysis provided quantification of the changes from each treatment group and among the treatment programs. Each group showed improvements from baseline. Trichloroacetic acid peels combined with application of the topical products improved skin topography to a greater extent than the less aggressive regimens. Histologic changes correlated well with the skin replica findings.

Conclusions A 10-week skin rejuvenation regimen objectively improved photodamaged facial skin. Significant changes are noted when combining topical treatments with superficial peels. Hence, use of a combination of trichloroacetic acid peels, 0.05% tretinoin emollient cream, and ascorbic acid lotions is well tolerated and superior to either component alone as part of a comprehensive skin care and sun protection program.

"In general, the use of 0.05% tretinoin emollient cream alone resulted in the weakest beneficial effect among the product groups."

[Fredrik]

[/b]"In general, the use of 0.05% tretinoin emollient cream alone resulted in the weakest beneficial effect among the product groups."

It´s not either or. Retinoids, topical C, peels, IPL, botox and sunscreens all enhance and complement each other. Use them all. The sunscreen will make the corrective effects of the peels last much longer. The same with tretinoin and C. Botox will enable the collagen stimulating treatments to work better by not shocking fibroblast by sudden compression (muscle movement). It´s a happy polyamorous marriage between all these modalities.

I´d like to mention that study is paid for by Obagi medical system that incorporates tretinoin with topical C and TCA peels (their "blue peel"). But of course, retinoids can only correct existing damage to a certain degree (modest to dramatic depending on initial damage and the subjects adherence to a sun protective behaviour). They can not correct like a series of medium depth TCA peels can.

But the thing is that retinoids can also prevent further photodamage. I have yet to see that TCA, salicylic or glycolic acid peels can do that (actually they´ve been shown to NOT enhance repair post UV-exposure). They seem to be able to treat and prevent benign neoplasias though, like actinic keratoses.

[Kingston]

I just read an interesting new article about the role of chronic inflammation in aging. It discusses the role of the skin barrier in aging and how harsh treatments like peels, AHA's and retinoids should be limited bc they constantly irritate and disrupt the skin barrier. It says we should instead focus on optimizing the skin barrier for anti-aging and reducing inflammation which are linked to skin diseases and aging. Of course, I would never give up my retinoid but I do think it brings up a good point about barrier repair moisturizers with ingredients like niacinamide, ceramides, fatty acids, cholesterol etc that should be incorporated into the regimen to reduce inflammation and to use a retinoid strength that does not cause irritation. It recommends that after using a retinoid one should follow up with a barrier repair moisturizer. I've heard its not best to use a moisturizer with tretinoin, but what are the actual drawbacks??? Ideally i would like to use tretinoin at night, wait one hour, and then apply a barrier repair moisturizer like Atopalm over top.

Here's the article and full version is attached....



1: J Cosmet Dermatol. 2008 Mar;7(1):78-82. Links
Chronic inflammation is etiology of extrinsic aging.
Thornfeldt CR.Founder & CEO, Episciences, Inc., Fruitland, ID, USA. drcarl@epionce.com

Skin care regimens using active ingredients that are recommended by physicians who treat mucocutaneous conditions including aging should become more focused on reversing and preventing chronic inflammation. This adjustment of therapeutic and preventive strategies is necessary because chronic inflammation appears strongly linked to many preventable and treatable skin diseases and conditions such as visible skin aging. Mucocutaneous inflammation as the final common pathway of many systemic and mucocutaneous diseases including extrinsic aging has been established at the molecular and cellular levels. The corollary to this strategy includes inhibition of primary activators of mucocutaneous inflammation such as stratum corneum permeability barrier disruption, blocking any pro-inflammatory environmental insult such as ultraviolet radiation, and quenching tissue responses to these insults. This review will present the scientific rationale substantiating the conclusion that chronic inflammation is the common denominator in many mucocutaneous pathophysiologic processes including extrinsic skin aging.

PMID: 18254816 [PubMed - indexed for MEDLINE]

Attached Files

•  inflammation.pdf   87.13KB   77 downloads

[Kingston]

In response to my above post about inflammation, I found another interesting article stating retinoids actually have a anti-inflammatory response to the skin....



Inflammation resolved by retinoid X receptor-mediated inactivation of leukotriene signaling pathways.

Kalsotra A, Du L, Wang Y, Ladd PA, Kikuta Y, Duvic M, Boyd AS, Keeney DS, Strobel HW.

University of Texas Health Science Center at Houston, 6431 Fannin St., Medical School Bldg. 6, Room 200, Houston, TX 77030, USA.

Leukotrienes are implicated in the pathogenesis of diverse, inflammation-driven diseases. Metabolic inactivation of leukotriene signaling is an innate response to resolve inflammation, yet little is known of mechanisms regulating disposition of leukotrienes in peripheral tissues afflicted in common inflammatory diseases. We studied leukotriene hydroxylases (CYP4F gene products) in human skin, a common target of inflammation and adverse drug reactions. Epidermal keratinocytes express at least six CYP4F enzymes; the most highly expressed and highly regulated is CYP4F3A-the main neutrophil leukotriene hydroxylase. Differentiation-specific factors and retinoids are positive CYP4F regulators in vitro, effecting increased leukotriene B4 hydroxylation (inactivation). CYP4F expression is up-regulated in situ in hyperproliferative dermatoses-an innate mechanism to repair and restore epidermal barrier competency-and after retinoid therapy. Enhanced CYP4F-mediated inactivation of leukotriene signaling is a previously unrecognized antiinflammatory property of therapeutic retinoids mediated by preferential interactions between retinoid X receptors and CYP4F promoter elements in epidermal cells.

[spacetime]

"In general, the use of 0.05% tretinoin emollient cream alone resulted in the weakest beneficial effect among the product groups."[/font]

Is 10 weeks sufficient time to realize the benefits of retinoid treatment? All evidence seems to suggest that with continued use the benefits will accumulate. I would like to see the duration extendded to 1 year and see what differences occur at that point. But as Fredrik stated, there's no reason not to combined these therapies.

[aconita]

For acne it might help but there are better options, in general is a bad choice.

 

My personal experience with it (a few years long) is negative, I discourage the use of it since there are better and safer options plus the stuff goes systemic big time and may cause unpleasant side effects.

 

For acne try simple glycolic acid peel 7-10% (or less for very sensitive skin) everyday (actually there is no peeling), no need for buffering, much cheaper and effective with no side effects or irritation.

[jadamgo]

Yes to the twice-a-day retinoid, but no to picking tretinoin over the synthetics, and no to using the highest concentration available!

 

Adapalene is widely considered one of the least irritating retinoids, and it has both anti-aging and anti-acne benefits. And all the people citing studies that the low concentrations work as well, and have fewer side effects, that's absolutely right! 

 

And aconita, yes to the daily hydroxy acid exfoliating! I personally do better with salicylic acid (also called beta-hydroxy acid) because it has anti-irritant effects, and as a rosacea sufferer, I need that effect. But lots of people swear by glycolic acid, and there's a lot of evidence to support either salicylic or glycolic for daily use. 

[aconita]

Rosacea can be cleared by copper salicylate which, by the way, has beneficial skin antiaging proprieties too.