Virginia Beach Retin-A doctors

I am glad to read you are having good results with the Retin A/Clindamycin combo, probably either Ziana or Veltin. 

Clindamycin is an antibiotic in the Lincosamide family. It works by interfering with the production of proteins by the ribosomes of the bacteria. Since our ribosomes are structured differently, we are able to tolerate Clindamycin. 

A drug called Lincomycin was the predecessor of Clindamycin, but Clindo, as it is affectionately called by us physicians, was found to be superior in killing bacteria, and thus has super-ceded Lincomycin. 

As far as acne treatment, Clindamycin has really become the topical antibiotic of choice and is by far, the most frequently used. The first topical antibiotic was Topicycline. This, curiously, was made by Proctor & Gamble, a company far better known for producing Crest toothpaste, Tide detergent, Bounty and now Gillette razor blades. Not only was it a decent product to treat acne, it was a hit in discos all across the country since it turned the faces of its users a colorful green-yellow color once the ever popular strobe lights of that era were turned on. However, it faded in popularity once topical erythromycin was introduced.  The bacteria figured out how to resist topical ( and oral) erythromycin, so the pharmaceutical makers developed topical forms of Clindamycin.

Upjohn was the first company to introduce Cleocin T and put it into various delivery systems including solution, pads, creams and gels. Later, it was found that adding Benzoyl Peroxide prevented bacterial resistance and BenzaClin was born. This was followed by two "me-too" drugs Duac and later Acanya, the former two using 5% BP,  and the later 2%.( Incidentally, bacteria do not seem to develop resistance to Benzoyl Peroxide since they are basically smothered by it. You have heard of anti-oxidants right? Well, BP is the supreme oxidant. It aggressively grabs electrons and puts the air into an oxidative state. It produces so much oxygen that the bacteria, which like oxygen in small amounts, are overwhelmed and essentially smothered. )

Later, Clindamycin was placed into Ziana and Veltin. This combines Retin A and Clindamycin. Its makers boast that Retin A opens up the skin and allows Clindamycin better penetration. An additional advantage is that Clindamycin is a pretty strong anti-inflammatory agent. This helps control some of the inflammation concomitant with the use of Retin A. Clindamycin does make the skin more tolerant of Retin A.

There are some other interesting facts about Clindamycin. A recent study showed that it may be the drug of choice for MRSA ( methacillin resistant staph aureus). Although physicians still mostly prescribe Doxycycline and Bactrim for this, this study showed that Clindamycin is actually the most effective. One problem, though, is that as monotherapy ( only using Clindamycin and not a combination therapy) resistance can develop. Another reason for physician reluctance to use oral Clindamycin is the possible development of Clostridium Difficile. This is due to the effectiveness of Clindamycin at killing off bacteria, even the "good bacteria" of the gut, allowing C Diff ( as we NOT affectionately refer to it!) to proliferate. C. Diff is actually a cousin of Clostridium  Botolinum, which has enjoyed a degree of fame by warping from a biologic agent of death to a killer of wrinkles. 

Physicians have to watch out for excessive use of topical Clindamycin. I have a patient with a rare disease called Hailey-Hailey who I was treating with TOPICAL Clindamycin into her armpits and groin. When she developed diarrhea, a culture was done and grew out the infamous, C. Difficile. She was treated with the old Gynecology stand-by Flagyl ( used for decades to treat Trichomonas, not so affectionately referred to as Trick) and did fine. Still, that is a cautionary tale. 

Clindamycin is also especially effective for toxic shock syndrome and malaria. 

Retinol is a very popular ingredient in skin care products. Since it is OTC, many companies that have hopped on the anti-aging bandwagon include it in their formulations. Like Retin A, it is a Vitamin A derivative. Basically Retinol, the alcohol,  undergoes conversion to Retinoic acid( tretinoin), the acid form, popularly known as Retin A. In this transformation, there is some loss of potency. Retinol is only 1/4th the strength of Retin A. However, it is quite a bit less irritating, making it an ideal OTC ingredient.

Is it safe: yes. Is it safe during pregnancy: probably. The stress here is in the word PROBABLY. No physician wants to endanger his patient. So, since we do not know absolutely for sure, whether Retin A is safe during pregnancy, prudence would compel us to advise patients not to use it during this critical time of development. There has not been a single study to my knowledge, that has shown Retin A to cause birth defects. However, there is not a totally acceptable, prospective, double-blinded, age matched ( no need for sex matched here!) study, the kind we physicians like to read, that shows Retin A to be safe either. Nor, will there ever be such a study, unless Fascists come to power. Medical studies are just not performed on pregnant women. One study the Boston University School of Medicine ( great school by the way) Collaborative Drug Surveillance Program cites demonstrated a curious finding that the rate of birth defects on babies born to women who used Retin A during the first trimester was actually less, 1.9% vs, 2,6%. This was obviously a retrospective study completed by the Group Health Cooperative of Puget Sound. The numbers were adequate ( 215 exposed and 430 age matched unexposed) and the babies were delivered in the same hospitals. Still, retrospective studies don't have the reliability of prospective studies, so we can not conclude that Retin A use during pregnancy is entirely safe.

The FDA tells pregnant women to keep their Vitamin A intake below 5000 I.U. Applying Retin A to the face, may increase the Vitamin A load slightly, perhaps enough to register but not much beyond that. Consuming vegetables like carrots, sweet potatoes, and spinach or eggs  which are loaded with Vitamin A and its derivatives would certainly drive up your Vitamin A level higher than Retin A. Further, our skin is laden with millions of Retinoid receptors, thankfully, for it is their activation that allows Retin A to do its magical tricks in keeping our skin young.

Now, getting back to Retinol. I do not know whether this has been studied at all as far as a pregnancy risk. Its penetration into the skin is quite a bit less than Retin A, so logically it should pose less of a risk rather than a greater risk than Retin A.  However, alluding to the same problem I mentioned earlier, a lack safety studies, it would be best to avoid Retinol during pregnancy too.

First, I think you might be surprised to see how many skin care products contain Retinyl Palmitate as an ingredient. It is very popular, since, unlike Retinoic acid, it does not need a prescription. Basically, in simple chemistry terms, there is a transformation from Retinol ( the alcohol form of Vitamin A) to Retinyl Palmitate ( an aldehyde derivative) to Retinoic acid ( tretinoin..Retin A) gaining  in strength. Retinyl, while not as effective, is milder than Retin A and is a good alternative for those who find Retin A irritating.

Now where people develop concern about Retinyl Palmitate and pregnancy is through extrapolation. Accutane, 13 cis- Retinoic acid, is a known teratogen ( causes birth defects). It is extrapolated that  related compounds may cause similar birth defects. The obvious logical misstep, is that Accutane is given orally, rather than applied topically.  Further, topicals containing these derivatives are customarily only applied to the face, not the whole body. True, the closer the compound is structurally to Accuante, the more concerned we should be: for instance Tazorac, whether rightfully or not, carries a Category X during pregnancy ( the other Retinoids are in Category C).

The FDA recommends that pregnant women keep their Vitamin A intake below 5000 I. U. a day. Applying Retinyl Palmitate increases the amount of Vitamin A, minutely. The absorption of this product into the blood stream is minimal. You would elevate your Vitamin A levels far more by consuming three carrots! In addition, we have retinoids in our system naturally.

There has not been a single study I am aware of, that shows that using Retinyl Palmitate during pregnancy causes birth defects. The reason, physicians warn patients not to use these products during pregnancy, is that it has not been PROVEN that they are entirely safe to use while pregnant either. It is very unlikely that such studies will ever be done. Nobody, ethically or legally, will perform such tests on pregnant women.