Will Retin-A really improve the appearance of acne scars and discoloration?
Does Retin-A Really Work for Acne Scars?
Doctor Answers 10
Does Retin-A Really Work for Acne Scars?
Retin-a (Tretinoin) works by increasing (stimulating) cell turnover and collagen production in the skin. If you think about it, retin-a works similar to a very light chemical peel: when applied topically, the retin-A increases the rate of cell turnover, thus increasing the skin’s own exfoliation process to remove dead cells while stimulating new skin cells faster, resulting in better skin texture and appearance. So yes, retin-a should work as a treatment for acne and can help minimize the appearance of acne scars.
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Retin-A helps more with discoloration than scarring
Retin A, by causing the cells of the epidermis to divide more rapidly, pushes out the pigment in the keratinocytes.This does help with what we call dyschromia, pigmentary discoloration. For this reason Retin A is often combined with hydroquinone.
Unfortunately, Retin A probably helps only with the most superficial of acne scars. Obviously, it is key when it comes to prevent them in the first place, but there is little in its action ( maybe its reputed ability to regenerate collagen) to diminish scarring.
Retin A and Acne Scars: Improvement in quality of acne scars with retinoic acid
Patients requesting improvement of acne scars are typically concerned about several things:
Improvement in pigmentation
Improved quality of surrounding skin on face
Improvement in contour irregularities and ice pick scars on the face
Retin A is an active exfoliator that speeds the skin cycle and increases deposition of collagen in the dermis. The retinoic acid will improve pigmentation by increasing cell turnover and speeding up the elimination of melanin in the dermis. It will also increase collagen and improve fine wrinkles and improve the overall quality of the skin. It does not, however, have an effect on deep contour irregularities and ice pick scars.
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Don't expect much from Retin A except if scars or wrinkles are extremely shallow
The effect of Retin A is superficial, and the changes that are seen are primarily epidermal. Therefore the only scars that can be improved would be those that are extremely shallow. The depth of your acne scars must first be evaluated once determined the proper treatment depth can be performed. If the scars are deep then there are alternatives such as TCA peel, dermabrasion, laser resurfacing and subcision.
Retin-A or tretinoin effective only as an adjunctive therapy for acne scarring
Prescription-strength topical retinoid such as Retin-A has been shown to stimulate collagen, enhance textures of the skin over time. It can be helpful as an adjunctive therapy to laser resurfacing for acne scarring. However, as a monotherapy, the scar revisional benefit of topical retinoid for significant acne scarring is quite modest. The keys are strict daily sun protection as sun exposure takes away collagen, no smoking, and see a board-certified dermatologist to minimize new acne cysts.
Retin A for colored acne scars
Retin A can help for red or brown acne scars by increasing the rate of cell turnover. The rate of cell turnover is the time it takes for skin cells to develop, die and flake off. By increasing this rate, Retin A can help remove the pigment associated with acne scars by causing these colored cells to flake off more quickly than without it.
Retin A will not help for textured acne scars.
Retin-A is one part of improving the appearance of acne scars and discoloration
Retin-A does two things for the skin. First, it increases cell turnover so dead skin cells are shed faster. This evens out skin tone and brightens the skin. Second, Retin-A stimulates collagen growth, which will even out the skin's texture to a small degree. '
It works well for superficial acne scars and discoloration, but for deeper scars that extend into the deep layer of skin called the dermis, other techniques like excision, laser, chemical peel, or dermabrasion are needed to get the best improvement.
Retin-A for acne scarring
Retin-A can provide some benefit for acne scarring, but the type of acne scarring you have (e.g. ice pick, rolled, box car etc) should be assessed by a skin expert (e.g. dermatologist or plastic surgeon) and then the best treatment can be suggested in light of your risk tolerance, budget etc.
Consider Intra-Dermal Botox for discoloration from Acne
Retin-A is certainly a proven and beneficial medication for overall skin care, reversing aging / sun damage and improving problematic skin.
Depending on the type of scars you have Retin-A is probably not going to be that helpful. While Retin-A does stimulate healthy cell turnover and collagen formation, it's effects are not significant enough to address scars. Better options include, lasers, dermabrasion and fillers.
As for the discoloration from acne (also known as PIH -Post inflammatory hyperpigmentation) you may consider the option of Intra-Dermal Botox. I have had good success with this technique in my patients and we have seen nice improvement in red spots, brown spots and "blotchy' skin related to the inflammation from acne.
...early scarring- possibly
Moving forward to 2014- treatments such as RF (radiofrequency / eMatrix), RF Needling (eprime), CO2 fractional and fraxel are all better treatments.
Dr Davin Lim
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.