I have fair skin with rosacea (pretty much under control with Metrogel). I am looking for something to reverse sun damage and make my skin look younger. Cannot tolerate Retin-A. Is there anything else?
What is a Milder Alternative to Retin A?
Doctor Answers 6
Tricks for making Retin-A more tolerable
Retin-A (tretinoin, retinal) is a great product for improving sun damaged skin. For most of my patients, the main reason for not tolerating Retin-A products is due to too frequent application initially. There are several tricks I use to make the product more tolerable for my patients.
1. I always advocate starting slowly-- a pea size amount is sufficient for the entire face. Use only twice a week (i.e. Mondays and Fridays) for a few weeks, then if tolerated, go to every other night. Finally, if you can tolerate every other night application, you can try doing it every night.
2. If it is still too drying even with infrequent application, I recommend using a moisturizer such as Cetaphil or Neutrogena first, then applying the Retin-A. This often will reduce irritation.
3. Next I would consider changing from generic versions of Retin-A to several new formulations which are much more hydrating for the skin. Both Renova and Refissa by Spear Pharmaceuticals contains tretinoin in an emollient base. Atralin by Valeant Pharmacueticals contains a glycerin based humectant. Avita, by Mylan Bertek, comes in a lower strength tretinoin so it is generally less drying. These brand name versions are usually more expensive. While they are not necessarily more effective for wrinkles, they are definitely more tolerable to use.
4. And Finally, some of my patients really do have very sensitive skin that just can't tolerate retinals. In those cases, I would recommend using an over the counter product containing retinols. Retinols are precursors to retinals. Since our bodies do not readily convert all of the retinols into retinals, they are usually more tolerable, though they tend to be less effective as well.
No matter which you choose, make sure you use a sunscreen during the day!
Many alternatives for Retin A
You still might tolerate Retin A in another form. There are four Retin A's which have been designed for patients whose skin is sensitive and irritated by the standard Retin A's.
A new one has recently hit the marked called Refissa. It is made by Spear Pharmaceuticals. It has extra emollients and is an elegant product. My patients seem to like it.
Renova, made by Ortho, the company which manufactures Retin A, also is a much less irritating product than its progenitor. Similarly, Avita and Atralin are smoother and can be used by patients who find Retin A too harsh.
You can certainly add a moisturizer. My favorites are Cerave ( non-prescription) and Bionect. The latter has the additional benefit of hyaluronic acid and the catechins from green tea.
Retinol, which is OTC, can deliver the same benefits as Retin A. It is not as potent since it requires the skin's conversion of the alcohol form (Retinol) to the acid form. However, the alcohol is less irritating to the skin. My favorite in this group is Roc Retinol Correxion (sic).
Retin-A is a great way to rejuvenate the skin but can be too strong for some people. I generally recommend that patients use the mildest concentration of Retin-A as it is easiest to tolerate. Some find that diluting Retin-A with a moisturizer can help. Also, Retinol is available over the counter and is not as strong as Retin-A but still can rejuvenate the skin.
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Alternatives to Retin-A
Retin-A, by prescription, is the most studied and most effective topical antiaging product. It should be started at a low concentration, and slowly the strength can be increased (e.g. every 4-6 months). If you have difficulty tolerating it, you can try using it as short contact therapy (e.g. wash off after 1 hour), and then work your way up. Or, put a moisturizer on over top of it. Or finally, go with a milder form such as over-the-counter retinol.