Dry Crepey Neck Skin: Can Retin A Help? Can Anything Help?

Crepeyness of the neck and of the lower cheeks is a common and distressing problem. While dryness does not cause wrinkles,  as a rule, it can accentuate any wrinkling or crinkling we have from such causes as excessive sun damage, menopause, etc. . Overly dry and wrinkly, crepey skin may also result from the overuse of strong soaps, hot water, scrub sponges and toners. In the latter, switching our cleansing routine to the use of lukewarm water, mild ("sensitive skin") cleansers and avoiding wash cloths or scrub sponges, as well as the frequent and generous use of moisturizers can help. 

But crepeyness of either the cheeks or neck that doesn't respond to the above regimen, like wrinkes and deep skin  folds, requires additional treatment measures. Retinoids (like Retin A) and alpha hydroxyacids may be helpful, but these agents take time to work (often weeks to months) and diligent use. Even so, often the results are subtle. I find these topicals  particularly useful as maintenance therapy AFTER success has been achieved with in-office treatments, such as mesotherapy or medical microneedling.

Medical microneedling uses a roller that contains numerous small needles. Rolled over the affected areas, the microscopic wounds that are created in this fashion stimulate new collagen and elastic fiber synthesis that may result in significant diminution of the crepeyness. Peptides, vitamins, antiiflammatory agents, and stem cell proteins may be added to the treatment to further stimulate new fiber synthesis.

Mesotherapy, may also prove helpful. Tiny amounts of  a diluted hyaluronic acid filler, such as Juvederm Ultra XC (which contains the local anesthetic lidocaine) may be traced in tiny injected droplets along the wrinkle lines or injected in microdroplets in a grid pattern throughout the crepey region. Not only may  the crepeyness plumped and straighened, but the installation of these tiny droplets of filler is believed to stimulate native collagen production. Here, too, other substances, such as vitamins, antiinflammatories, growth factors, and peptides, may be added to the injected mixture to enhance its effects. Results from either medical microneedling or injection mesotherapy typically require a series of about four to six treatments at monthly intervals. 

When beginning to use Retin A, often it is necessary to skip nights until one builds up a tolerance to it. This is particularly important for the neck skin. Using moisurizers on "off" nights is a good strategy. Over time one becomes used to the Retin A and can use even stronger concentrations to obtain better results. Repeated superficial chemical peels can make this process work even better. See link below.

The first thing to try for dryness is a good non-irritating moisturizer, like Cetaphil or Cerave.  In the winter you would want to use creams, as opposed to lotions.

Retin A can be drying and can initially contribute to crepiness.  One way of avoiding that is to start using it no more than twice a week in the evenings, then slowly build up to every night.  Make sure the skin is dry before applying Retin A.  Also, you can apply a thin layer of a moisturizer under Retin A to help alleviate some of the dryness.

As far as spots are concerned, Retin A usually decreases spots on the skin over long-term use, however it does thin the stratum corneum (the dead skin cell surface) which may reveal underlying pigmentation and may also allow more UV light through.  Therefore use a broad-spectrum sunscreen, at least SPF 50, every day.