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Prescription retinoids: Which one to use?

By Paula Begoun

Problem: I have been using Retin-A Micro and although I love the positive effects it has on my blemishes and blackheads, I don't know how much longer I can tolerate the dryness and flaking it causes. My dermatologist mentioned that Tazorac may be a better option for me, but this sounds similar to tretinoin, so I'm apprehensive. Will I be able to use tretinoin without negative side effects, or am I doomed to skin that's blemish-free but dry as the Sahara Desert?

Solution: Tretinoin therapy has always been somewhat of a double-edged sword. Users often love the results they get from using prescription tretinoin products but side effects such as dry, flaky, reddened skin can occur, and are sometimes severe enough that the patient has no choice but to discontinue using it. Tretinoin is one of several retinoids, a group of ingredients derived from vitamin A. All forms of Retin-A and Renova contain tretinoin in varying concentrations. Most dermatologists begin their patients on the mildest strength tretinoin and increase the strength only if no results are seen (which is rare). Tazorac contains the retinoid tazoratene, while the prescription product Differin contains another retinoid, adapelene. All of these products have legitimate research showing that they are effective in reducing blemishes and blackheads. However, which prescription retinoid is gentlest on skin is up for debate, and often depends on the unique relationship of the subject's skin to the particular retinoid. All retinoids can cause irritation or provoke a sensitizing reaction, but exactly how you will react to the various retinoids or which one will be the most effective for you can only be determined by experimentation.

Because you have had problems with Retin-A Micro, I strongly suggest you try other retinoid options to see how they work for you. Your dermatologist was on the right tract by suggesting Tazorac as an alternative to Retin-A. There is no guarantee you will not have the same problems with Tazorac, but it's worth trying in the hopes that your skin will respond favorably. You may also want to consider Differin (available in cream or gel form). Keep in mind that many patients who use retinoids tend to apply too much at once, under the assumption that if a little bit works well, more must work better or faster. Yet that is not the case with retinoids. Applying more Retin-A, Tazorac, or Differin than what is recommended per use will not net you better or faster results, but will very likely cause more pronounced side effects, particularly dry, flaky skin. In general, a pea-sized dab of any of these retinoid medications is all you need for the entire face. With careful adherence to the application instructions, diligent use of sunscreen, and a willingness to experiment with the various prescription retinoids available, it is quite possible you will find the solution your skin needs to reap the rewards of retinoid therapy without the unsightly, uncomfortable side effects.



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