Overview

Prescription retinoids have a number of names including Retinoic Acid, Retin A and Vitamin A. In fact, it is part of the retinoid family and a derivative of Vitamin A. It is a highly effective medication that increases the rate of skin cell turnover. In Australia, it's only available via prescription so that doctors can counsel patients on the best way to use and apply it.

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Prescription retinoid is an effective treatment for acne, photoageing (UV induced ageing), irregular pigmentation as well as other skin conditions dermatologists and GPs often prescribe it as a 'first line' treatment to help manage mild acne, reduce fine lines and wrinkles and to assist to fade irregular pigmentation.

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How does it work?

Prescription retinoid works in a number of ways, some of the key benefits are:

• It stimulates the growth of new skin cells and increases the rate that old skin cells are shed.
  Prescription retinoid works to reduce the production of sebum (the oil on your skin) as well as reduce keratinization (the production of excess skin cells) which both lead to the formation of comedones (blackheads). For anti-ageing, the increased cell production and turnover helps to improve fine wrinkling, reduce irregular pigmentation, and roughness.
  

• It promotes collagen production.
  Collagen is the protein that contributes to our skin's strength and elasticity. As our body's collagen production reduces with age it causes our skin to sag - a key sign of ageing. Increased collagen helps to plump the skin and increases epidermal thickness.

• It has anti-inflammatory properties.
  For inflamed acne (papules and pustules) prescription retinoid helps by reducing redness and swelling.

How does Prescription Retinoid compare to everything else on the market?

Prescription retinoid is a prescription medication, only available from a doctor. Its strength and potency distinguishes it from any over-the-counter creams which are typically weaker. It is recognised as a 'silver bullet' by many doctors because of its raft of benefits.

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Prescription retinoids come from the same family as retinol - both are a derivative of vitamin A. However, it can be distinguished from retinol, which is available in store because it is less potent, and therefore is classified as a cosmetic (as opposed to a medicine).

What strength should I use?

Everybody's skin is different - some are more sensitive than others. So it is important that you use the strength of prescription retinoid that is best for their skin. Your doctor will help you with this process.

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Prescription retinoid is available in a variety of strengths: 0.018%, 0.025% and 0.05% w/w. Whilst these seem like minuscule amounts, prescription retinoid is quite potent. It's best to start on a lower strength and increase it if your skin tolerates the concentration.

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Many patients experience dryness, irritation, redness or peeling if they use a concentration that is too strong for their face – or if they use it too frequently. This is often referred to as "retinization" which occurs when the patient's skin does not tolerate the treatment.

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There are a number of ways you can manage this transition: you can apply a moisturiser first as a barrier, start by using it less frequently or apply the prescription retinoid for a short period each evening, washing it off the face after a few hours. Your doctor will also help you through this process.

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If you are using prescription retinoid to treat your acne then you may experience some 'purging'. For those prone to acne, there may be a 2-6 week period where you experience acne breakouts before your skin clears up. This is a product of the acne surfacing as the skin cells are regenerated by the prescription retinoid.

How long before I start to see results?

The key to getting the best results whilst using prescription retinoid is to use small amounts, consistently. Patients only need a pea-sized amount to be spread across the face.

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For anti-ageing, clinical trials suggest that patients will ordinarily experience the following improvements within the first 3 - 6 months:

• an improvement in fine wrinkles;
• a reduction in pigmentation; and
• more uniform skin texture.

If patients are not experiencing any changes after 8-12 weeks, patients may change to a topical combination or try a higher strength (ie from 0.018% to 0.025%).

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For acne, patients should see a reduction in the number of comedones or inflammation within the first 12 weeks.

How to apply it?

Only use prescription retinoid at night because it makes the skin very photosensitive. Be sure to wear a broad-spectrum sunscreen, preferably SPF 30 or SPF 50+, containing a physical barrier (such as titanium dioxide), whilst on the treatment.

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Be careful to avoid the more sensitive parts of your face: do not apply too close to the eyes, the lips, the irritated areas or in the creases of your nostrils.

How to transition onto Prescription Retinoid?

• A good way to start your treatment is by using prescription retinoid every third night and seeing how your skin reacts.
• If your skin is tolerating the treatment, you can increase the frequency of application to every second night. If your skin continues to tolerate the prescription retinoid then you can increase frequency to every night. Be guided by how your skin feels and responds to the treatment.
• If your skin becomes irritated apply it less often and take a break for a few days. Note that it is normal to feel some irritation but this should reduce as you continue to use the treatment. If it persists or is severe, stop treatment and contact your doctor. For most people, the skin gradually gets used to prescription retinoid.
• If you have sensitive skin, you can wash the treatment off, after an hour or so.

To reduce irritation:

• use a mild cleanser and wait until skin is completely dry before applying it
• apply a thin layer (using too much increases irritation and won’t make it work faster)
• avoid using other acne medications or active ingredients on the skin unless advised to by your doctor
• if your skin shows signs of not tolerating prescription retinoid, you may use a moisturiser as a barrier, prior to applying the treatment
• avoid any treatments that might further irritate the skin such as waxing or laser.

Who can use Prescription Retinoid?

Prescription retinoid is generally safe for most people to use but you should discuss your skin profile and medical history with your doctor to ensure that it is right for you. For example, it may not be appropriate if you have other skin conditions and it should not be used by women who are breastfeeding, pregnant or trying to conceive.

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