DR. ROLLINS: Try the cream of the crop — retinoids — for younger-looking skin | PostIndependent.com

DR. ROLLINS: Try the cream of the crop — retinoids — for younger-looking skin

Scott Rollins
Free Press Health Columnist
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What skin-care product can truly slow skin-aging and turn back the clock on skin health? Only the retinoids have decades of research showing they can smooth fine lines, fade dark spots and make pores look smaller.

The only problem is that these products can cause so much irritation that people often give up long before any benefits are noted. Here are some tips that will help you pick the best product and enjoy younger, more incredible-looking skin.

First, here’s what makes the retinoids so effective at slowing skin-aging. These vitamin A derivatives bind to receptors in the skin cells and induce many nourishing activities, such as turning up production of the skin, plumping and firming collagen fibers while turning off the collegenase enzyme that breaks down collagen. They increase hyaluronic acid, which is the jellylike material that holds moisture in the skin, increase the turnover of skin cells, and encourage oxygen-carrying blood vessels to form. All this leads to firmer, more radiant skin, with less sunspots, fine lines and pores.

Retinol is the precursor to retinoic acid, the active retinoid that works in the skin. Retinoic acid is about 10-15 times stronger than retinol. This is why over-the-counter (OTC) retinol products are easier on the skin than the retinoic acid-containing prescription creams.

Start gently, especially if you are a first-time retinoid user or have sensitive skin. OTC retinol products are good choices because the retinol is slowly converted to retinoic acid, which means it will take more time (about 12 weeks) to notice a difference in your skin compared with prescription products (4 to 8 weeks).

Look for products formulated with at least 0.1% of retinol (the most effective retinoid in OTC versions) and packed in aluminum tubes (air and light can degrade the formula, reducing effectiveness). If you don’t notice benefits after 3 months and you tolerate this strength then consider trying a prescription-strength formula. This is a good approach anyway as the OTC product will have helped your skin get prepared for the prescription retinoid, so you’ll be less likely to suffer the irritation that is common with the more powerful version.

For the best improvements in skin, nothing compares to the prescription retinoids. The most commonly prescribed products for anti-aging purposes are Renova (its emollient base makes it especially suitable for those with very dry skin), Avage (the strongest retinoid and is ideal for seriously sun-damaged skin), and Differin (easiest on sensitive skin). Your doctor will decide what formulation (gel or cream) and strength will work best for you and monitor your skin’s response over time — however, we see many patients that are started on too strong of retinoid so be sure to request the lowest strength for starters. We generally prefer the gel formulations.

Take your time and plan ahead! It takes about 4 to 6 months for your skin to adjust and tolerate a retinoid. Because of the normal irritation, plan to avoid major trips or events where you would prefer to not have a red, slightly irritated-looking face! Colorado is especially tough on retinoid users because of our dry climate. The increased humidity of summer makes it a good season to start a retinoid.

Another tip for starting a retinoid is to take some time off with other skin irritants such as scrubs, exfoliants, alcohol-based toners and astringents. Avoid chemical peels, facials and waxing during the early phase of adjusting to retinoids.

Focus on the thicker sun-damaged areas of the face taking care to avoid sensitive areas such as lips and upper eyelids. After applying, immediately pat your skin with a tissue and if you are using too much product the tissue will stick. Next time, use about half the amount.

Because sunlight will reduce the effectiveness of retinoids, we always recommend applying before bedtime. Cleanse the skin about 20 minutes prior to applying a retinoid and let the skin dry. Repeat, let the skin dry. Moisture will increase the risk of irritation that leads to the dryness and redness caused by retinoids. Wait another 20 minutes before applying moisturizers to avoid sealing the retinoid into the skin.

Another special skin-destroying threat caused by living in Colorado is our high altitude. We get more ultraviolet rays than our flat-land companions which means more sun damage, skin cancer and sunburns. Since retinoids help remove the dead surface skin cells, they also remove some of our sun protection. Be extremely vigilant about regular sunscreen and be sure to only use a product with titanium dioxide or zinc oxide to truly block the damaging UVA and UVB sun rays.


It may take up to a full year to get to your ideal dose of retinoid, so please be patient! Go slowly, maybe using a retinoid twice per week for a few weeks, then every other day for a few weeks, with daily use only when you can tolerate comfortably. Those with fair complexions and sensitive skin will take longer to get to daily use and some may find every other day use is plenty.

Retinoids for anti-aging can produce dramatic improvements in the overall health and look of your skin. Regular ongoing use is necessary to keep the benefits, but your reward will be more youthful- and sensational-appearing skin.

Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call 970-245-6911 for appointments or more information.

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