Topical retinoids

The group of medicines known as retinoids are derived from Vitamin A. Creams containing the retinoids retinol and retinaldehyde can be obtained over the counter at pharmacies and supermarkets. Other topical retinoids containing tretinoin or isotretinoin require a doctor's prescription. Adapalene is a related prescription medicine.

Topical retinoids can be applied to any area but are most often used on the face, the neck and the back of hands.

There are many brand name face creams that contain retinol or retinaldehyde, which are quite well tolerated and may help improve the appearance of aging skin.

The trade names of the more potent topical retinoids available on prescription in New Zealand are:

• Retin-A Cream (tretinoin)
• Isotrex Gel (isotretinoin)
• Differin Gel, Cream (adapalene)

Retinova Cream (tretinoin emollient) is no longer available. Your doctor may also import other brands of tretinoin.

Topical retinoids are effective treatments for mild to moderately severe acne. In the last few years tretinoin has also been shown to reverse some of the changes due to photo-aging, i.e. sun damage. If used long term, it may reduce some fine wrinkles, freckles, comedones (whiteheads and blackheads), and solar keratoses (dry scaly sun-spots). They may also be used in bleaching creams to reduce pigmentation in melasma.

Retinoids can irritate the skin and increase the chance of sunburn. Excessive use results in redness and peeling.

Dryness caused by a topical retinoid

Follow these instructions carefully:

• Use your topical retinoid on alternate nights at first. If you have very sensitive skin, wash it off after an hour or so. If it irritates, apply it less often. If it doesn't, try every night, and if possible twice daily. The skin gradually gets used to it.
• To reduce stinging, apply it to dry skin ie 30 minutes after washing.
• Apply a tiny amount to all the areas affected, and spread as far as it will go.
• Don't get it in your eyes or mouth.
• Always apply a sunscreen to exposed skin in the morning.
• Wear your usual make-up if you wish, and use cleansers and moisturisers as often as required.
• If you have acne, make sure cosmetics are oil-free.
• If your skin goes scarlet and peels dramatically even with cautious use, the retinoid may be unsuitable for your sensitive skin.