If you suffer from acne or you’ve begun to experience first signs of phot-ageing, you might benefit from using topical retinoids. These are vitamin-A derivatives that open up blocked pores smooths out irregular texture and blur fine lines. Initially they may irritate but, using a gradual step-wise programme most individuals find them to be very useful and easy to tolerate.
What are topical retinoids & who benefits
Retinoids such as adapalene and tretinoin normalise cell-turnover in the skin, reduce blocked pores (blackheads and whiteheads) and reduce inflammation. They’re effective for teenage and adult acne, management of oil and enhance texture and tone from sun exposure. Expect fewer blocked pores in 4–6 weeks, clearer lesions in 6–8 weeks and pigmentation changes or fine lines in 8–12 weeks. Retinoids are not recommended in pregnancy or breastfeeding. If you get eczema, rosacea or very sensitive skin, discuss with a clinician first and consider a more gradual introduction programme. If stinging persists, reduce to twice a week and buffer with a blank moisturiser; it is acceptable to take a break for a few nights and recommence more slowly.
Adult acne in a nutshell
Acne in adults is normal in the 20s and 40s and more frequent in females. Acne is found in half of the adults aged between 20–40 years, with a higher percentage in females. Flares routinely accompany hormonal changes and pregnancy and PCOS. Acne may also arise at the perimenopause with waning oestrogen production. Whatever the trigger factor is, a simple regimen—the gentle cleansing, a non-comedogenic moisturiser and daily SPF—promotes clear skin in conjunction with daily retinoids.
Adult acne is treatable. Acne can have a very significant impact on the mental well-being of patients as well as causing lifelong scarring. Not all treatments work for all patients, but with support and guidance from an experienced clinician there are always options to gain control over acne.
Dr Robert White, Doctify-rated GP with Extended Role (GPwER) specialising in Dermatology and Skin Surgery
9 ways to utilize retinoids the intelligent way
1) Start low and go slow
Start with a low strength (adapalene 0.1% or low-strength tretinoin) on two or three nights a week. Gradually increase only when tolerable for a complete week.
2) The “pea-size” rule on normal skin
Apply a pea-sized quantity to the entire face on completely dry skin. Apply dots to forehead, cheeks and chin and then thinly spread across the face avoiding eyelids and the immediate lip line.
3) Moisturiser “sandwich” in order
Buffer vulnerable spots (sides of the nose, corners of the mouth) with a mild, fragrance-free moisturiser before and after using retinoid. Look for ceramides, glycerin or hyaluronic acid. Lipline protection with balm and patch test new products in the back of the ear or jawline first before using them elsewhere.
4) Purge vs irritation
Further lesions in weeks 2–6 are possibly a transient cleansing. Ongoing burning, redness or swelling is typical of irritant dermatitis—space applications, buffer or pause and recommence more slowly.
5) Sun sense
Use broad-spectrum SPF 30+ daily in the morning and reapply with outdoor exposure, and save retinoids for the evening. Vitamin C is usually fine in the morning under SPF.
6) Benzoyl peroxide/antibiotics combination
Apply benzoyl peroxide in the morning and your retinoid at bedtime to keep irritation in check. If you’re given antibiotics, stick to the short course; retinoids keep results up and relapse down after you’re done with the antibiotics. Do not stack AHA/BHA acid on the same night you’re developing tolerance on, and come in one active at a time.
7) Oil control without over-stripping
Gentle morning and evening cleansing with a gentle, pH-balancing cleanser. Avoid abrasive face scrubs and stacking high-concentration actives. Niacinamide 2–5% helps with concerns of rosacea and oiliness. When you’re feeling oily at midday, continue the use of the blotting papers rather than washing again to maintain the barrier.
8) When to change strength or molecule
If acne persists after 6–8 weeks of tolerance, your clinican may strengthen or swap molecule—e.g., to micro-encapsulated tretinoin for comfort. Gradually move up and do not introduce more than one change at a time.
9) Safety first
Do not use in pregnancy or breastfeeding. Patch-test if reactive, and consult if severe redness, swelling or burning persists and does not resolve with spacing and buffering.
When to see a dermatologist
Make an appointment if you get moderate-to-severe acne, scarring, repeated dark marks (post-inflammatory hyperpigmentation) or are not improving after 8–12 weeks of appropriate therapy. A specialist will be able to tailor strengths, consider recommending antibiotics or hormone options where appropriate and help prevent scarring. Flares on the jaw that come back before the period and worsening may involve hormonal offenders; a physician can talk about targeted options.
Dr Robert White is a Doctify-rated Extended Role (GPwER) in General Practice with a specialist interest in Dermatology and Skin Surgery. He treats acne in adults of all ages and is dedicated to evidence-based medicine with clear education on routines, prescriptions and procedure options when appropriate.
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