Do you know that tretinoin, the active ingredient in Retin A, breaks down in sunlight?

And, do you know that if you apply it to moist skin, it’s more likely to cause peeling and skin irritation?

Lastly, do you know that some of the common and really good ingredients in other skin care products aren’t compatible with tretinoin?

Used correctly, tretinoin does amazing things for skin. I love tretinoin and have personally used it for over 25 years. My skin looks better now than it did then. I’ve also written thousands of prescriptions for it in that same period of time and I’ve helped the same number of patients integrate it into their skin care treatments.

Just this last month I had interesting conversations with two of these patients, both of whom expressed gratitude for my recommending tretinoin and attributed the healthy condition of their skin to their years of tretinoin skin therapy:

The first patient is a woman in her early 60s with rosacea and a history of skin cancer who said that she had more wrinkles 15 years ago when she started using tretinoin than she does today. Her pores appear smaller and her skin texture is better, and she feels it’s the tretinoin that’s helped.

The second patient just turned 39 and looks like she is in her mid-twenties. She started using tretinoin at 27 and says she, too, looks better now than she did then. While getting a pedicure to celebrate her birthday, the woman giving her the pedicure was astonished when she found out that my patient was over 30.

Tretinoin therapy is well worth the effort in my opinion, but there are tricks to doing it right.

The three key tricks I tell my patients for using Retin A (tretinoin) correctly

1. Always apply it to your skin at bedtime, never use it during the day.
2. Never apply it at the same time you also have products on your skin that contain glycolic acid or benzoyl peroxide .
3. Always wait at least 15 to 30 minutes after washing your skin and applying any other skin care products before you apply tretinoin. I personally keep my tube of tretinoin on my bedside table and read a little to pass the time before I apply it.

My tube of tretinoin sitting on my bedside table

Additional treatment tips to help skin tolerate tretinoin therapy

• Start tretinoin therapy by using the product twice a week (every third night) and slowly increase to every night over a month or two as your skin adjusts. A little scaliness and irritation is normal at first, but if the treated skin becomes really sensitive, back off and wait. Let the skin return to normal then begin treatment again. Slowly try to increase to every night as your skin adjusts.
• Apply a ‘pearl-sized’ portion to the face. Use the same amount for the neck and/or chest.
• If your skin continues to become irritated and just won’t adjust to tretinoin treatment, then switch to entirely non-irritating cleansers like Toleriane Cleanser or Nobel Zinc Soap. Many cleansers are too irritating for tretinoin treated skin.
• If your skin becomes red and irritated for any reason (eg. wind burn, sun burned, harsh skin care products, surgical or cosmetic procedures etc.), don’t apply tretinoin until your skin has entirely returned to normal. This is because tretinoin irritates irritated skin!

Important things to know about tretinoin treatment

• Tretinoin-treated skin is very exfoliated and should not be waxed for hair removal.
• Any doctor or skin care specialist performing a procedure such as a chemical peel, microdermabrasion, laser or light treatments etc. needs to know you are on tretinoin. They may ask you to stop it for a period of time before and after your treatment.
• Anyone who is or may be pregnant should not use tretinoin.
• Anyone using tretinoin must sun protect their skin or they will have more skin sun damage than if they never used tretinoin, again because tretinoin skin is very exfoliated.

Lastly, why bother with this tricky and sometimes inconvenient skin care treatment?

Scientific studies and my medical experience give me so many reasons to be a big fan of tretinoin:

• It has proven itself to reduce, reverse, and prevent wrinkles. The younger a person starts (teens and twenties), the more benefit they receive, but it’s never too late!
• It helps lighten and prevent age spots.
• It builds collagen to thicken and increase the structural strength of treated skin.
• It helps to decrease a person’s risk of developing skin cancer.
• Skin just looks better and younger when they use tretinoin.

I’ve used tretinoin for over 20 years and will continue to do so. I see the benefits every day in the mirror and for me these benefits outweigh the inconveniences. How about you? What are your stories?

If you found this information helpful, you may want to read:

5 Steps For Smart Sun Protection

How To Get The Most Out Of Your Anti Aging Skin Care

How To Unclog Your Clogged Pores

When you use a self tanner, do you have soft, moist, evenly bronzed skin?

Or does your skin look like a cross between an alligator and a leopard with the smell of mayonnaise overlaid by cheap perfume?

There are a few tricks to looking (and smelling) good in self-tanners! I’ve learned them over the years from my patients who do it well. The problem is that self-tanners naturally get stuck in the thicker areas of your skin like your freckles and over your knees. They also dry out your skin and the active ingredient has a funny mayonnaise-like smell. I still love self-tanners and will take them any day over sun damaged skin, but… there are some tricks to getting the look you want with self-tanners.

3 Steps For Applying Self-Tanning Products So You Look (And Smell) Great

The general concept: Self-tanners stain the outer, dead skin cell layer of your skin, showing off how thick and how dry this layer is. Understanding this is key. Your skin needs to be exfoliated and moisturized BEFORE you apply self-tanners. Plus, you’ve got to be careful that you put much less product on the thicker areas of your skin like your knees, elbows and feet.

Step by step instructions for applying self-tanners like a pro:

1. Prepare Your Skin First!

Keep your skin exfoliated and hydrated in preparation for self-tanners. This means physically exfoliating your skin in the bath or shower and moisturizing immediately after toweling dry. Physical exfoliation is where you scrub off the extra dead cells using something rough. I’ve found the most effective products for this are the Body Buf Puf or the Salux Cloth. Other options include a luffa sponge or an exfoliating body polish. Of course scrub gently, but use more pressure and scrub longer over the thicker skin areas of your knees, elbows, the back of your hands and tops of your feet. Immediately after toweling dry (within three minutes — no more) apply a rich moisturizer. Ideally your moisturizer should contain an alpha hydroxy acid for additional exfoliation. I’ve found the best exfoliating moisturizer for this is Glytone Body Lotion (which is in my Anti Aging Body Skin Care Kit along with the Salux Cloth). Less strong, but still effective are the drug store products AmLactin Cream or Lacticare Cream. I’ve used them all and Glytone is by far the most effective and it’s what I’ve used for years for my own skin.

2. Know When And How To Apply Self-Tanners

Apply self-tanner immediately after toweling off from your bath or shower. You can apply it before, or in place of, your moisturizer. Don’t put the tanner on your skin if you haven’t just bathed because you’ll get the alligator look. You can apply moisturizer like Glytone Body Lotion on top of the tanner if you’re using a product that isn’t too heavy. This will give you the best results.

Apply very little product over areas of your body with thicker skin. Using your leg as an example, put some product in one palm, rub your hands together and then smooth the product over the thinner skin on your lower leg and thigh, but avoid touching your knee or foot until you have almost no product left on your palms, at which point you can very briefly rub your palms over the back of your foot and the front of your knee. Because the thick skin in these areas picks up more product, they can look much darker than the thinner areas of your skin, giving them a dirty look.

Always wash the product off your palms entirely when you are done. If you don’t, your hands will look dirty. Your palms qualify as areas of thick skin and will stain darker than the rest of your skin if you don’t wash them well and immediately after applying self-tanner.

Lighten overly dark areas by physically exfoliating them. If, for some reason, you still find that some areas of your skin are darker, giving you a spotty or dirty look, you can lighten the color in the shower with a light physical exfoliation using the Salux Cloth, Buf Puf or a body polish.

3. Be An Artist

Refine your technique to get a natural look. Apply more product over the parts of your skin that would naturally be darker if you had a sun tan to give them slightly more bronzed color. (Meaning the tops of the arms should be darker than the under surface of the arms!) This can be done by applying more product the first time, or doing a second application. Also, if you don’t intend to apply the tanner to your entire skin surface, then feather it in to those areas by gradually applying a thinner layer as you approach them, don’t stop abruptly leaving a big color difference. Self tanner application is a lot like painting and you can dial in the color you want by putting more or less product on your skin.

Products:

There are tons of options available. I prefer a thinner product that allows you to put your moisturizer on top without feeling heavy or greasy. My favorites:

Avene Moisturizing Self-Tanning Lotion My new favorite! It has a light feel, no heavy fragrance and a relatively hypoallergenic base that’s perfect under Glytone Body Lotion. I like it so much I’ve decided to carry it at OTB Skin Care!

Clarins Gelee Auto Bronzante Express. Clarins consistently gets high ratings for its self-tanners. I used this product for years and it, too, works well under moisturizer. The fragrance is subtle and the color good.

L’Oreal Sublime Bronze Spray. This is a great way to apply tanner to your back! I’m not fond of the fragrance, but the spray is brilliant.

Jergens Natural Glow and Neutrogena Summer Glow (this may no longer be available). These good products are a little too heavy to use under a moisturizer. This means you’ll get the best results if you use them every other day alternating with an AHA moisturizer on alternate days to avoid the dry alligator look.

Self-tanners work beautifully to give you great looking bronzed skin….without the wrinkles and age spots you’d get from the sun. By knowing how to apply them, you can rely on self-tanners to give you a tan look whenever you want it.

Remember, self-tanner color does not give you any sun protection so follow my recommendations for sun protecting your skin.

If you found this information helpful, you may also want to read:

Back And Chest Acne: Will They Ruin Your Summer?

The New Celebrity Beauty Trend-Going Natural

Dermatologist’s 3 Simple Steps For Sandal-Ready Feet By Spring

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I love it!

Bonnie Fuller, Editor in Chief of Hollywoodlife.com made my day on the Today Show this week when she said that the new big celebrity fashion trend is celebrities flaunting their natural beauty; going ‘au naturale’ in the media with untouched photos,minimal makeup and pride in being naturally beautiful.

Jessica Simpson, Demi Moore, Britney Spears – they’re all doing it publicly and Bonnie Fuller says we’re just seeing the tip of the iceberg with this trend!

I’m in nirvana; naturally beautiful is IN. Good skin care and healthy living are golden. Sedate me! I’m apoplectic. I’ve been about this for years.

Except for a rare few, being naturally beautiful, without a lot of makeup and tricks, only happens with a healthy lifestyle and smart skin care. I tell patients this all day, and I work at it myself. Now it’s in!

A patient of mine who’s a living example of this came in for an appointment just a few days before Bonnie Fuller’s Today Show interview. This patient just turned 38 and she’s followed my skin care advice since she was 27-and-eleven years later her skin looks better than it did eleven years ago. She gave herself a birthday pedicure and the woman doing her nails couldn’t believe she was over 30. She looks years younger than her age because she’s been using my rejuvenating skin care recommendations every day for the last 11 years and she stopped the clock! She’s also a health-conscious, California girl living a healthy lifestyle which has a huge impact too.

So, how do we claim our natural beauty?

The 4 Essential Steps For Being Beautiful Naturally – that I’ve learned from my patients, my medical practice and life as a healthy living Californian.

Starting from the outside and working in, and with links to more in-depth information on my blog and web site:

1. Rejuvenating skin care is a must. Your skin is the wrapping paper you show to the world and it makes or breaks your look. We now have super effective products that tune-up skin without surgery. The most effective combos for my patients:

• Antioxidant Facial Skin Care with Glycolic Acid: This improves age spots and rough, wrinkled skin texture giving all skin types a more luminous and healthy look. Some antioxidants in particular are almost like ‘magic’ in how they protect, heal, and boost the skin’s collagen-forming function. I’ve put the most effective products together in a kit and it’s my absolute favorite skin care regimen available without a prescription.
• Glycolic Acid Facial Skin Care: This improves age spots and rough, wrinkled texture for that luminous healthy glow.
• Sunscreen! You can’t have meaningful skin rejuvenation without it.
• Anti Aging Body skin Rejuvenation: Exfoliation and strong glycolic acid really make body skin soft, dewy and ready for revealing fashions or fake tanning lotions.

2. Exercise is a must. My formula is 150 min of cardio per week in three 50-minute segments, resistance weight work and balance/stretching exercise like with yoga.  A good workout takes years off your looks and is the instant fountain of youth.  Just tonight, when I came home from spinning class, my husband said, “wow, you look great and your skin looks amazing!” (Cardio gets him every time.)

3. Healthy diet is a must. This means a mostly plant-based diet of fresh, well-sourced food, almost no processed foods, moderate alcohol and no junk food. Pretty strict, but just look at your appearance after a junk food binge-it shows with a puffy sallow complexion, etc. Probiotic rich foods are also important because healthy digestion helps you absorb the good stuff from your food.

4. Managing stress is a must. OK, here I’m no pro. This is my growing edge. When you’re stressed, you look ‘stressed out’ and it’s not pretty. Find whatever it takes to help you gain inner tranquility; it may be yoga, meditation, prayer, walks in nature, full deep breaths throughout the day, time with friends-whatever it is, just do it on a regular basis. You’ll glow.

Going natural is a great trend. It gives us reasons to take really good care of ourselves because -

you can’t fake natural beauty and it’s the style trend for 2010!

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Hi Dr. Bailey,
I am 50 years old and currently using your Anti-Oxidant Kit without Glycolic Acid along with tretinoin 0.5% at night.  I really like it very much. I recently introduced the C/R/S Cell Anti Aging Serum 15%. I am finding this to be somewhat drying and I’m wondering if this is a normal reaction to this product?  Also, I’ve started out by using it every other day. Will I still reap the benefits by using it this way or is everyday the way to go?

Another question I have is about the Buf-Puf. Can this be used every day? I am using the Replenix Scrub twice a week which is quite the work horse! I have somewhat sensitive skin so I have to be careful not to overdo.

I love your site and your blog! The information has been incredibly helpful.

Thanks!
Robin

Dear Robin,

This is a great practical question.  You’re using the best and most powerful anti aging skin care products made.  The dryness you describe sounds like what I see when these products push up against the limits of what a person’s skin can currently handle. By taking little breaks in how often these products are applied, the skin can gently adjust.  When the skin is ready, it will probably be able to handle more regular use.

Occasional dryness and irritation happens to almost everyone using strong anti aging products.  That’s because both vitamin C and glycolic acid have an acid ph which means they’re sort of like lemon juice.  Add to this the fact that tretinoin (Retin A and Renova) and glycolic acid both powerfully exfoliate dead skin cells to uncover the underlying soft new cells and you can see why an acid ph can occasionally cause chapping and dryness.

Here’s what I tell my patients who are experiencing dryness or irritation from their professional anti aging skin care products:

• If the dryness occurred after adding a new product, or increasing the strength of a product they’ve been using successfully, then stop just that one product until the skin goes back to normal.  This may be a few days or as long as a week or two.  When the skin is ready, resume using the product just once or twice a week.  Slowly increase to everyday use as the skin adjusts.  If the skin again becomes dry and chapped then take another break until the skin settles down, then restart.  The trick is to find that application frequency and product strength for your particular skin.
• When a person’s skin is really chapped, sunburned or broken out with a rash for any reason, they need to entirely stop most of their anti aging products until the skin has entirely returned to normal.  In this case, I recommend washing with a gentle cleanser like Noble Zinc Soap or Toleriane Cleanser applying Replenix CF Cream, a gentle moisturizer like Glycolix Elite (without glycolic acid) and sunscreen during the day.  When their skin is totally back to normal they can very slowly resume their other anti aging products-as tolerated.  It’s important not to apply vitamin C, tretinoin or glycolic acid to irritated skin because it makes the irritation worse.

Your second question about whether you’ll benefit from vitamin C if you don’t use it everyday is a question many people ask me.  Interestingly, vitamin C anti aging products like C/R/S don’t need to be used every day because tests have shown that 50% of the high skin concentrations obtained from applying professional vitamin C products are still present in the skin after 4 days.  I tell my patients to apply C/R/S at least three times a week, and especially when they’ll be in the sun; vitamin C is a great second defense against free radical sun damage- and we want that.

Your last question is about the additive benefits (or problems) from multiple exfoliation products.  Yes, you can overdo it.  You have to figure where that perfect amount of exfoliation is for your skin.  Exfoliated skin is soft and luminous, but it’s more sensitive and requires special care. For most people I find that using Replenix Scrub twice a week OR gently washing with a Facial Buf Puf every day is usually just about right.

I hope this information is helpful.  Thanks for sending me a great question that brings to light something many people experience with professional anti aging skin care products.

Warm Regards,

Cynthia Bailey MD, Dermatologist

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

It’s not an impossible promise.

Sun protection is the single biggest fountain of youth for your skin. Sun causes skin thinning, wrinkles, age spots, and ‘broken capillaries,’ not to mention skin cancers. No matter how old or young you are, sun protection from this day forward will help you ’stop the clock’ on skin aging.

Sunscreen is one of your main tools to sun protect your skin. Starting with the right product is the first step, knowing how to use it is step two. Here’s how I personally use sunscreen and what I tell my patients:

Dermatologist Dr. Cynthia Bailey’s Recommendations For How To Apply Sunscreen

When to apply sunscreen:

Sunscreen should be applied 15 to 30 minutes before sun exposure.

Be sure to let the product sit on your skin for the full 30 minutes if you’ll be swimming or sweating. Use a ‘very water resistant’ sunscreen if you plan to be in water. ‘Very water resistant’ means the product should protect you for up to 80 minutes in the water. If you or the water will be moving around (ie. swimming, being in a Jacuzzi or the ocean) that time will be shorter.

Where you need to apply sunscreen:

Every inch of your skin that isn’t covered by clothing needs sunscreen. That means ears, lips, back of your hands, back ofyour neck, top of your feet, top of your head, etc. You don’t need sunscreen under your hat or under sun protective clothing, but you need it everywhere that isn’t covered.

How much sunscreen you need to apply:

The amount you apply is important but confusing and there isn’t a short answer. The average-sized adult should use 1 ounce (which is equal to 1 shot glass or equal to 2 tablespoons) to cover their entire body – but body sizes vary and you don’t need to apply sunscreen under your clothes. So how much you subtract from this amount depends on your body size and how much of you is covered by clothing.

Facial application amount is also confusing because the 1 teaspoon rule from years ago was meant for the entire head and neck, including the scalp. Again, you need to figure out how big your exposed face, ears and neck is relative to a teaspoon, and whether you’re bald or have hair on your scalp. For me, it takes about 1/3 teaspoon of sunscreen to really protect my face, ears, the front and back of my neck and behind my ears. I’m more careful to apply this generous amount if I’m going to be in the sun all day, even with a hat. If I’m indoors a good part of the day, I may use as little as ¼ teaspoon on my face and neck. I put sunscreen on every morning before I start my day and I recommend that you do the same. Be prepared, not surprised when you’re unexpectedly caught outside.

When to reapply sunscreen:

You always need to reapply sunscreen after being in the water or sweating heavily.

Sunscreen also needs to be reapplied after two hours of sun exposure just to be safe. That’s because you’ll undoubtedly rub some of the product off your skin. Plus, sunlight gradually breaks down the active ingredients when the UV rays hit them on your skin, so you need to add more. At a minimum I recommend you reapply mid-day. When I’m out gardening, I put on sunscreen and wear a broad-brimmed hat. At noon, when I break for lunch, I reapply my sunscreen. I always use a sunscreen that contains at least 5% micro zinc oxide because over the years I’ve found that this ingredient lasts longer in the sun than other sunscreen ingredients.

Other important things to know about sunscreen:

If you use makeup with sunscreen you still need to wear sunscreen!

There are 2 reasons for this:

1. Most makeup doesn’t have 5% or more micro zinc oxide and, in my opinion, this ingredient provides the protection you need.
2. Even if your makeup has 5% or more zinc oxide in it, you’re probably not going to put that ¼ teaspoon that I recommend on your face and neck because the makeup color would look too heavy. Instead put your sunscreen on first and then add the makeup on top for color and appearance. If your makeup provides additional sun protection then that’s terrific and you’ve got really great anti-aging skin care to keep your skin young for years.

Don’t ever rely entirely on sun screen for your skin’s sun protection!

Yes, I mean that. Sunscreen isn’t perfect and you’re not going to be perfect at applying it.

First and foremost, keep the sun’s UV rays off your skin with clothing and a full, broad-brimmed hat. Try to be in the shade and try not to be out in direct sunlight between 10 am and 4pm. This means — seek the shade, wear sun protective clothing and a hat AND apply sunscreen to the parts of your skin not covered by clothing or directly under the hat.

Remember, good sun protection is your skin’s fountain of youth. You can have soft, even-colored skin with hardly any wrinkles all the way through your life. I see it in my office every day.

To Learn More About Sun Protection You May Want To Read

How To Pick The Best Sunscreen

If You Want A Nice Sunburn, Use Last Year’s Sunscreen

Making Sense Of The Vitamin D Dilemma And Sun Exposure

Dermatologist’s Simple Trick To Test Your Sun Exposure

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