Dermatologist Dr. Cynthia Bailey answers your questions about skin care and skin problems
Hi Dr. Bailey,
I am 49 years old. I use Tretinoin 0.05% for sundamage and aging purposes. Is it possible to add Glycolic acid to my routine also? I am wondering if there is a Glycolic face cream I can add?During the day I am currently using Daily Moisturizing Face Cream for Dry to Normal Skin and the Citrix Antixodant SPF30 sunscreen.
Thanks so much!
I love both tretinoin and glycolic acid for sundamage and anti aging skin care. Tretinoin and Glycolic acid are both powerful anti aging skin care ingredients that make very noticeable improvements in the appearance of the skin by:
- Lighten age spots
- Smooth and exfoliate the skin giving it a more luminous character
- Work to reverse wrinkles by building new collagen just underneath the surface of the skin.
The ultimate anti aging skin care product combo is to use both of these and throw in a strong professional level vitamin C product every 4th day. Each of these ingredients works to rejuvenate the skin by a different mechanism, and thus combination therapy yields more age reversal that using just one alone.
Unfortunately, all these highly effective anti aging ingredients are irritating. Only people with really tolerant skin can combine tretinoin and glycolic acid therapy. People with sensitive skin (especially people with rosacea, eczema or facial seborrheic dermatitis) typically have to pick either tretinoin OR glycolic acid. People who can’t tolerate using tretinoin with glycolic acid can sometimes tolerate using just one of these ingredient with a topical vitamin C product. This is because the vitamin C is not exfoliating. Vitamin C is, however, irritating to exfoliated skin so it’s still a little tricky.
The reason that it’s tricky to combine these wonderful and effective anti aging ingredients is that the glycolic acid and the tretinoin are both very exfoliating. Exfoliated skin has a more refined and luminous appearance, but also absorbs things faster. Because the glycolic acid and the vitamin C both have an acid pH, they can be irritating to exfoliated skin. In addition, tretinoin causes a ‘break in’ rash (called retinoid dermatitis) when a person first starts using it. The skin adjusts in about a month and the retinoid dermatitis typically goes away, but skin with retinoid dermatitis gets really irritated from the acid pH of the glycolic acid or the vitamin C products.
When people want to try to combine anti aging home therapy, my favorite method is to start them on the tretinoin at night for at least 2 months. When their skin has adjusted to the tretinoin, we add professional level glycolic acid during the day as I describe below.
When the combination is tolerated and can be applied every day, then we throw in the Professional Cell Repair Serum at least twice a week in place of the glycolic acid.
To help the skin tolerate this powerful anti aging treatment, I add Replenix CF cream twice a day. I’ve found Replenix to really increase a person’s ability to handle more anti aging skin care products than it otherwise would.
When a person wants to try combining glycolic acid and tretinoin therapy I recommend they start with one first, let the skin adjust for a month or two, then add the second. They use the second product a few days a week to begin with. Gradually, as their skin adjusts to the new second product, they work up to using the second product every day. If parts of their face do well with the combination but other areas become irritated, then they don’t put the second product on the sensitive areas. When their skin gets irritated for any reason, they need to stop both products until the skin is back to normal, at which point they repeat this process over a shorter period of time.
Of course, any exfoliating anti aging treatment means that a person MUST wear a 5% or more microsized zinc oxide sunscreen like Citrix every day, all year, regardless of their planned activities. Because exfoliated skin allows more damaging sun rays to enter the skin, I also want people to wear hats and try to keep their face out of direct sunlight as much as possible. This is important for skin cancer prevention, and it’s also critical for their anti aging skin rejuvenation to be effective.
Because combination therapy is complicated and involves layering products on the skin, I write out the order of product application for my patients. The typical product application regimen that I recommend is:
- Wash with a gentle cleanser (eg. Calming Zinc Soap or Toleriane Cleanser)
- Replenix CF Cream
- Glycolic acid product (choose based on your skin type) or Professional Cell Repair Serum
- Moisturizer if needed (eg. One of our Daily Moisturizing Face Creams, or your favorite non copper containing moisturizer)
- 5% or more micro sized zinc oxide sunscreen (Citrix is the most popular)
- Wash with a gentle cleanser as above
- Replenix CF Cream
- Daily Moisturizing Face Cream of choice if needed
- Wait 15 minutes then Tretinoin (begin every 3rd night and gradually work up to every night)
If a person finds that they are unable to tolerate both tretinoin and glycolic home therapy, then I recommend they try combining tretinoin at night, Professional Cell Repair Serum during the day and have occasional glycolic acid peels done carefully by a skin care professional. Again, the exfoliation achieved with tretinoin makes the peels tricky and the skin care professional needs to be experienced with this situation. The risk is that the peel may be go too deep and injure the skin, potentially causing scarring. Remember, professional skin care is capable of creating powerful skin rejuvenation, but there are risks; professional anti aging skin care products have to be strong in order to overcoming nature, it’s not like buying some fluffy, ineffective products at the department store.
I wish you the best of luck. Be sure to talk with your tretinoin prescribing doctor about what you’ve learned here. This information is general information and I can’t promise it is appropriate for your specific skin.
I hope you found this helpful and informative. Thanks for sending me your question.
Cynthia Bailey MD, Dermatologist
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