Dear Dr. Bailey,
I am using tretinoin 0.5% and glycolic acid 20.0%. Recently I’ve been alternating every other night, but I find this always leads to a “peely” day on the mornings after glycolic acid nights. In order to avoid this, yet still reap the benefits of both, I’m considering doing a glycolic acid week alternated with a tretinoin week. Do you think this is a good idea?
In the past, I’ve done glycolic acid in the AM and tretinoin in the PM, but I find this to be too much, and enjoy just a nice, simple antioxidant/sunscreen routine in the morning.
I like protecting and preventing my skin from aging, but having peely days is no fun!
Thank you for your time!
This is both an excellent and an aggressive anti-aging regimen. Not many people can combine these two ingredients at this strength, so your skin is pretty tolerant. You’re lucky because combining these two anti-aging ingredients gives fantastic rejuvenation benefit to skin! It’s a tricky regimen though, as you have seen.
I have a number of patients like you whose skin allows them to combine glycolic acid and tretinoin skin care products on a regular basis. Usually I have them try to get up to the highest tretinoin cream first which is the 0.1%. We hold there for 2 years and then begin the alternate night treatment with glycolic acid. In the interim we either try to use glycolic acid peels to get the glycolic acid benefits, or we try to add the glycolic during the day if there skin will allow it. If they’re using a glycolic product during the day I usually have them also use a vitamin C product (always C/R/S because I believe it is the best Vitamin C product) every 2nd or 3rd day in place of the glycolic acid product to reap the benefits of Vitamin C too.
In my practice trouble shooting the peeling from this regimen includes:
- Taking a look at what skin cleansers are being used. It’s often the cleanser which is the step in a skin care regimen where a little irritation sets off the peeling. I always recommend avoiding foaming cleansers with sodium laurel sulfate when tretinoin patients suffer from peeling. Sodium laurel sulfate also compromises the barrier strength of the skin and we don’t want that because the skin is very exfoliated by both the tretinoin and the glycolic acid. Toleriane Cleanser is my favorite gentle non-medicated cleanser for Retin A users – it actually hydrates while it cleanses and is never irritating.
- Adding Replenix CF Cream or Green Tea Antioxidant Skin Therapy – Replenix Power of Three Cream twice a day after washing and before anything else goes on the skin is the other great trick I use to coax the skin into accepting this regimen without peeling. This helps to soothe the skin, allowing us to push on with the tretinoin and glycolic acid products. As always, it’s important to wait 15 minutes after washing and applying products at night before applying tretinoin. If not, the peeling starts in a few days.
If that doesn’t work then additional options we consider are using a lower strength glycolic acid such as a 15% product. It actually makes a big difference with the professional skin care products that I use which are Glytone and Glycolic Acid Anti-Aging Face Cream 15%. 15% is still really ‘beefy’ in terms of rejuvenation.
I’ve never recommended that patients alternate at 1 week intervals like you’re considering doing. The usual recommendation is at least twice a week with tretinoin to maintain results after nightly use for 2 years; my preferred goal is every other night, which allows for the occasional missed night with an end result of twice a week!
I hope that helps. Of course, this information is general information from my patient experience. You need to ask your prescribing doctor for advice for your specific treatment with tretinoin as it is a prescription drug. I’ve listed some more of my post about tretinoin use below.
Cynthia Bailey MD, Dermatologist
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