Key to Anti-Aging: Tretinoin vs. Retinol
Tretinoin (generic for Retin-A) or Retinol are key components to every anti-aging regimen; they are used in the most effective anti-aging creams available. Make these components a part of your nightly skin care regimen to achieve and maintain the youthful appearance of your skin.
How does Tretinoin and Retinol work?
Tretinoin is a vitamin A derivative composed of retinoic acid. It is a prescription medication (only distributed by a physician) that has multiple effects on the skin, including normalization of skin differentiation, reduction of acne, and improvement in fine wrinkling, mottled pigmentation, and rough skin texture.
Retinol, compared to tretinoin, is also a vitamin A derivative, but is the inactive form of retinoic acid that is then activated to retinoic acid by the skin. It offers similar anti-aging effects as tretinoin and is appropriate for those who struggle with more sensitive skin and cannot tolerate the use of tretinoin.
How should the creams be used and what are possible side effects?
Use: Only a small amount applied as a thin layer to the skin is needed. The cream should only be applied at night, since the sunlight deactivates the medication. If you are using the cream for the first time, begin applying the medication once every other night and then increase to nightly as tolerated in 3-4 weeks.
Side Effects: Tretinoin and Retinol may cause increased dryness, flaking, redness, sun sensitivity and irritation. Side effects can be reduced by applying the medication as a thin layer to a dry face (at least 10 minutes after washing) and using a moisturizer afterwards. Caution should be used with sun exposure by wearing a broad-spectrum sunscreen SPF 30+ in the morning and wearing a hat when outdoors.
Common Pigmented Skin Growths
Moles (medically known as nevi) are the most commonly known pigmented growths by the non-medical community; however, there exists other non-cancerous growths that also present with pigmentation.
Seborrheic Keratoses often draw immediate attention due to their irregular pigmentation and warty texture. Also known as “barnacles of aging”, these growths typically appear in multiples over the age of 30 and can develop anywhere on the skin. They often range in color from tan to brown to black and have either a waxy, scaly or warty texture. It is not uncommon for these growths to change in size, color, and texture. Because of this, they often draw concern by patients as meeting ABCDE criteria for melanoma. Fortunately, these growths are not derived from melanocytes (pigment-producing cells) from which melanoma skin cancer arises. Seborrheic keratoses instead are non-cancerous growths of the skin. Risks factors for their development include age and genetics. Rarely, the sudden onset of multiple seborrheic keratoses has been associated with adenocarcinoma cancer of the gastrointestinal tract.
Various cosmetic procedures can be performed if seborrheic keratoses become aesthetically bothersome. These growths are only removed in the physician’s office using a liquid nitrogen application (cryotherapy), electrodessication, curettage, or application of highly concentrated hydrogen peroxide (known as Esktata).
Solar lentigenes, also known as age spots, liver spots, or sun spots, are areas of increased pigmentation on the skin due to hyperactive pigment-producing cells. They arise on the areas of the skin that have sustained excessive sun exposure over one’s life such as the face, forearms, hands, upper body, and even lower legs. Solar lentigenes are considered as one of the first signs of sun damage and when present are viewed as a risk factor for skin cancer development. Patients should adhere to strict sun protection to minimize their appearance and prevent development of new spots.
There are multiple ways to reduce the appearance of solar lentigenes. The least aggressive approach is to use prescription-grade lightening creams that often include a combination of the following ingredients: hydroquinone, tretinoin, kojic acid, licorice root, azeleic acid or tranexamic acid. Use of topical creams for lightening requires application one to two times daily for at least 3 months, in most cases longer, to see their benefits. For patients with more extensive involvement, resistant lentigenes, or wishing to see more immediate results, cosmetic procedures such as cryotherapy, microdermabrasion, medium-depth chemical peels, and laser therapy can be performed. These therapies are offered as a series and can be paired with a lightening cream in between sessions.
All patients while undergoing any of the lightening therapies above should adhere to a strict sun protection regimen by applying a broad-spectrum sunscreen daily with a minimum SPF 30+, re-applying sunscreen when outdoors every 2 hours, along with wearing a wide-brimmed hat and sun protective clothing. This will help preserve the lightening effects offered by the above therapies long-term.
Dermatosis Papulosa Nigra
Dermatosis papulosa nigra are non-cancerous, small, brown growths that most often appear on the face in those with darker skin. They are often hereditary and present as multiple growths. Unfortunately, there is no topical cream to prevent their development, but growths can be treated by electrodessication or laser if desired for aesthetic purposes.