Prolonged Breakouts While Using Topical Retinoids

Q: Prolonged Breakouts While Using Topical Retinoids

Hello： For a detailed introduction to topical retinoids, you can refer to the article from Med's Good Friends at https：//www.medpartner.club/topical-retinoids-introduction/. <br>If the skin lesions do not improve or worsen, it is recommended to consult a nearby dermatologist for

Topical retinoid exacerbation phase

Hello, Doctor.
I stopped taking oral contraceptives after five to six years, and my skin condition has become quite unstable.
I did some research online and learned about the effects of retinoids (A acid) for treating acne and anti-aging, so I wanted to give it a try.
I visited a dermatologist who prescribed me retinoid (tretinoin) to apply.
It has been three months now; I didn't use it every day during the first month, but since then, I've been applying it almost every night before bed, using a pea-sized amount of tretinoin mixed with Vaseline or Avène lotion, and I haven't used any other skincare products.
During the day, I mostly just apply Avène sunscreen.

In these three months, I haven't experienced much peeling or stinging, but I still keep getting acne, mostly concentrated on the outer sides of my cheeks.
Many of them are cystic acne, feeling like a lump under the skin that sometimes hurts, or hard comedones that fall off when I pick at them.
Sometimes it seems like the new acne is less than before, but there are also sporadic signs of worsening, which is quite distressing.
So I would like to ask the doctor a few questions:
1.
I always thought this was a normal period of worsening, but it seems to have lasted too long?! Is this normal? Most information I found online says that after three months, the skin condition should improve significantly, but I have yet to see that day (crying).
Should I continue using it?
2.
I have tried taking a break from applying tretinoin for two to three days, and no new acne appeared, and it seems like the existing acne faded on its own.
Does this mean I am not suitable for tretinoin, or could it be related to the brand of tretinoin?
3.
Previously, I mostly had acne on my forehead or chin, so why am I now getting acne on my cheeks while using tretinoin?
Thank you, Doctor, for your patience in reading and answering my questions!

Ping, 20~29 year old female. Ask Date: 2020/04/23

Dr. Li Yufen reply Dermatology

Hello: For a detailed introduction to topical retinoids, you can refer to the article from Med's Good Friends at https://www.medpartner.club/topical-retinoids-introduction/.
If the skin lesions do not improve or worsen, it is recommended to consult a nearby dermatologist for diagnosis and treatment at http://www.derma.org.tw/user_finddoctor.php.
Consider whether to combine with other oral medications or topical treatments for acne.
Thank you!

Reply Date: 2020/04/23

More Info

Dear Patient,
Thank you for sharing your experience with topical retinoids, specifically tretinoin (A酸), and your concerns regarding the prolonged breakouts you are experiencing. It's understandable to feel frustrated when the expected improvements in your skin condition do not align with your experiences. Let's address your questions one by one.

1. Prolonged Breakouts: It is not uncommon for individuals to experience an initial worsening of acne when starting topical retinoids. This is often referred to as the "purging phase," where existing comedones (clogged pores) come to the surface. However, if you have been using tretinoin consistently for three months without significant improvement, it may be time to reassess your treatment plan. While some individuals do see improvements within this timeframe, others may take longer. The absence of peeling or irritation is a positive sign, but the persistence of cystic acne suggests that your skin may not be responding as expected. It is essential to communicate this with your dermatologist, as they may consider adjusting your treatment or exploring additional therapies.

2. Temporary Break from Tretinoin: Taking a break from tretinoin and noticing a reduction in new breakouts could indicate that your skin may be sensitive to the formulation or that the retinoid is not the right fit for you. Different brands and formulations can have varying effects on the skin. It's also possible that your skin may benefit from a different approach, such as incorporating other acne treatments like benzoyl peroxide or salicylic acid, which can help manage breakouts without the irritation that some experience with retinoids. Again, this is a discussion best had with your dermatologist, who can provide personalized recommendations based on your skin's response.

3. Location of Breakouts: The shift in breakout locations can be perplexing. Acne can be influenced by various factors, including hormonal changes, skin type, and even the specific areas where products are applied. The cheeks are often a common area for cystic acne, which can be related to hormonal fluctuations or even lifestyle factors such as diet and stress. It's also possible that the application of tretinoin is affecting the skin's oil production and leading to breakouts in areas that were previously less affected. Your dermatologist can help you identify potential triggers and adjust your treatment accordingly.

In summary, while some initial breakouts can be expected with the use of topical retinoids, prolonged worsening of acne is not typical and warrants further evaluation. It is crucial to maintain open communication with your dermatologist about your experiences and concerns. They can help determine whether to continue with tretinoin, adjust the dosage, or explore alternative treatments that may be more effective for your skin type and condition.

Remember, managing acne can be a complex process, and it often requires patience and a tailored approach. Don't hesitate to reach out to your healthcare provider for guidance and support as you navigate this journey.

Best wishes for your skin health,
Doctor Q&A Teams

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