Skin Health: A Guide to A-Retinoids and Treatment Progress

About the skin?

I am currently using one capsule of retinoic acid daily and have started applying Silian ointment for about three months.
When can I expect to see improvement, or is it still in the detoxification phase? It feels like the signs of improvement on my face are quite slow.
I am approximately 175 cm tall and weigh 64 kg.
I usually go to bed around 11 PM to 12 AM and wake up around 9 AM to 10 AM, trying to get a full 8 hours of sleep.
I have heard that it can take up to 8 months to see results.
Recently, I have become accustomed to wearing a mask when going out, as I find the pigmentation bothersome.
Should I continue wearing a mask? I have many questions.

Guagua, 20~29 year old female. Ask Date: 2008/03/17

Dr. Cai Changlin reply Dermatology

Hello, regarding your question, I would like to respond as follows: The oral isotretinoin you are using is currently known in the medical field as the most effective last-line treatment for acne.
However, even so, patients with cystic acne typically require a longer treatment duration compared to those with regular acne.

As for how long the treatment with oral isotretinoin will take, the most important factor is not the total duration of the medication but rather the cumulative total dosage.
Patients on lower doses will generally take longer to see results compared to those on higher doses.
For example, considering your weight of 64 kg: two patients with the same severity of acne at 64 kg, one taking three capsules daily will see results faster than one taking just one capsule daily.
However, patients on higher doses may experience more pronounced and severe side effects compared to those on lower doses.
Therefore, with patience, even patients on lower doses can reach the same treatment endpoint as those on higher doses.
The total cost of medication will be similar, but patients on lower doses may experience fewer and less severe side effects.
You mentioned that someone improved after eight months, but this cannot be used as a reference for you because: first, the severity and type of acne vary from person to person; second, the dosage they took may not be the same as yours; third, individuals may have different adjunctive treatments; and fourth, each person's constitution and lifestyle are different.
Thus, others' treatment durations should only serve as a reference.
However, some experiences from others can be useful, such as the clearance rate after treatment, recurrence rate, and the fading of pigmentation, which you are concerned about.
The issue of pigmentation is something every acne patient experiences.
The fading of acne-related pigmentation, like any skin pigmentation disorder, requires patience.
This is because the process itself takes time.
Current medical advancements have provided us with topical agents that can accelerate the fading of pigmentation, but even so, this process still requires time and patience.
Additionally, it is essential to consistently use sun protection—such as applying sunscreen and wearing hats—to prevent further pigmentation.
With patience, you will gradually observe the pigmentation transitioning from red to lighter and darker shades.
You are already using the best medication for treating acne and are on the right path.
Now, all that remains is the patience to continue on this journey.
I wish you all the best in your treatment process.

Reply Date: 2008/03/17

More Info

When it comes to skin health, particularly in the context of using A-retinoids (like tretinoin or adapalene) and other topical treatments, it’s essential to understand how these medications work and what to expect during the treatment process.

A-retinoids are a class of compounds derived from vitamin A, and they are commonly used to treat various skin conditions, including acne, photoaging, and hyperpigmentation. They work by promoting cell turnover, which helps to prevent clogged pores, reduce inflammation, and improve skin texture. However, the initial phase of treatment can sometimes lead to what is known as the "retinoid purge," where the skin may appear worse before it gets better. This is due to the increased turnover of skin cells, which can bring underlying impurities to the surface.

In your case, you mentioned using A-retinoids and a topical medication called Silian for over three months. It’s not uncommon for patients to experience a slow improvement, especially in the early stages of treatment. While some individuals may see significant changes within a few weeks, others might take several months to notice a marked improvement. The timeline can vary based on several factors, including skin type, the severity of the condition being treated, and adherence to the treatment regimen.

Regarding your concerns about the duration of treatment, it’s important to follow your dermatologist's advice. While some anecdotal reports suggest that it may take up to eight months for some individuals to see significant improvement, this is not a universal timeline. Continuous use of A-retinoids is often necessary for long-term benefits, and many patients find that their skin improves gradually over time.

As for wearing a mask, it can be beneficial in certain situations, especially if you are concerned about environmental factors such as pollution or UV exposure. However, wearing a mask for extended periods can sometimes lead to skin irritation or exacerbate conditions like acne, particularly if the mask traps moisture and heat against the skin. It’s crucial to maintain a proper skincare routine, including cleansing and moisturizing, to minimize any potential irritation from mask-wearing.

In terms of your overall skincare routine, here are some recommendations:
1. Moisturization: Ensure you are using a non-comedogenic moisturizer to help combat dryness that can occur with A-retinoid use. Hydration is key to maintaining skin barrier function.

2. Sun Protection: Always apply a broad-spectrum sunscreen during the day, as A-retinoids can increase your skin's sensitivity to the sun. This is crucial to prevent further pigmentation issues.

3. Gentle Cleansing: Use a mild cleanser that does not strip your skin of its natural oils. Avoid harsh scrubs or exfoliants that can irritate the skin further.

4. Patience and Consistency: Stick to your treatment plan as prescribed by your dermatologist. Consistency is vital for seeing results with A-retinoids.

5. Consultation: If you feel that your skin is not improving or if you experience excessive irritation, it’s essential to consult your dermatologist. They may adjust your treatment plan or suggest additional therapies to help manage your skin condition.

In conclusion, while the journey to clearer skin can be frustrating and may take time, adhering to a consistent skincare regimen and maintaining open communication with your dermatologist will significantly enhance your chances of achieving the desired results. Remember, every individual's skin responds differently, and patience is often a crucial component of the healing process.

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