Retinoic Acid Strategies
Your patient asks about possibly using Retin A. Now what? Lucky for us, retinoids have progressed so much over the past 40 years that we now have different avenues to help the patient realize benefits without all the harsh side effects of earlier years - redness, dryness and flaking, all of which contributed to poor patient compliance.
Fortunately with the new ointments, creams and gels, we now have several options to offer. Tretinoin, available in 0.025% to 0.1% formulations, is prescription only. New nonprescription retinoid-based skincare choices include the addition of retinol and retinaldehyde. These nonprescription products allow the skin to convert retinoic acid as needed without overirritating or overdosing the skin, thus allowing for less redness, irritation and flaking. Preference is for patients to use retinoic acid, but due to the undesired effects, patients exhibit poor compliance. The alternative forms do not exhibit these side effects.
Maximizing patient compliance is made easier by choosing the most appropriate retinoid-based topical. Selection should be made based on the type and age of the patient's skin and consideration of the climate in which the patient lives (dry vs. humid). When treating for photoaging, you can begin with a retinol or retinaldehyde and gradually introduce a prescription form of retinoic acid.
The success of any skin care regimen that includes retinoic acid is dependent on patient compliance. Some experts suggest starting low (0.025%) and building up to 0.1% as the patient's skin becomes more tolerant. Another option is to start with 0.1% and direct the patient to use it 2 to 3 days per week for a month and increase to 4 to 5 days the following month until daily use is achieved. Educating patients about controlling side effects is paramount. By educating and taking it slow, and adjusting based on side effects, compliance is increased.