Tretinoin? Adapalene? How to find the Right Prescription Retinoid for Your Skin | Dr. Sam Ellis

Dermatologists love retinoids, especially prescription retinoids like tretinoin, adapalene, and more. Retinoids are a gold standard ingredient for treating acne and the signs of aging. I like to get my patients started on a prescription-strength retinoid to help them achieve their skin goals, but did you know there are different brands for each type of prescription retinoid? I discuss the differences between them in this video, plus share some tips on how to incorporate retinoids into your skincare routine.

Today i’m going to be talking about retinoids retinoids are vitamin a derived molecules and they are one of the best weapons we have in dermatology to fight premature aging as well as acne there are over-the-counter versions of retinoids that you can buy but then there’s this whole other world of prescription retinoids and i feel like those don’t get talked about

A lot so today i’m going to delve into the topic of prescription retinoids and tell you everything you need to know i’m dr sam ellis and i’m a board-certified dermatologist i’m here to help you understand your skin and find skincare products that work for you i think before you can even begin to understand how a retinoid works you sort of have to understand what

The skin looks like under a microscope so you have this very top layer called the epidermis that is made of several layers of skin cells and then below that you have the dermis within the epidermis there’s this little very top layer of dead skin cells called the stratum corneum and when you’re using a retinoid what you’re doing is you’re signaling the cells in the

Epidermis the ones that are many many layers thick to start proliferating so growing and maturing in an organized fashion so normally you have this bottom layer of cells and they’re slowly making their way to the top layer the outer layer of your skin and then they sort of get sloughed away that happens about once every 28 to 30 days but that doesn’t always happen

In the most organized way and so what retinoids do is they signal your skin to start maturing these cells in an organized fashion and sloughing them off in the same way to me it’s like getting all your skin cells on the same page and being like listen up we’re gonna glow now when you have acne what happens is you have this hair follicle so all these itty-bitty hair

Follicles on the face and within them there are dead skin cells that are also kind of maturing and sloughing off and when you have acne what can happen is those skin cells can get very sticky and clump together with the oil that your skin creates called sebum and make this little micro plug and that micro plug can cause inflammation and you get them plugged plus the

Inflammation equals acne so when you use a retinoid it starts signaling the cells inside your hair follicles to break apart so that they don’t form that plug and it also sends anti-inflammatory signals to the surrounding tissue to say okay i saw that you got a plug but can you please calm down now it used to be the thinking that retinoids were only good for what

We call non-inflammatory or comedonal acne so that’s acne with a lot of texture but not a lot of redness because they’re so good at kind of relieving that microcomedone or that micro plug that happens in the skin but what we found over time is that retinoids are actually very good for inflammatory acne as well so really any type of acne that you have a retinoid is

Going to be a mainstay in your treatment and really it should be a prescription retinoid now when it comes to anti-aging retinoids work sort of in a similar way being anti-inflammatory and making sure that the cells of your top layers of skin are sort of sloughing off in a very normalized way but what we’ve also found is that they inhibit certain molecules that

Exist in the skin that break down collagen and elastin over time collagen and elastin is what makes your skin bouncy and stretchy so that when it sags it bounces right back you can look at older people who have hanging skin they’ve lost the elasticity and they’ve lost the collagen in their skin so if you can use a retinoid and inhibit the molecules that normally

Break down that collagen and elastin you’re going to be in better shape the other thing is that we also know that retinoids are collagen stimulatory so the body especially after the age of 25 is not so keen on the idea of making new collagen and that process really slows down in the skin but if you use a retinoid you’re constantly signaling your skin to make new

Collagen keep your skin plump keep it looking good because you’re getting that cell turnover this can also help with things like scarring pigmentation dullness if anyone asks me like what is the best anti-aging thing i can use for my skin i mean besides sunscreen it’s absolutely a retinoid for all of those reasons just to be crystal clear think of retinoids as

The word retinoid is an umbrella term and under the category of retinoids there are numerous different types there are ones that are available over the counter things like retinol and retinaldehyde and then there are prescription strength retinoids and not just prescription strength but they’re actually different molecules so they’re molecules called tretinoin

Tesaratine adapylene those are all examples of prescription strength retinoids and the big difference is the ones you can purchase over the counter like retinol when they are absorbed into the skin they need to undergo additional conversion steps to reach their active form whereas prescription strength retinoids they’re already in their active form they can go

Straight in and signal the cell and so for that reason they’re stronger they tend to be more effective but they also can cause more side effects so they can be more irritating leading to redness and dryness and peeling and all the things people who have tried prescription retinoids and feel like they’ve failed them feel what i try to talk to my patients about is

That that phase of that peeling and dryness and redness generally doesn’t last more than four weeks now four weeks seems like a very long time when you’re suffering from peeling and dryness but most people can get through it if you can’t if that’s not going to work for you that’s when using an over-the-counter retinoid might be more beneficial but you have to

Remember they’re not nearly as potent when you compare retinol over the counter to tretinoin prescription tretinoin is about 20 times stronger so as long as you have that framework in mind you’re going to get results from both but you can think of the timeline as being different and maybe the intensity of the response being different as well i think what a lot

Of people don’t realize when it comes to prescription retinoids is not only are there multiple types like i mentioned tretinoin to zeratine edapoline triferitine so those are different molecules but then there are also different brands of them so take tretinoin for example this is like the og acne fighter retinoid as well as the og anti-aging retinoid it has

Multiple brand names so there’s altrano retin-a retin-a micro renova those are all different brands of tretinoin and when they’re different brands that can mean that they’re different strengths so tretinoin goes from prescription strength 0.02 all the way to 0.1 so the strengths differ but so does the vehicle that the tretinoin is in so it can be in a cream

It can be in a lotion it can be in a gel it can be in like a microsphere preparation so different brands will prepare the tretinoin in different ways and in different concentrations because one putting it in a different vehicle can change how effective the product is but it also can change how well tolerated it is sometimes creams can feel more hydrating than

Gels but some people will prefer a gel preparation because it goes on the skin more smoothly so if someone isn’t going to jive with generic tretinoin then thinking about a brand name tretinoin product might be worthwhile one thing you might also be curious about is whether these brand name tretinoin or other prescription retinoid products are more efficacious

Than their generic counterparts and really generally no sometimes they can cause less irritation so if that’s going to increase compliance and make someone use their product more because they’re less irritated then i suppose you could say they’re more efficacious but generally speaking when it comes to brand name versus generic prescription strength retinoids

When you’re treating acne the higher percentages tend to work better for the treatment of acne but when you’re treating photo aging which is what a lot of my patients are using their prescription retinoids for low strength often works just as well as high strength so for example in a study that compared 0.025 percent tretinoin so the lowest strength generic you

Can get versus tretinoin 0.1 to the highest generic you can get across the board they had the same like favorable outcomes for the treatment of photo aging like their skin overall looked better under the microscope it showed the same reversal of signs of aging but the higher percentage showed more irritation so when i’m prescribing tretinoin for the purposes of

Anti-aging i tend to recommend lower percent strengths because you get the same outcome with less irritation moving on to the other prescription retinoids you have tezeratine which comes in brand name tazerac also comes as a raslo it comes in a foam form which is generally for the treatment of psoriasis not for acne called fabular so again there’s different brand

Names of tazeratine and tizeratine i feel like it’s regarded as the most powerful retinoid and it is it’s super powerful it’s the one i would use if someone is having terrible acne breakouts and i feel like their skin isn’t going to be too sensitive because the other thing to keep in mind about tesseratine is that it can be quite irritating to the skin perhaps

More irritating than tretinoin or dapolene so the two other common prescription strength retinoids that we usually use for demonstration purposes i have tezeratine 0.1 percent cream here you can see the tube is not that well used because i i can’t really tolerate it but that’s the cream and then i have a raslo here which is tazeratine so brand name lotion 0.045

I’ll put that one there so the cream thicker for sure we know that this cream in studies has proved to be quite irritating for a lot of people but it’s also been proven to be incredibly effective for treating acne as well as post-inflammatory hyperpigmentation so it has a lot of amazing effects but the irritation part if that makes someone unable to use it it

Doesn’t matter how good it is and then we have the lotion here brand name razzle and it’s just so smooth so light it’s less irritating than the generic 0.1 percent cream so yeah the back of this hand is going to be so smooth but i think in general people want to know you know is tesseratine better than tretinoin and i think for acne it probably is a little bit

Better that’s what the studies show at the highest concentrations of both but when it comes to treating photo aging they’ve done studies where they’ve compared to zeratine 0.1 percent cream to tretinoin 0.05 percent cream and they performed similarly so they had the same effects of reversing brown spots dullness under the microscope the skin looked better so i

Feel like people always want to zeratine because it’s the strongest but it’s not for anti-aging so you have to follow the data not the reputation and just because a product is more irritating especially with retinoids it does not mean it’s working any better now we’ll talk about adapoline so adapylene is more commonly known in brand form as differin and it

Exists as point one percent or point three percent the point one percent is actually available over the counter which is fabulous and then the point three percent is prescription but adapylene it’s such a great retinoid because it’s way more gentle on the skin so studies show that it causes less irritation than both tretinoin and tesaratine and if you have someone

Who’s really struggling with their acne and has sensitive skin i will almost always start them on over-the-counter different over-the-counter adaptolene because i want them to be able to tolerate it and i don’t want them to be scared of using retinoids and truth be told the data shows that adaptaline is very effective for the treatment of acne so why not start with

Something more gentle work your way up and then maybe move on to tretinoin at some point if you feel like you need more improvement but honestly adaptaline is so good this is the one by laroche posse this is the epiclar it’s really long too this is in like a gel lightweight gel form i love a dappling i feel like it’s one of my favorites for my teenagers to start

Or if someone brings in a preteen who’s just starting to get those little breakouts introducing something that i know is not going to be super irritating makes me feel better it makes the parents feel better makes the patients feel more motivated to treat themselves because they’re not going to experience all this redness some people will still experience that even

With this it is still prescription strength even though it’s over the counter now but adaptolene is one of my faves and it’s so good and then last but not least when it comes to prescription topical retinoids we have to i just feel ridiculous holding this up back leaf this is triferatine cream it’s 0.005 so this is like a little gel this is also proven to help

With facial acne but it’s also fda approved for the treatment of truncal acne so acne on the chest and back frankly i would feel fine using tretinoin tazeratine adaptolene on the trunk as well but this is the one that’s fda approved for that and there is no generic form of that maybe that will come in the future to be perfectly honest i do not prescribe a lot

Of brand name retinoid products and really the reason for that is cost they tend to be incredibly expensive and i don’t think they’re often needed to get the results you want there is this subset of people who will not be able to tolerate a generic retinoid but will be able to tolerate a brand name and for them we’ll go for it but we’ll try the generic first but

In general that is my philosophy so let’s say you’ve been given a prescription retinoid and you look great how do i use this without getting a ton of irritation and getting super discouraged one understand that even if you do all the things i’m about to talk about you might have some irritation and that’s okay you’re trying to normalize the way your skin cells

Are maturing and turning over and while they’re getting organized they get disorganized first and so that first few weeks of your cells being disorganized that’s when you’re going to see the largest amount of like peeling flaking and redness just general irritation but what can you do so one you want to apply your retinoids to dry skin when you apply it to wet

Skin oftentimes you’ll get more irritation so if you can pat your skin dry let it sit for 10 minutes before putting on your retinoid that’s generally the way to go another thing you want to think about is putting it on over a moisturizer and people might go like oh over the moisturizer is not going to block it from penetrating and maybe a little bit but not in

A significant way so you put your moisturizer on you wait like 10 minutes and then you would go in with your prescription retinoid you don’t have to do it that way but if you’re really prone to irritation or you would classify your skin as sensitive that can be incredibly helpful and then the other thing is really not going in every single day from the get-go

I usually recommend my patients start twice a week mondays and thursdays if they can do it twice a week then we move up to three times a week or every other day and over the course of many weeks we work up to every single day but that is not a fast process and if you expect to be able to go from zero to sixty your irritation is gonna go from zero to sixty as

Well so those are my biggest tips is over moisturizer start slow i always start with a low percentage applying it to dry skin here’s the deal tretinoin and tazeratine have many studies to show that they are both effective for the treatment of acne as well as many different types of photo aging and hyperpigmentation so if someone’s coming to me with photo aging

Or pigmentation concerns i generally will choose tretinoin mostly because it’s less irritating than tezeretine but if they’re not getting enough oomph with their tretinoin and they really want to try to zero teen that’s when i will prescribe to xeratine for that when it comes to acne i almost always start with adapalene why it’s it’s shown to be really effective

And it’s less irritating so why not start there we can always move on a lot of times by the time someone’s seen me in my office they’ve already given over-the-counter adaptoline a good trial run and so they’re ready for something different but i almost always start with a dappling for the treatment of acne tretinoin should be used at night it is unstable when

Exposed to uv light and so i generally say use it at night yes some of the brands say that you can use it during the day but just so you don’t have to worry about it if it’s tretinoin use it in the evening when it comes to tesaratine and adapylene these are photostable molecules meaning that the exposure to uv light doesn’t break them down or make them less effective

So you could put them on in the morning or use them in the evening as well another thing people often want to know is whether or not retinoids make you more sensitive to the sun and there’s actually some debate in the literature about this some people think you initially are sun sensitive and then after a few months of use you lose that photo sensitivity but just

To be safe i always recommend that when you’re using a retinoid or really just always you should be wearing a sunscreen during the day and sun protecting so it doesn’t really matter protect yourself so that is your introduction to prescription retinoids if you have any questions throw them in the comments below i would love to answer your retinoid questions you

Can also follow me on instagram at dr samantha ellis i talk about retinoids but i talk about all things derm and skin and procedures so if you’re interested in that we can hang out there i think i’m supposed to say like and subscribe so please do and i’ll see you on my next video take care

Transcribed from video
Tretinoin? Adapalene? How to find the Right Prescription Retinoid for Your Skin | Dr. Sam Ellis By Dr. Sam Ellis