Use And Side Effects

Proper selection and usage of the topical retinoids is crucial to maximize efficacy and patient adherence and satisfaction. Treatment should begin with the lowest concentration of medication, usually in a cream-based form if available (21). Application should occur at night to dry skin, 20 to 30 minutes after the face has been washed with a mild, nonsoap cleanser (21). A pea-sized amount should be dispensed and equally divided over two index fingers, which then dab the medication evenly onto opposite sides of the face and spread the medication into a thin layer until no visible product remains (21). Hands should be washed afterwards to avoid retinoid dermatitis (21). Application should first occur every other night for one to two weeks depending on the skin type so as to minimize the initial irritation that may otherwise discourage adherence to the treatment regimen (1,21). Oily skin is better able to tolerate the potential irritating effects of the retinoids and, as such, a shorter introductory period may be utilized (21). Non-comedogenic moisturizers can be used to minimize xerosis, erythema, and stinging (2). Patients should be instructed that as long as four to six weeks of use may be required before the onset of efficacy and that an initial flare in acne may occur following two to four weeks of use due to an accelerated evolution of preexisting microcomedones (3). Periodic encouragement and reassurance may be necessary. Four to six weeks of nightly application should occur, after which the concentration may be increased if the desired results are not obtained (21). An additional benefit to topical retinoid use is the potential to improve and prevent the postinflammatory hyperpigmentation often seen in darker skin types as acne lesions heal.

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