Posts Tagged ‘tretinoin’
In the world of medical aesthetics, hydroquinone is often a necessary part of skin care. It is the gold standard for treating dark skin irregularities known as hyperpigmentation. As effective as it is, there is a rising concern regarding the number of people who are using hydroquinone incorrectly, without on going professional guidance. Many of those who are using hydroquinone do not understand the risk of hydroquinone resistance or how to properly use it, as to enhance efficacy. It is important to use hydroquinone in a way to maximize it’s benefit, before the skin builds a resistance and how to properly transition off, to reduce incidence of rebound hyper pigmentation. Always seek a professional guidance before starting or continuing hydroquinone use. It should be used only under the strict supervision of a professional.
Why do we need Hydroquinone?
Hydroquinone is the single most effective topical ingredient for treating skin discolorations. Skin discolorations can include sun spots, Melasma and Post Inflammatory Hyperpigmentation (PIH), pigmented acne scars. When the skin is inflamed it can respond by over producing melanin, this inflammation can come from acne, injury, surgery or aesthetic procedures such as laser or chemical peels. UV exposure and hormones can also induce skin discolorations. In the world of medical aesthetics we are really dependent on the ability of hydroquinone to quickly correct hyper pigmentation. There are non-hydroquinone skin brighteners that are very good products, however they are not as effective as hydroquinone. That does not mean that botanical lighteners do not have a place, as you will learn, both hydroquinone and non-hydroquinone brighteners are important.
Resistance to Hydroquinone
Hydroquinone works by inhibiting tyrosinase, which is necessary for melanin production. It is believed that with extended hydroquinone use, the skin will compensate by increasing tyrosinase. This would causes the skin to become resistant to the effects of hydroquinone. When the skin becomes resistant to the effects of hydroquinone it will quit improving the hyper pigmentation. To prevent building resistance, it is not recommended to continue use for extended periods of time with out cycling off. It is usually recommended to cycle off hydroquinone after about 4-6 months. If needed, hydroquinone may be resumed after about 2 months. If you stop hydroquinone “cold turkey”, there is a risk of rebound pigmentation. To prevent rebound pigmentation, it is generally recommended to transition your skin off. While transitioning off and breaking from hydroquinone, continued stimulation with a retinoid is beneficial. When it is time to transition off your hydroquinone, you may begin to incorporate a non-hydroquinone skin brightener. There are several professional products that may be recommended. Exact regimens will vary individually, depending on skin condition and any skin treatments, such as laser treatments or chemical peels, that are planned. Do not attempt to cycle off hydroquinone without professional guidance!
Maximize Hydroquinone Effectiveness
When using hydroquinone to treat hyper pigmentation, the goal is to correct the condition before the skin builds resistance. In order to maximize effectiveness, we need to use a high quality hydroquinone product in the appropriate dosage, along with products that optimize penetration, assist in correction and protect from exacerbating factors.
We want to use enough of hydroquinone to reach correction, so a skin care professional needs to show you how to measure your hydroquinone and give you a time frame that you should expect to run out of product. Using hydroquinone every morning and night is a common protocol for treating facial skin.
We want the hydroquinone to have optimal ability to penetrate and work. Prepare the skin by cleansing with an appropriate cleanser. This would exclude anything that does not sufficiently clean the skin or leaves any occlusive film, this could inhibit product penetration. For this reason, I generally do not recommend cleansers like CeraVe or Cetaphil. Anything that is too harsh or active, should also be avoided, as we do not want to induce any unnecessary inflammation or irritation. After cleansing, an appropriate toner should be used, this will restore the skins PH balance after cleansing, preparing it for corrective skin care products. (astringent is not toner). Hydroquinone should be applied after toner, unless you have been instructed to use a Vitamin-C serum or other corrective serums. Always, confirm with your Esthetician or provider, the order your products should be applied.
When Hydroquinone is used with a mild exfoliant and Tretinoin (Retin-A), the pigment will be more evenly distributed. The goal is not just to suppress the production melanin (pigment), it is to have even distribution of the pigment. When the skin has hyper pigmentation, the melanocytes are not functioning properly. Not only is there an over production of melanin, but the pigment is not being evenly distributed to skin cells called keratinocytes. When Hydroquinone is used with Tretinoin, it works to evenly distribute the pigment. A mild chemical exfoliant will enhance the process by increasing the skin cell turnover. It is important that the exfoliant be appropriate to your skin type and personal skin care regimen, to reduce risk of any unnecessary inflammation. Here is the icing on the cake, tretinoin will also treat acne, increase collagen production in the dermis, as well as glycosaminoglycans such as Hyaluronic acid that bind to water and improve skin moisture. There is also evidence that tretinoin may positively effect gene expression in the skin. – Yes, please! I want all of that.
Sun protection is important for several reasons. 1) UV exposure stimulates the production of melanin, while hydroquinone is working to suppress it. It literally, defeats the purpose of using hydroquinone, if you do not have proper sun protection. 2) Hydroquinone, tretinoin and exfoliants can all cause photosensitivity of the skin. 3) Heat, including heat from the sun dilates capillaries in the skin and induces inflammation, which can exacerbated pigmentation problems. 4) UV exposure causes skin discolorations, free radical damage and breaks down collagen and elastin.5) UV rays damage DNA and causes skin cancer, and melanoma can be life threatening.
Your sunscreen should be an SPF 30 or higher and should have zinc oxide. Zinc Oxide can help by blocking some of the UV induced heat, that contributes to inflammation and exacerbates hyper pigmentation. Zinc also provides broad spectrum protection from UVA/UVB rays without the irritation occasionally seen with chemical sunscreens. Professional zinc products are more elegant and will look better on the skin. Using a moisturizer, BB Cream or cosmetic with an added SPF, is not enough. It is important to have an actual sunscreen, with high broad spectrum coverage. Sunscreen should go on after any moisturizer, it is the last thing you put on, but before makeup. Sunscreen needs to be used EVERY day!
Topical antioxidants are useful for many reasons, but in regards to skin discolorations we especially like topical Vitamin-C. First, Vitamin-C reduces oxidized dopaquinone, which helps further brighten the skin. Perhaps, more importantly, Vitamin C helps to reduce inflammation in the skin that can cause or exacerbate hyper pigmentation. Some antioxidants, including Vitamin-C also have photo-protectant ability, enhancing the effectiveness of sunscreen. They works by neutralizing the UV rays, rather than reflecting or absorbing UV rays like a sunscreen, so use them together to maximize your protection. We recommend using an l-ascorbic acid form of vitamin c, in serum form. A quality l-ascorbic acid, needs to be packaged in a glass bottle with a glass dropper, the bottle should be dark to reduce oxidation of the product.
Not all skin care products play well together and there are some skin care products that may be contraindicated to your personal skin care regimen. For example, you should not use any product that contains benzoyal peroxide with products that can oxidize, such as Hydroquinone and Vitamin-C Serums. Always inform your Esthetician or skin care provider of the products you are using, and do not add anything new without having it approved first.
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After Obagi Most Women Go Naked
The Obagi Nu-Derm® system is the world’s #1 professional skincare program, used by more than 11,000 physicians throughout the world. It is the most effective treatment for skin health restoration, correcting complex problems such as acne, melasma (brown spots), fine lines, wrinkles, and scars.
The Obagi Nu-Derm System contains prescription-strength formulations that can only be sold through a licensed physician, such as a dermatologist or plastic surgeon.
*Take a moment to watch the Obagi video at the end of this post.
The goal of the Obagi Nu-Derm system is to create soft, radiant- looking skin, increase skin tolerance and restore normal skin functions. The problem is, it only works if you use it. It works even better when you use it correctly. Dr Zein Obagi created the Obagi Nu-Derm as a skin health restoration system, and the products are designed to be used together. Each of the products are good individually, but if you don’t use the full system, you will not see the amazing results that Obagi is famous for.
- Increase smoothness
– Reduce pore size
– Improve elasticity
– Normalize oil production
– Increase skins own ability to hold moisture
– Increase skin tolerance to all external factors
– Generate a balanced, even skin tone
– Reduce hyperpigmentation ( freckles, age spots, melasma, Post inflammatory hyperpigmentation )
I have worked professionally with the Obagi products for over 10 years, and have had “literally” thousands of clients on the Nu -Derm system. The results shown in the before and after photo’s are typical and common. If you use the Obagi system correctly you will experience skin transformation. Using a specific dose and frequency that’s recommended specifically by your skin care professional for your skin condition, the prescription-strength system exfoliates old skin leaving healthy, new skin that looks and acts younger and healthier. The products in the Nu-Derm System are clinically proven, prescription-strength, ingredients that work to improve your skin cell function, compared to retail products that contain more cosmetic-based ingredients.
Obagi System: Steps 1-6
All of the products are labeled AM, PM or both AM/PM and numbered 1-6 in the order you would use them. The lines between the letters in the word OBAGI are designed as a tool to measure product. For example from the O-A = 1/2 gram ( thick like toothpaste).
Step #1 Cleanser AM/PM
Foaming Gel – For Normal/Oily Skin or Gentle Cleanser – For Normal/Dry Skin
Proper cleansing is necessary
Step #2 Toner AM/PM
Adjusts the pH of the skin for increased penetration of the system ingredients.
Exfoderm® Forte – For Normal/Oily Skin
An alpha hydroxy acid (6% glycolic acid, 4% lactic acid) that removes old skin cells while promoting new skin cells for a lighter, brighter, firmer complexion for skin that needs deeper exfoliation.
Step #5 Bleander & Tretinoin PM (mixed as prescribed)
This step restores damage to the deeper layers of the skin. It restores skin elasticity by enhancing the production of collagen and elastin.
A topical prescription treatment that contains 4% hydroquinone to target hyperpigmented (discolored) areas of the skin and increase the penetration of the active ingredients of the system.
Tretinoin Cream 0.025%, .05% , or.1% (as prescribed)
A topical prescription, use as directed. *Do not wax skin that is treated with tretinoin.
Step #6 Healthy Skin Protection SPF 35 AM
A sunscreen with 9% micronized zinc oxide and 7.5% octinoxate that helps to protect newly transformed, younger looking skin and prevents further sun damage. This is a physical/chemical sunscreen with UVA/UVB protection.
If you just want to FEEL good you should get a spa treatment. If you want to LOOK good, then follow the recommended Obagi Nu Derm protocol. Generally, with a more aggressive protocol you will have more reaction, however you will also have more stimulation, see correction faster and build up tolerance more quickly. That doesn’t mean everyone should start out aggressively, individual system protocol is determined by skin type.
Reaction Phase: Out with the Old
Inital correction and stimulation phase
This is the time in which the damaged top layer of skin is replaced by a new layer of healthier cells. It takes about six weeks for ” newborn” cell to reach the surface of the skin and exfoliate.
You WILL experience one or more of the following symptoms:
– Dryness – Itching
– Burning – Redness
– Sensitive skin
– Exfoliation ( flaking and peeling)
These reactions are a sign the skin restoration is in process. The Nu- Derm system is accelerating the skin cell turnover to alter the rough top layer of the skin.
Tolerance Phase: In with the New
Correction and stimulation continues
Your skin has built tolerance , skin improvement is viable. The skin increases the production of collagen and elastin, to diminish wrinkles and reduce pore size.
Correction Phase: Healthy Glow
Finally, your skin enters the last stage and you are ready for a maintenance protocol. Skin tolerance is now complete.
“Begin with the end in mind.” – The 7 Habits of Highly Effective People
Peeling is more severe in the center of the face and around mucus membranes (eyes, nose and mouth). You can try focusing product use on the forehead and cheeks and blending them in toward the center of the face. Most people notice that the peeling reaction peeks late afternoon-early evening. It is okay to cleanse your face later in the day ( at least 4 or 5 hours later) and reapply sunscreen and makeup. Cleansing the skin can help slough off some of the loose peeling skin. If you have an social event and need to stop reactions, discontinue step 5, four days before event. Obagi Action and Tolereen are “control” products that can be used as needed to relieve surface tightness, itching and dryness. Control products should only be used temporarily, as they slow the skin restoration process. Be sure to discuss options for controlling your reactions with your skin care professional.
Obagi Nu-Derm Action
A moisturizing cream to be used as needed to soothe areas of dry, flaky skin.
Obagi Nu-Derm Tolereen
Contains 0.5% hydrocortisone for the temporary relief of itching and burning associated with minor skin irritations.
Find Obagi neer you. www.obagi.com
Tretinoin ( retinoic acid) is the acid form of vitamin A and is available as a cream or gel (brand names Retin-A, Renova, Aberela, Airol, Atralin, Avita, or Stieva-A). Tretinoin was FDA approved as a topical medication in 1971. Tretinoin treats acne, minimizes pores and reduces oiliness. The anti-aging benefits of tretinoin include, reducing appearance of fine lines and skin discoloration.
Tretinoin promotes detachment of cornified cells and the enhanced shedding of corneocytes from the follicle. Tretinoin also increases the turnover rate of thin, loosely-adherent corneocytes. By making keratin softer and more gelatinous, the stratum corneum becomes soft and compact. Tretinoin suppresses the melanocytes, this is why it is often used when treating skin discoloration.
Tretinoin stimulating fibroblast.
It is believed that tretinoin stimulates the fibroblast. Some studies suggest that tretinoin can help firm the skin by stimulating fibroblast activity. Fibroblasts produce collagen, elastic fibers, and the ground substance of the dermis. With age fibroblasts become smaller and less active.
Tretinoin enhances the skin healing process.
Studies show that topical use of tretinoin before chemical peels, enhanced healing. There is more epidermal regeneration and collagen regeneration appears to be faster when skin was pre treated with tretinoin.
Tretinoin makes my skin peel and it feels tight and dry.
Initially, tretinoin dehydrates the skin the outer surface of the skin ( stratum corneum ), causing a rapid exfoliation. The good news is, tretinoin repairs the damaged keratinocytes, increases mitosis, and restores proper hydration. With time your skin builds up tolerance and reactions subside.
Does tretinoin thin the skin?
I have heard people say, “don’t use tretinoin it thins the skin”. I think there is some confusion, about what part of the skin is thinning and if that is a good or bad thing.
Tretinoin works by thinning the outermost layer of the skin (stratum corneum), while cells in the epidermis are stimulated to produce a thicker epidermis layer. Collagen production and cellular growth in the dermis layer also increases. Although it is true that tretinoin does thin the stratum corneum, it actually makes other layers of the skin thicker. Thinning the stratum corneum isn’t exactly a bad thing. With age the statum corneum can become thick and dehydrated causing the appearance of fine lines and rough, sallow skin.
Epidermis Stratum corneum, outermost layer with dead keratinocytes being exfoliated off.
Is retinol the same as Retin-A ( tretinoin)?
Many people confuse retinol with Retin-A (tretinoin). Retinol and retinoic acid (tretinoin) are related but distinctly different. Retinol, retinal and retinyl palmitate, do not have the same effect on the skin as tretinoin/ retinoic acid. They first need to be converted by special enzymes into the active metabolite, retinoic acid. Unfortunately , the conversion rate is low and varies among individuals. The other problem is that when retinols are exposed to air, they can become oxidized and degraded. There are some companies that have produced retinol formulas that are more stabilized.
Tretinoin vs AHA’s
Tretinoin causes a rapid coarse exfoliation, which is the shedding of attached group of cells. AHA’s cause shedding of individual cells. The action of AHA’s is extracellular, compared to the intracellular action of tretinoin. The intracellular action of tretinoin works goes into the dermis and stimulates the fibroblast. The effects of tretinoin can last up to four months even after product has been discontinued, in contrast to the short lasting smoothing effects of AHAs.
Tretinoin is a drug.
Tretinoin is a drug and should be used only as prescribed. There are certain contraindications for using Tretinoin, including pregnancy and nursing. You should not wax skin that has been treated with tretinoin and some skin treatments are not recommended while using tretinoin. Be sure to discuss possible contraindications with your skin professional.
*You should never purchase Tretinoin or any other prescribed drug on line.
Isotrex: This drug is NOT FDA APPROVED!
The FDA has sent out warning letters to company’s that are selling Isotretinoin drugs online.
Isotrex is a topical Isotretinoin drug used to treat acne. There are not any topical Isotretinoin drugs that are currently approved in the US. The only form of Isotretinoin that is FDA approved is Oral Isotretinoin (Accutane), and it is very regulated. Isotrex is a category X drug, in comparison to Percocet and Tretinoin ( Retin-A) that are category C drugs. Do not confuse Isotretinoin with Tretinoin, although they are both Vitamin A derivatives, Isotretinoin can have severe side effects and is a category X drug.
I worked for a doctor that prescribed Isotretinoin ( Accutane) and I was the i Pledge designee for the clinic. Every month I had to schedule patients for lab work, doctor’s visits, and register patients with i Pledge. I can tell you it is a lot of work. Special Prescribing Requirements for Isotretinoin Isotretinoin is only dispensed one month at a time, so every months patients will need to return to their doctor to have a pregnancy test, and blood work done before you physician can register you for that month. Patients must also go to the i Pledge website and answer a series of questions and reregister every month. After you have met all of the i Pledge requirements you have 7 days from the date on the prescription to get your prescription filled at an approved pharmacy. If you do not fill your prescription within 7 days you are not eligible for another month. You will repeat this entire process every month for up to five months. Many insurance company’s do not cover Isotretinoin, and the cost ranges from $500 – $900 a month depending on the brand. Patients may also be responsible for covering the costs of monthly lab work and doctor’s fees. You should check with your insurance company to see what they cover. With all that said: Brand names for oral Isotretinoin: Brand names for topical Isotretinoin : If you suffer from acne, call Paradise Valley Skin Klinic to schedule a free consultation. Shapiro Plastic Surgery, Paradise Valley Skin Klinic
Because of isotretinoin�s teratogenicity and to minimize fetal exposure, isotretinoin is approved for marketing only under a special restricted distribution program approved by the Food and Drug Administration. This program is called iPLEDGE™. Isotretinoin must only be prescribed by prescribers who are registered and activated with the iPLEDGE program. Isotretinoin must only be dispensed by a pharmacy registered and activated with iPLEDGE, and must only be dispensed to patients who are registered and meet all the requirements of iPLEDGE.
I believe that Isotretinoin is a good idea for some patients. If someone is suffering from severe or cystic acne and has exhausted all other options, they may want to consider Isotretinoin. There are many acne treatments available, if you are compliant and patient they are very successful. You should discuss options with your doctor.
Accutane, Claravis, Amnesteem, Stret
Isotrex, Isotrexin ( not approved in US)
I worked for a doctor that prescribed Isotretinoin ( Accutane) and I was the i Pledge designee for the clinic. Every month I had to schedule patients for lab work, doctor’s visits, and register patients with i Pledge. I can tell you it is a lot of work.
Special Prescribing Requirements for Isotretinoin
Isotretinoin is only dispensed one month at a time, so every months patients will need to return to their doctor to have a pregnancy test, and blood work done before you physician can register you for that month. Patients must also go to the i Pledge website and answer a series of questions and reregister every month. After you have met all of the i Pledge requirements you have 7 days from the date on the prescription to get your prescription filled at an approved pharmacy. If you do not fill your prescription within 7 days you are not eligible for another month. You will repeat this entire process every month for up to five months.
Many insurance company’s do not cover Isotretinoin, and the cost ranges from $500 – $900 a month depending on the brand. Patients may also be responsible for covering the costs of monthly lab work and doctor’s fees. You should check with your insurance company to see what they cover.
With all that said:
Brand names for oral Isotretinoin:
Brand names for topical Isotretinoin :
If you suffer from acne, call Paradise Valley Skin Klinic to schedule a free consultation.
Shapiro Plastic Surgery, Paradise Valley Skin Klinic