Retinoid creams, gels or capsules

Treatments using retinoids can be very effective at unblocking pores of acne spots and preventing new blockages from developing.  

Retinoids are derivatives of Vitamin A. They can either be applied on the skin (topically) or taken by mouth (orally) in the form of capsules.

Topical treatments

Retinoid creams and gels are adapalene (Differin), tretinoin (Retin A, Re Trieve) and tazarotene (Zorac). There is also a two-in-one product (Epiduo gel and Epiduo forte gel) that combines adapalene and benzoyl peroxide.

Retinoid creams and gels can be very effective at stopping or reducing mild to moderate acne.

During the early days of therapy with topical retinoids, blackheads will begin to dislodge. You may experience some redness, discomfort or peeling.

  • After three weeks, you may see new acne appearing. This is normal but it will soon disappear. 
  • After six weeks, there should be good progress and a noticeable difference in the amount of acne. 
  • After 12 weeks, your acne should be under control and further improvement is still possible.

For quicker inflammatory acne improvement and control, retinoids can be combined with an antibiotic at the beginning of treatment. 

This combination reduces levels of acne causing bacteria and directly reduces inflammation. Irritation, can affect 10-20% of people when they begin using topical retinoid treatments. 

For women and teenage girls with acne, hormonal treatment in the form of the oral contraceptive pill, cyproterone acetate or spironolactone can be combined with a topical retinoid to help with longer-term acne control. Your doctor will be able to advise you. Retinoid creams or gels can be continued for several years to help keep acne at bay. 

How to use topical treatments 

  • Cleanse face no more than two or three times a day. Do not overwash. Pat your face dry without rubbing
  • Wait until face is touch-dry (approximately 15-20 minutes) before applying the topical cream
  • Avoid applying to the corners of the mouth, nose, and eyes or on other sensitive areas
  • Apply at least half an hour before going to bed
  • If irritation occurs, oil free moisturiser used together may be helpful.
  • If stinging and redness is extreme, notify your GP

Potential side effects

Although retinoids are very effective at treating acne they can cause side effects. 

It's important to have regular check-ups with your prescribing doctor because they can tailor your therapy and give you more information on how to manage or prevent side effects.  

Dryness

Retinoids work by reducing the size of the sebaceous glands and the amount of oil they produce. So, one of the most common side effects is dryness, scaliness or skin irritation. This can be reduced by taking precautions such as washing with a gentle soap-free cleanser and using an oil-free non-comedogenic moisturiser (preferably with sunscreen SPF 30). 

When you start treatment with retinoid creams or gels, only apply a thin smear every second evening to the acne prone areas.  After several weeks, if you have minimal skin dryness and irritation, you can start applying the creams every night for maximum benefit. By this time, your skin will have partially adapted to the irritating effects, so the creams and gels will be better tolerated.

To help protect your skin, try to keep your showers shorter than two minutes and use lukewarm water rather than hot. Using a moisturiser on your face regularly will help keep the dryness under control. The best type of moisturiser is an oil-free face moisturiser for sensitive skin. 

Dryness may be worse when you’re in air conditioning or a low humidity climate. If you wear contact lenses, you may also find it difficult to tolerate the lenses with higher doses of isotretinoin due to dryness. Eye drops (e.g. Thera tears) may be helpful.

Men with severe acne who shave should try both an electric and safety razor to see which is more comfortable. If you use a razor, soften your beard thoroughly with soap and warm water. To avoid nicking pimples, shave as lightly as possible. Shave only when necessary and always use a sharp blade.

Patients prone to eczema may need to increase moisturising their skin to prevent any flareup of their eczema.

Flare-ups

When you take isotretinoin capsules or use retinoid creams or gels, it’s important to be aware that although this is the most effective acne treatment, your acne may get worse about three weeks in. An antibiotic or anti-inflammatory may be prescribed in conjunction to try and prevent this. Don't give up! 

This initial flare-up is thought to be partially due to excess oil being squeezed from the sebaceous glands. With continued therapy, acne flares generally become less severe, less frequent and shorter in duration, and in most cases the acne improves. If you are concerned about a flare-up in your acne after starting a new acne therapy you can contact your prescribing doctor for advice. 

Sun sensitivity

Retinoids make skin more easily irritated by sun, wind and water. Increased sun sensitivity leading to quicker sunburn is common in Australia, particularly in spring and summer. It’s important to take extra sun protection measures such as wearing sunscreen, a broad-brimmed hat, protective clothing and trying to stay in the shade. 

It’s a good idea to check the UV Index via news reports, weather updates or websites before you head outside.