The New Retinoid Rules for Sensitive Skin
While dermatologists are nearly united in their unwavering adoration for retinoids-"the single most important class of ingredients for healthy skin," notes dermatologist Jeannette Graf, M.D.-the sensitive among us tend to have more of a love-hate relationship with the vitamin A derivatives. Because along with four-plus decades of studies supporting their ability to boost cell turnover, ramp up collagen growth, neutralize free radicals, diminish pigment production, shut down acne and ward off skin cancer (love!), comes the inevitable adjustment period, something docs call "retinization"-and we call six weeks of raw, flaky, no-concealer-can-hide-this hell (hate!). Still, according to New York dermatologist Dendy Engelman, M.D., "even sensitive skin can be trained to tolerate vitamin A derivatives," so really, the only women who shouldn't use retinoids are those who are pregnant or nursing.
But about that training period: There will be some sloughing. And while it certainly seems like a red flag, it's actually an early sign of a retinoid's efficacy. Here's the deal: Upon application, the ingredient binds to DNA, and immediately begins directing the skin's proteins and enzymes to do certain things-the first of which is to cast off the piled-up dead cells from your skin's surface. "Normalizing that top layer-flattening it out to what it should be-causes some water loss initially, which can make sensitive skin seem drier and more irritable," says Doris J. Day, M.D., a dermatologist in New York City. But if you push through and continue to use your retinoid, "it'll absolutely make your skin healthier and more resilient, so it behaves better and acts less sensitive over time," Day says. Even sexier, it'll leave you with the most insane glow and reduced fine lines. Below, the ultimate guide to choosing a formula that works for you.
Prepare Yourself. A hallmark of sensitive skin-rosacea and eczema types, in particular-is a compromised moisture barrier that means "retinoids can penetrate more than they should, essentially increasing the dose and resultant irritation," says Joely Kaufman, M.D., a Miami dermatologist. The fix? Before even looking at a retinoid, take two weeks to strengthen your barrier by abstaining from stripping cleansers (use micellar water or a cream instead of a gel or foam) and all forms of exfoliation. During the day, wear a broad-spectrum mineral-based sunscreen every day (derms love Elta MD UV Clear SPF 46); at night, layer on an intensive healer, like Avene Cicalfate Repair Cream. Finally, once skin is in peak condition, consider this: "It can take at least six months to see the full effects of a retinoid cream, so either commit fully or don't bother at all," says Kaufman.
Pick the Right Formula. Barring bad acne or severe wrinkles, most dermatologists will start sensitive types out with an over-the-counter vitamin A cream to jumpstart rejuvenation rather than a prescription version. The two most effective non-Rx forms are retinol and retinaldehyde-the skin converts both into retinoic acid, the active ingredient in prescription retinoids like Retin-A, Renova and Atralin. Now, here's the really fascinating part (skin nerds, unite!): Based on clinical studies and accepted conversion rates, .05 percent retinoic acid (and its equivalent, .5 percent retinol) is the concentration shown to improve sun-damaged skin-meaning you don't necessarily need to jump into the prescription realm to reap legit anti-aging benefits, explains Vivian Bucay, M.D., a dermatologist in San Antonio, TX. "When recommending retinol to a sensitive patient, I may start with a .25 percent formula, but my goal is always to work her up to the more effective .5 percent strength," she says. Her go-to formulas include ingredients that hydrate (like Neutrogena Ageless Intensives Deep Wrinkle Night Moisturizer with hyaluronic acid) or are otherwise engineered to offset irritation, such as Skin Medica Retinol Complex 0.5, which includes redness-relieving peptides. For the ultra-reactive who can't yet tolerate retinol, there's the milder retinaldehyde found in Avene Physiolift Night.
Ease In. Start out using your magic potion just two nights a week, adding a night every other week as tolerance develops. (Night is key, as sunlight deactivates vitamin A.) Before applying a retinoid, Bucay advises prepping skin with a moisturizer that contains anti-inflammatory green tea polyphenols (Replenix CF Cream) or niacinamide (SkinCeuticals Metacell Renewal B3), or a smart mix of barrier-replenishing lipids like those in SkinCeuticals Lipid Restore 2:4:2, to curb potential side effects. After moisturizer, squeeze out a pea-size drop of retinoid and smooth it over your forehead first, then cheeks, nose and chin, avoiding the corners of the mouth, nostrils and upper eyelids. "The skin of the forehead and cheeks is thicker, less sensitive and doesn't have any folds where retinoids can pool and intensify," explains Bucay, so it better tolerates the slightly larger dose that comes with being the first area hit.
Know When to Back Off. "Clinically, we've seen that it takes about three weeks for skin cells to adapt to retinoic acid and begin building their tolerance," says Engelman, which is why some degree of irritation is totally normal early on. However, she adds, "if it goes beyond a little bit of redness or light peeling, dial back to once-a-week use, or switch to a weaker formulation." During this phase, warning signs can be super-subtle, says Kaufman, adding that one of the first things sensitive types tend to notice is an uncomfortably tight feeling post-cleansing. Tread lightly during seasonal changes, too, says Graf: "A drop in humidity can dry out the skin, causing unexpected bouts of irritation."
Navigate Rough Patches Like a Pro. Knowing that irritation is normal doesn't make it any easier to wake up to. But derms swear these tools can help mend skin fast:
1) Two tabs of a non-steroidal anti-inflammatory drug-aspirin, Advil, Aleve-can bring relief within an hour or so, according to Engelman.
2) The gentlest cleansing brush or softest washcloth, circled over skin with zero pressure applied to buff away annoying flakes as needed.
3) The mega-moisturizing Avene Cicalfate mentioned above-when everything else stings, this stuff soothes.
4) 1 percent hydrocortisone cream dabbed on your worst spots, twice a day, for up to three days.
5) A sheer tinted primer or moisturizer with minerals, antioxidants, and sunscreen, like Colorescience Skin Calming Face Primer SPF 20.
Choose Products That Play Nicely with Retinoids. Bolster the anti-aging effects of your retinoid with antioxidants, sunscreen and peptides during the day while avoiding harsh cleansers, toners, AHAs and BHAs (glycolic, lactic, salicylic acids) and zit creams with benzoyl peroxide, which can actually deactivate retinoids.
