Question– I am a twenty year old African Americn woman with very sensitive skin. I have hormonal acne and I am hoping that Retin A will stop the breakouts. However I’m breaking out more and my skin is very dry, flaky and sore. I’ve been using shea butter over Retin A at night. In the morning I use Neutrogena sunscreen. Any help would be appreciated.
Answer– Dryness is part of Retin A treatment and the flaking is a sign that the skin is getting rid of dead skin that is blocking the pores. However I am concerned with the sense of irritation you are experiencing. Retin A needs to be used very very carefully with skin of color. The inflammtion from Retin A can unfortunately trigger hyperpigmentation or darkened areas on darker skin tones. To avoid problems I can recommend two options:
Option 1— You can stop using Retin A for a week then start using it again , but twice a week, not every night. After two weeks if the skin seems comfortable, you can step up to three times a week. I would stay at that level and not go to on to an every night regimen. I would also stop using shea butter which can clog the pores. To relieve dryness I recommend using an oil-free “smart moisturizer” with hyaluronic acid like Derma e Hyaluronic Acid Rehydrating Serum. I call this a smart moisturizer because it supplies a natural moisturizing factor in our skin, rather than an oil that can trigger more breakouts. To prevent the dreaded purge I would also ask your dermatologist for a combintion benzoyl peroxide/clindimycin gel to be used in the morning under the oil free sunscreen.
Option 2 — If you have hormonal acne, I would ask your dermatologist about esrogen therapy such as Ortho TriCyclen. If the acne is triggered by hormonal imbalance, its going to be very difficult for any topical therapy to make a difference. Frequently, doctors combine hormone therapy with an oral form of Retin A such as Sotret or Claravis. This will give you the benefits of Retin A without the risks of deveoping irregulr pigmentation.
Retin A and Shea Butter
One final thought– I am a huge shea butter fan. Its soothing, natural and makes dry skin glow. If you have dry skin and are using Retin A for its anti-aging benefits, shea butter can calm down flaky, parched skin. However if you are using Retin A for acne, shea butter is too rich and heavy.