Question: I’ve tried just about everything for acne. I wanted to try Retin A but my doctor gave me a prescription for Azelaic acid. Do you think it could help or should I go to a doctor to give me what I want?
Answer: Azelaic is one of the newer acne fighters. It is found on a yeast that lives on our skin and is a natural anti-inflammatory compound. It is a triple threat against acne– kills bacteria that provoke breakouts, decreases the growth of pore clogging keratin and reduces irritation. But wait there’s more. Azelaic acid is effective for lightening dark spots and melasma because it inhibits the production of melanin. It is especially effective for darker skin tones because it avoids the problems of irritation of Retin A and Benzoyl Peroxide. Azelaic is also prescribed for types of rosacea breakouts that resemble acne eruptions. Finacea is a 15% Azelaic gel that has been a pproved for both mild to moderate acne and rosacea.
You can also find azelaic acid in over the counter products, but usually the concentration is not listed on the label. One excellent example where the this info is available is Acne Gel from PCA Skin that contains 5% Azelaic Acid and 2% salicylic acid ( Its available online from The Derm Store). You can also try to get the azelaic acid levels in a product by writing to the manufacturer.
One final thought: Azelaic acid works for less severe acne. If you have cystic and/or hormonal acne, Azeleic alone will not get the job done.
I got a great email from a 16 year old who is using Retin A micro for acne control. Like most of us, she got the prescription with little or no advice about how to use it. She wanted to know what scrubbing grains, toners and moisturizer I would recommend. She was concerned about the redness and peeling and wanted to avoid these problems with additional skin care products
Retin A was actually originally developed and approved for acne management. This vitamin A derivative helps the skin to empty pores clogged with debris, shuts down overactive oil glands and helps skin turnover to reduce discolorations from old acne eruptions. This process includes flaking off old dry keratin that is contributing to blocked pores and breakouts. Some peeling and flaking is necessary and actually good. However you need to keep it under control to avoid too much redness and irritation.
The solution is to allow Retin A to do what it does best. Twice a day use an extremely gentle oil-free cleanser such as Cetaphil Gentle Skin Cleanser and apply with damp cotton pads. Rinse off with handfuls of lukewarm water. Even a washcloth can be too rough in the first months of Retin A treatment Start by using Retin A every other night and gradually, over three weeks, work up to an every night routinue.
In the early months of using Retin A its very import ant to avoid additional irritants such as scrubbing grains or pads, toners and even alpha hydroxy acids ingredients such as glycolic acid. It certainly takes a leap of faith to abandon these tried and true acne aids and simply trust Retin A to clear your skin– but that’s the best way to succeed. These products and ingredients are simply too irritating to be used at the beginning of Retin A therapy and can make the skin so red and sore that people abandon Retin A treatment.
Using a moisturizer to control the peeling can actually lead to additional breakouts. If your skin becomes too irritated and flaky, use a tiny dab of oil-free moisturizer and take a two day Retin A holiday. In the morning make sure to use an light fragrance-free oil sunscreen such as Aveeno Ultra Calming Daily Moisturizer SPF 30. Retin A increases sensitivity to sun damage and its ESSENTIAL to use a sunscreen each and every day– even when its cloudy.
After six months, you skin will become comfortable, even bored with Retin A. At this point you can amp up the impact by adding exfoliators such as 3M Buf Puf Pads or my beloved Clarisonic cleanser. Toners and peels with glycolic acid can provide additional benefits for acne-prone skin. But if irritation and flaking reappear, cut back on the extras and focus on Retin A.