Retin a

Retinoids and Retinols (derivatives or metabolites of Vitamin A) have been around for years and are proven to stimulate collagen production.  They  help with diminishing pigmentation, reduce lines/wrinkles, tighten pores, increase blood flow to the skin, fight acne and improve acne scarring.  They can also help diminish the appearance of stretch marks!

Retinoids (tretinoin) are retinoic acid and are available in various strengths.  Retinols are applied and are converted in to retinoic acid in the skin.  The ingredient deck will likely  include retinol or retinyl palimitate.  They are both converted into retinaldehyde and then retinoic acid in the skin.  Products with retinyl palimitate are the weakest and might be appropriate for individuals with very sensitive skin, as they need to go through several conversions to become retinoic acid.

For the history buffs, Retin-A was patented in 1967 after being developed by Dr. James Fulton and Dr. Albert Kligman at The University of Pennsylvania during the 1960s.  Kligman coined the term “photo aging” back in the ’60s. (funny we continued to sun for years and years!)   In skin care we frequently prescribe a topical treatment called Kligman’s Formula which contains a combination of Retin-A, hydroquinone, Fluocinolone and Kojic Acid for photo aging.   Originally Retin-A was for acne and hyperkeratic conditions, such as actinic keratosis.  Over time the anti-aging benefits were realized and a new patent was obtained in 1986 for wrinkle reduction. Additionally, retinoids have been shown to be beneficial for decreasing basal cell cancers.

So, how to introduce a retinoid to your skin care regime?  If you have sensitive skin starting with an over the counter retinol (or even retinyl palimitate if very sensitive) would be beneficial, ideally a 0.1% Retinol.  Once acclimated to the over the counter version a prescription strength product can be introduced as needed.  There are numerous formulas on the market and your dermatologist or skin care provider can help to select which formula would be best for your skin type.  The number one problem with retinoids is compliance.  There tends to be irritation/flaking as the product is introduced (resulting in  increased cellular turnover)  which leads to individuals ceasing the use of the product.  Ideally a product is slowly introduced and frequency of use is gradually increased.  For instance: 2x/week for 2 weeks, 3x/week for 3 weeks, every other night for 4 weeks and then every night if tolerated. Retinoids are applied at night because the sun can destabilize the product.   You may find it beneficial to have a more emollient night cream as the retinoid can dry the skin.  These products do not make you more sensitive to the sun despite this lingering stereotype.  As a matter of fact, many providers find starting a retinol or retinoid in the summer to be beneficial as the more humid air helps with the side effect of skin dryness.

Once on a retinol/retinoid it can take 3 months to acclimate to the product.  It can also take this long to start to realize the results, although I think most people see improvement almost immediately.  If you start on a product and find it too irritating, even with a titrating schedule, you may want to try a weaker formula.

Once on a retinol/retinoid be aware that your skin is more sensitive.  If you wax you should stop using your retinol/retinoid for 5+ days prior to waxing.  If you are having other skin care treatments done make sure to let your provider know you are using a retinol/retinoid.

*Pregnant and breast feeding women should not use these products.






cold sore

They are mean, nasty, painful and unsightly.  If you are a fellow sufferer you know exactly what I am talking about!

They can be predictable.  For instance, after too much sun or wind, a fever, stress or anything taxing on your system.  But they can also be unpredictable, coming on out of no where for no apparent reason,  leaving your lips looking swollen, sore and uninviting.

Cold sores (or fever blisters) are  caused by HSV (herpes simplex virus)  type I.  Genital sores are generally caused by HSV type II.  However, both can occur in either location.  Transmission is through intimate contact, such as kissing or oral sex.  An oral lesion can be transmitted to the genitals and vice versa.  A lesion is contagious until it completely crusts over or heals.  Once infected, outbreaks are  frequently associated with stress, certain foods or a womans menstrual cycle.  Between outbreaks the virus lays dormant in the nerve cells until it is activated.  Most individuals report feeling  itching or sensitivity right before an outbreak.  Ideally, this is when treatment is initiated  in order to reduce the severity of an outbreak.  The sooner anti-virals are introduced the better.

There are numerous anti-virals to treat HSV I or II.  Acyclovir (Zovirax), Penciclovir (Denavir) and Valacyclovir (Valtrex) are commonly prescribed.  Abreva® (docosanol) can also be applied topically to help to reduce the severity of an outbreak by preventing the virus from replicating.  Ideally, if you suffer from cold sores frequently enough, you have a supply of your medication of choice available at all times.


I find these single dose ampules very helpful as well.  They are a combination of an numbing agent and alcohol.  If a cold sore gets to the blistering stage these really dry it out and reduce the healing time in addition to numbing the area slightly.  I find having a small bag with a dose of Valtrex,(my medication of choice) an ampule of Orajel™ and Abreva® in my purse to be the most proactive way to deal with cold sores.

In my line of work we frequently put patients with a history of cold sores on antivirals prior to treatments that can induce an outbreak.  For instance, IPL’s, laser treatments, chemical peels or lip injections. Prevention or prophylactic treatment seems to be the best approach.

Also, sunscreen can be very helpful in the prevention of UVA/UVB induced outbreaks.  I love elta MD® UV lip balm.  It has transparent zinc oxide, is water resistant and has a nice minty taste.

Elta Lip

There are other dietary supplements that can be helpful, for instance the amino acid Lysine.  Although it is not well studied and in high doses over time can create complications, such as kidney problems.

Ultimately, each individual learns there own triggers and can plan accordingly.  Some people have an initial outbreak and then never have a reoccurrence.  (lucky ones)

Hopefully this quick synopsis helps my fellow sufferers!