COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE in Visual Studio .NET

Generate QR Code in Visual Studio .NET COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE

COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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FIGURE 30-4 Redness, aking, and tender skin are common symptoms after beginning a retinoid These symptoms usually improve with time weekly treatment with tretinoin was less effective in sustaining the clinical improvement achieved by the initial treatment regimen of tretinoin once daily The same study also demonstrated reversal of the beneficial effects of tretinoin treatment after discontinuation of therapy for 24 weeks This indicates that patients must continue tretinoin therapy at least 3 times a week to maintain clinical improvement Dry skin is also a common complaint of patients treated with retinoids The flaking that patients experience when using retinoids often leads them to believe that their skin is dry, although the observed flaking is caused by a different mechanism than those leading to dry skin The dry skin noted by retinoid users is likely due in part to an increase in transepidermal water loss (TEWL), which accompanies topical retinoid use The increase in TEWL is an effect typical of topically applied retinoids and is thought to be associated with a perturbation of the stratum corneum water barrier function28,29 Although retinoids
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increase cell proliferation, this leads to a decrease in ceramide biosynthesis (at least in the short term) This decrease in ceramides, a vital component of the water barrier of the stratum corneum, may partly explain the xerosis seen with retinoid use30 (see 11) The side effects commonly seen in patients who have been started on retinoids can usually be lessened by directing the patient to apply small amounts of the retinoids at less frequent intervals The lowest available dose should be started initially A topical retinol can be used first Once the patient is consistently applying the retinol nightly, the strength of the retinol can be increased Once the maximal retinol strength is reached, the patient can be seamlessly switched to a prescription retinoid Alternately, a patient can be started on Tri-Luma, which is a combination of hydroquinone, tretinoin, and a mild steroid The mild steroid prevents irritation while the hydroquinone hastens the resolution of solar lentigos, thereby increasing patient satisfaction and compliance Whether retinol, Tri-Luma, or a less irritating retinoid such as Differin is chosen to start therapy, in individuals with sensitive skin the frequency of use can be slowly ratcheted up as the patient s tolerance increases Once the patient is using the lowest strength of a particular retinoid every night for 3 months without redness and peeling, the strength of the retinoid can be
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CHAPTER 30 RETINOIDS
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TABLE 30-1 Instructions for Patients Using Retinoids (eg, Atralin Avage, Differin, Tazorac, Retin-A, Renova, Retinol, Tretinoin, Tri-Luma, Ziana) for the First Time AM: Use cleanser, moisturizer, and sunscreen as directed by your skin care specialist PM: 1 Cleanse face 2 Apply antiaging, acne, or rosacea treatment product 3 Mix pea size of retinoid product with a pea size of moisturizer Apply to face Do this again to neck and chest Notes: 1 Use retinoid every third night for the rst 2 weeks 2 If you have no redness, increase to every other night for 2 weeks 3 If you have no redness, increase to every night 4 Once you have used it every night for 3 months, ask your physician to give you the next strongest formulation 5 You may only be able to use the product on your neck twice a week The neck is more sensitive than the face 6 Do not apply a moisturizer with glycolic acid or salicylic acid at the same time that you apply the retinoid If you use these products, apply them and wait 30 minutes before applying the retinoid Glycolic acid and salicylic cleansers are ne to use 7 Do not use facial scrubs, microdermabrasion, or at-home chemical peels unless these are prescribed by your skin care specialist 8 Stop retinoid products 1 week before facial waxing to avoid skin burning from the wax 9 If you have questions, visit wwwSkinTypeSolutionscom
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increased to the next level In the primary author s experience, patients who are given this regimen along with careful instructions on how to apply the retinoids display increased compliance as well as benefits from the topical retinoids Table 30-1 lists the instructions that should be given to patients who are beginning retinoids for the first time It is important not to begin other irritating agents at the same time that a retinoid is started, such as facial scrubs, chemical peels, or microdermabrasion These can be added later once the retinoid is sufficiently tolerated However, many dermatologists have observed that patients who have been on hydroxy acids for extended periods before beginning retinoids may exhibit less irritation from the retinoids The reason for this is currently unclear However, it is believed that the hydroxy acids enhance the function of the skin barrier, leading to less absorption of the retinoids Using barrier repair moisturizers in addition to the retinoids can be very helpful to increase tolerability (see s 11 and 32)
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