My derm says I should go back on my retinoid. I quit about two months ago because I was sick of having a red wrinkle around my neck, along with horribly dry skin overall. So here's my question: Is Tazorac the only retinoid that will work with short contact therapy . . . or did I just make that up? In the back of my head, I want to say that someone told me that tazoratene is the only synthetic retinoid and therefore it doesn't have to undergo a timely change to become active. This is why short contact therapy works. Retin-A and Differin, however, have to undergo a change once applied to the skin, and therefore short contact would end up being several hours as opposed to thirty seconds with Tazorac. Anyone have a clue?

We told you that, too.


[Is Tazorac the only retinoid that will work with short contact therapy]

No, they've used short-contact tretinoin to speed up diabetic wound healing. It probably works for other things, too, but there hasn't been an acne or anti-aging study using it with short-contact therapy to prove it.

[someone told me that tazoratene is the only synthetic retinoid and therefore it doesn't have to undergo a timely change to become active. This is why short contact therapy works. Retin-A and Differin, however, have to undergo a change once applied to the skin, and therefore short contact would end up being several hours as opposed to thirty seconds with Tazorac.]

Tazarotene, too, undergoes conversion in the skin, to tazarotenic acid. I don't think the reason you've heard is why it's effective.

Rougier found that some topicals achieve a reservoir effect in the stratum corneum after contact periods as short as 30 minutes. So these gals and guys (Bershad et. al) decided to try it for acne, and it worked. They compared three twice daily sessions using taz+taz (T+T), taz+vehicle (T+V, or once daily application of taz with once daily application of vehicle), and vehicle + vehicle (V+V).

Here's the application schedule, per application:

"The dosage of gel per application was approximately 0.6 g, described and demonstrated to patients as a pea-sized amount. Patients rinsed with lukewarm water after contact periods starting with 2 minutes per application; they used a timer to be precise. All patients were instructed to increase the contact period, if tolerated without local effects, in 1-minute increments at intervals of at least 3 days to a maximum of 5 minutes. The written instructions directed patients to reduce the contact period to 30 seconds if peeling, erythema, dryness, burning, or itching occurred. In such cases, patients were to increase the contact period in 30-second increments at intervals of at least 3 days, if tolerated, to the 5-minute maximum."

Treatment success was nearly twice as high in the T+V group when application time exceeded 3.5 minutes compared to less than 2 minutes, but only slightly greater for the > 3.5 minute group than for < 2 minutes in the T+T group.

The gel was used in this study. It was for acne. I wouldn't try this method with the cream.

The full study is here:
Arch Dermatol. 2002 Apr;138(4):481-9.
Successful treatment of acne vulgaris using a new method: results of a randomized vehicle-controlled trial of short-contact therapy with 0.1% tazarotene gel.
Bershad S, Kranjac Singer G, Parente JE, Tan MH, Sherer DW, Persaud AN, Lebwohl M.
http://archderm.ama-assn.org/cgi/reprint/138/4/481

There have also been studies using short-contact taz for psoriasis with the gel with results showing it is just as successful as long-contact but less irritating.

Edited to add: I don't think short-contact therapy will be just as effective as conventional leave-on for correction of photodamage. It is a very unfortunate fact with anti-aging that irritation is proportional to efficacy. For an extreme case, consider phenol vs. a light glycolic peel. One can replace a facelift, the other does essentially nothing.

Do what you can stand, though. A little bit is going to be much better than nothing. People's tolerances of topicals range by 30-fold or more, just as with tolerance to UV radiation. Some people have a much stronger skin barrier function than others, and those with the weakest barriers will get quite a bit more action from a much lower dose.

the tazorac cream is stronger than the gel

The gel is stronger than the cream.

http://www.entrepreneur.com/tradejournals/article/print/94329376.html

Usually alcohol base gels are strongest, followed by water base gels (in this case there is a glycol enhancing penetration), followed by creams.

Creams get prescribed more often for anti-aging purposes because aged skin tolerates it better. But creams break some of us out.

I use the gel, I love it to pieces.

Hateme, you can use a moisturizer before or after to 'cut' it to lessen the side-effects. I get sores on my neck and chest (worse on chest) from Taz, but really have not been bothered by the cream like that (at all). Using a moisturizer before or after will dampen the good effect also, btw.

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DCNGA has left the board and is no longer taking PMs.
She requests that if you wish to e-mail her to use her direct e-mail address which is: laserandiplsupport@gmail.com

I can use taz 0.05% gel lavishly AM and PM and it takes about 3 days to get a flake and a rosy glow. Usually I apply only at night. My skin is thick, oily, Mediterranean, the pale olive unexposed type that goes brown with exposure. I can handle a lot more irritation than most people. I have gone to work a few times with flakies on my chin and I get comments but this is only rarely. Since a few of the women I work with are comparing me to their daughters, not knowing I am only a few years younger than them, I think it's a price well worth paying.

[I keep thinking maybe I'm aspiring to heights much too lofty to actually obtain: no side effects at all . . . including no dry skin. Perhaps that's unreasonable? ]

Yes, the key is to push a bit, and when you do get irritated, back off for a few days, then try again.

[ My face tolerates the stuff fine; it's my neck that gives me mad problems.]

This is expected. There is a much richer blood supply and network of pilosebaceous units on the face, which can tolerate more abuse and recover more quickly than the neck, hands, arms, chest, etc. My neck gets really itchy sometimes.

[When I'm on the goods, I have a permanent red line around my neck, just above the suprasternal notch, where I have a . . . well a horizontal wrinkle. The retinoid seems to sink into deep wrinkles or folds and do a real number.]

You'll need your derm or PS to help you there. If you can't handle the ongoing things you might need a series of peels every few months or so when you can hide out until recovery.

I apply retin-A and a topical ascorbic to my neck, about every other night or so. But they get a lot more irritated and angry when I try anything really strong.

[ I used the philosophy miracle worker retinoid pads for about a month, but I didn't notice my of a chagne. Thank you again.]

Don't bother with OTC retinoids, they aren't even 1/10 as effective. Stick with your derm. You need the heavy artillery and he or she will help you with a routine you can learn to live with.

I've also had horrible experiences with Retin A - even the .025% strength, I was beet-red with horrible flaking for months until I finally stopped using it. I started with a new derm in January and she convinced me to try Renova. I love it! I have some peeling/flaking with it but none of the angry redness that I had with Retin A. You might want to see if your derm can give you some samples - mine actually gave me enough sample tubes to last for a couple of months. I use it every other night and on the "off" nights, I use a glycolic acid. My skin has never looked better. Good luck.

the most effective VitC is that which you make as you use it. There's a science to it, that I cannot match at home,

Which part of the homemade routine makes you uncomfortable? Maybe I can help.

I ended up going to the SAS product called CHAS which is an equivalent to VitC serum, except she uses MAP.

about MAP vs L-AA

Using equal percentages of each in an almost identical otherwise topical (formulated to different pHs however, MAP at 7.0 and AA at 3.5)

MAP is 1/5 as effective as AA in free radical inhibition.

MAP is ineffective in preventing lipid peroxidation compared to AA.

This is kind of expected as the MAP molecule is 4.3x as big as the AA molecule. So one would expect less than 1/4 the activity, as a percentage by weight at optimal formulation pH because about 3/4 of the molecule is not AA but attachments. It's not going to penetrate the skin as easily, either, since it's a bigger molecule.

Ref is:
In vitro antioxidant activity and in vivo efficacy of topical formulations containing vitamin C and its derivatives studied by non-invasive methods
Patrıcia et al, Skin Research and Technology 2008 14, 376-380

I wouldn't recommend MAP. L-AA is a lot cheaper and more effective.

That's because most people with anti-aging concerns have dry skins and don't tolerate the alcohol or gel-based formulations that penetrate more readily and deliver more of the active. Creams slow down the rate and amount of active that penetrates, which is why I don't think short-contact therapy with the cream would be very useful. The papers I've read on short- contact therapy all used the gels.

I've used both and vastly prefer the gels. The cream forms give me cosmetic acne on my chin, which I loathe. As a person with oily skin already, the last thing I want to do is to put more oil on my face.

I think the gels are a better deal--you get a lot more bang for your buck, if you can handle it. And if you can't handle it straight, you can dilute (with something pH-appropriate), use short-contact therapy, apply less, apply less often, etc.

DCNGA, I will PM you.