I thought this quick post might be useful for those suffering from acne who are about to embark on a topical acne treatment (usually paired with oral medication also) or those curious about prescription retinoids (vitamin A) and their use as ‘preventative’ anti-ageing products. I’ve recently tried both Epiduo and Differin and so my thoughts on the subject are ‘fresh’ 🙂 Along with some journal article studies I will mention, the following post is for the most part based on my personal experience. My acne has flared up in recent months quite bit, after I decided to stop taking the contraceptive pill (as an FYI, I was on Jasmin, which worked brilliantly at controlling my acne in recent years) so off I went to the dermatologists office once again… As I am turning 29 this month (eek!) and skincare obsessed, I understand the curiosity around using strong retinols or retinoids for anti-ageing purposes. I have always chosen skincare products based on the philosophy to prevent damage rather than correct (where I can mind you… a bit of both is needed usually!). With that in mind, let’s get into it 🙂
I first went on Epiduo, along with an oral antibiotic (doxycycline). Epiduo contains 0.1% adapalene (a retinoid) and 2.5% benzoyl peroxide. I had never used Epiduo before so I was really intrigued and a little scared at the same time lol I have been using retinols for a long time (Futurederm’s Time Release Retinol 0.05% is a staple of mine) and benzoyl peroxide 10% as a spot treatment. I had never ever used them together however and generally speaking wouldn’t recommend it unless your doctor recommends it. Why? Both vitamin A (whether its a retinol or retinoid) and benzoyl peroxide exfoliate the skin. Together, they can seriously irritate the skin (i.e. burning sensation) and over exfoliate. They are wonderful ingredients in their own right of course, for example, benzoyl peroxide is an antimicrobial which kills the bacteria that leads to breakouts and helps prevent spots from appearing. It also dries spots out, which is great for speeding up the healing process of a spot that has already appeared and developed. It can also stop spots from coming to the surface (even cystic acne) hence it is a great spot treatment. I use a 10% benzoyl peroxide, which is the strongest strength you can get over the counter at a chemist. I wouldn’t smother my whole face in it however, so even though Epiduo contains ‘only’ 2.5% benzoyl peroxide, that can be seriously drying if you are applying it all over your face. Adapalene on the other hand, is a type of retinoid. It unclogs blocked pores through exfoliation, helping to stop acne from forming under the skins surface and decreased the swelling and inflammation associated with acne. Retinoids and retinol are one of the few ingredients proven to repair skin damage, so hence it is so wonderful as an anti-ageing ingredient. 0.1% adapalene is double the strength of my ‘staple’ retinol serum, so on it’s own it would irritate my skin at first thanks to it’s strength and exfoliating properties, let alone adding it it to benzoyl peroxide!
My dermatologist suggested that when I first apply Epiduo to my skin, I leave it for 10 to 15 minutes and then wash it off if I feel a burning sensation. I was to use the product every second night at first. The thinking was I could build up my skins tolerance to the product, until I could leave it on for the whole night and use it every night. Because I already used similar ingredients on my skin regularly previously, I didn’t feel any burning or discomfort on my first application. The product is a gel, so I could see if my skin was turning red after 10-15 minutes and it wasn’t, so left it on for the whole night (I did check my face every hour or so for a couple of hours before going to sleep that first time). In the morning my skin was dry and pink maybe, but it didn’t feel burnt and it didn’t feel to bad generally (success, I thought!). It turns out, that even using it every second evening over a prolonged period of time, my skin became so so incredibly dry, that ‘regular’ moisturising products that I owned weren’t cutting the mustard. You have to be careful when buying ultra-hydrating products when you have oily skin, because you need to add the right kind of moisture back into your skin in order to not inflame acne. When I tried using Epiduo a few evenings in a row, my skin looked pink but it felt burnt. The top layer of my skin would turn all crusty and after a long day at work, it was soooooo dry, that even talking hurt (because the skin around your mouth moves and would ‘crack’). It was such an uncomfortable feeling, I couldn’t get used to using it every evening. It was also super hard using my regular makeup to cover it, because nothing wanted to ‘sit’ and adhere to my skin. Flaky skin means flaky makeup, which looks awful. Whether I was using it every night or every second night, my skin was also extremely sensitive – I would recommend you stay away from products with to many ingredients, fragrances and essential oils while you are on Epiduo. They will sting. Did it work is healing and stopping new acne from forming though? Yes. But I almost wonder if the strength of exfoliation meant that it was burning my acne away lol I know it may not work like that per se, but my skin was probably incapable of producing the oils and bacteria needed to form new spots.
Epiduo works really well together with doxycycline. In a randomised controlled trial, adapalene–BPO (Epiduo) with oral doxycycline reduced acne severity rating in more patients than doxycycline alone (31.5% vs 8.4%, respectively; p < 0.001). Improvements in total lesion count were maintained for 24 weeks after stopping doxycycline by 79% of patients who continued using adapalene–BPO (Gold et al., 2010). The study didn’t follow up with participants after they stopped using Epiduo to see if the acne reoccured, or for those who continued to use Epiduo, what happened after the 24 weeks after giving up doxycycline.
After using the antibiotics and Epiduo for about 3 months I wanted to stop and try something else. The reason why was that I was still getting acne on my neck (another major pain) and while my acne had reduced, it hadn’t gone away completely. If it had, I’d put up with the side affects, but it hadn’t. Also, being on antibiotics isn’t a very long term solution. You may be on it for 6 to 7 months at most, but then you need to stop so your immune system doesn’t become resistant to that type of antibiotic. So for me, if it wasn’t working at the 3 month mark, I wanted to try something else (also, I had used oral antibiotic as an acne treatment back in high school and it didn’t work for me then – I gave it a go this time because my acne isn’t as bad as it is in high school, but bad enough that it was starting to get seriously annoying when travelling for work).
On a side note, I really liked that the Epiduo gel is housed in a pump bottle. Most types of vitamin A are quite unstable (it’s an unstable antioxidant) so air and light can oxidise the product over time (lessening its effectiveness). It has quite a nice gel texture and isn’t greasy. I payed around $30 for mine (with a prescription). Prescription prices can vary drastically depending on which chemist you go to, so definitely shop around if you don’t have a trusted chemist you visit regularly.
Differin is quite famous in the skincare world, being known as an effective anti-ageing vitamin A treatment, without the frills of a over the counter product. It contains the same type of vitamin A as Epiduo, adapalene. It also contains the same strength, 0.1%. After wanting to stop the antibiotics and Epiduo because it’s not a long term solution, my dermatologist suggested I try Differin and I also went back on Aldactone (spironolactone). I was on Aldactone for a couple of years back in the day and it worked brilliantly for me then. It’s a medication that wasn’t originally designed for the treatment of acne but it lowers your testosterone levels, which has a side effect of reducing the oil your skin produces and refining the texture of your skin (bingo!). At the end of Jan I will have been on it for 3 months and while it’s definitely started to work, it hasn’t worked as quickly as I had hoped (hormones take agggges to settle, so I shouldn’t be surprised). In the meantime, it’s given me some time to see how the gentler Differin has effected my skin.
Adapalene is actually called an alternative to tretinoin. Tretinoin is the active component of vitamin A. Generally speaking, retinol or retinoids need to be converted in your skin to tretinoin (the active form of retinol). Differin should in that case be somewhat gentler but still very effective at 0.1%. I didn’t experience much irritation from Differin at all, because my skin was used to the 1% adapalene contained in the Epiduo gel. It’s described as a cream on the tube, but it’s actually more like a gel-cream, very light and easily absorbed. As with all acne treatments, you need to give them time to work. It’s not a magic bullet that decreases your acne quickly. I’m not finding it to be that effective at decreasing blackheads (at the moment) but it’s definitely helping to minimise spots and the amount of cystic acne that forms. While it’s a treatment you need to use long term, I am happy that it also works so well long term in correcting all sorts of damage and skin processes. E.g. because retinol and retinoids reduce sebum production and exfoliate the skin (as with all exfoliants), skin thins a little at first and may appear to look less plump. However, after the first 4-6 weeks, retinol/retinoids may paradoxically make skin thicker! This is because retinoids inhibit the creation of three distinct collagen-degrading enzymes: collagenase, gelatinase, and stromelysin (Fisher et al, 1996). When these collagen-degrading enzymes aren’t functioning properly, your skin appears firmer, stronger, and more elastic (Futurederm, 2015). Fine lines and wrinkles also appear to be repaired. That’s why dermatologists love vitamin A! Remember that UV rays also damage collagen production, so again, if you are using retinol to either prevent damage or repair, it does both!
Are prescription retinoids better than over the counter retinol products (even those at a 0.1% strength also)? I don’t think so. Regular retinol gets into the deeper layers of the skin where collagen forms, while some retinoids work best and stay in the upper layers of the skin (Yan et al., 2006). Maybe this is because retinoids transform into tretinoin quicker? In saying all of this, 1% retinols that you can buy over the counter can be expensive (like Skinceuticals 1% pure retinol retails for $111 and Adore Beauty sells Skinceuticals at a very reasonable price compared to other retailers!). Differin on the other hand retails for about $75. That’s a lot for a prescription topical treatment. I’m pretty sure I tried Differin in high school and I’m sure it cost around $30 back then. I think the price has gone up so much because it’s become popular as an anti-ageing treatment and not just for acne sufferers. It’s still cheaper than most actives that you buy over the counter, so while I was shocked at the price, I can live with it!
I will probably be using Differin for a while now. At the end of January I will have been using it for 3 months. The 50 gram tube will certainly last me longer than that. OH I should also mention that I have been using it every second night, so that I can use other chemical exfoliants on the altering night (you shouldn’t use AHAs and BHAs with retinol/retinoids, because it degrades the vitamin A – even if a company tries to tell you otherwise, it’s not true). I wish the product wasn’t housed in just a metal tube because an airless pump dispenser would keep it stable for longer, but at least the metal would help insulate it a bit more than plastic (I think?). It’s a good idea to use up retinols/retinoids within a year, so I’ll be done with it much earlier and I keep it in a dark and mostly cool draw in the bathroom. I may start using it every night if my dermatologist thinks it’ll really help – I’ll ask him on my next visit. I might do an update on how I like the Differin in a few months time, but in the meantime, I think it’s pretty good 🙂
As a quick side note – remember that you must use sunscreen during the day when using strong vitamin A products/derivatives. Your skin will also becomes super sensitive to UV rays, upping the probability of you getting burnt (and causing more damage!).
I hope you Beauties enjoyed this run down and hearing about my acne treatment plan inadvertently! 😛 Let me know if you have any questions and if you have ever tried prescription retinoids. I’d love to hear about your experiences also!
Catch ya next time!