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Retinoids 101

What Are Retinoids?

A Retinoid is an umbrella term used to describe Vitamin A derivatives. Retinoids are powerful enough to improve overall skin texture, acne marks, discoloration, fine lines and wrinkles, as well as decrease oil production leading to less acne.

How Do Retinoids Work?

In simple terms, retinoids stimulate rapid cell renewal and turn over while also keeping pores free from blockage.

They slow the breakdown of collagen and thicken the deeper layer of skin where wrinkles start.

Retinoids also help improve uneven skin tones and brown spots.  It does this by sloughing them off and reducing melanin production.

Prescription vs Non-Prescription

What’s the difference between retinols you can buy in a department store and prescription Retin A?

Medical providers can prescribe Tretinoin (Retin A) which contains Retinoic Acid.  These formulations are only available by prescription and contain active ingredients.

Non-prescription “over the counter” products usually contain vitamin A derivatives such as retinol, retinyl palmitate, retinyl acetate, or retinyl linoleate.  The biggest difference between the two types are how they work at the cellular level.  Retinols are not active products and need to be converted into retinoic acid at the cellular level before they can work. The more steps that the Vitamin A derivative needs to take before it becomes the active retinoic acid, the less potent it becomes.  With any non-prescription strength product, it’s important to know what ingredient is being used, and how far it is from being activated.

The active Retinoic Acid product works quickly, but can be associated with more side effects.  At the end of the day, Retinols and Retinoic Acids are able to do the same thing, but it may take a lot longer to see results with retinols.

Lloyd Dermatology Center now offers more options of your topical medications available within our office.

Skin Basic offers medical grade cosmeceuticals (non-prescription retinol products)

How To Get Started?

If you are a newbie to Retinols/Retinoids, the trick is to start out slow! Your skin will tolerate the medication if you start out slow and build up your frequency of use.

Retinoids can cause some redness, dryness, and irritation in all skin types, regardless of being dry or oily.

*Only use your retinoid at night as they are deactivated by the sun.

Start out by using a small “Pea Size” amount, once or twice a week. (Monday, Thursday) If you are using it twice a week, space out your days. The goal is to work your way up to nightly usage, but it takes time to get there with prescription strength medications.

If you need to moisturize your skin with the use of retinoids

  1. Wash your face
  2. Apply your moisturizer
  3. Apply your topical retinoid.

*Lloyd Dermatology Center now dispenses more retinoid medications in office.

Retinols are often easier to tolerate on sensitive skin, and an individual can build up their frequency of use quicker with this non-prescription product. Retinols can still cause drying and irritation, so it is just as important to start out slow with usage and build up to every night.

*If you are not a patient at our office and want to find a retinol product that is right for your skin type, visit Skin Basic to discuss our non-prescription products.


FemiLift (FDA) – Dr. Madeline Tarrillion

U.S. Food and Drug Administration (FDA) Clearance of CO2 lasers:

Genitourinary syndrome of menopause (GSM), previously known as vulvovaginal atrophy (VVA), is a condition affecting postmenopausal women, which usually includes vaginal dryness, burning, itching, irritation, urinary incontinence, dysuria (pain with urination) and dyspareunia (pain with sexual activity). Standard therapies include vaginal moisturizers, low dose topical estrogen, and selective estrogen receptor modulators. Patient compliance can be low due to numerous factors: cost, inconvenience, method of application, safety concerns, etc. Topical estrogen is currently considered the gold standard therapy for GSM; however, patients and providers are seeking out more affordable, convenient, durable, effective, non-hormonal management options.

For years the CO2 laser has been broadly used in the field of dermatology for the treatment of skin. The CO2 laser fractional micro-ablative technology has been shown to remodel the vaginal connective tissue with the production of new collagen and elastic fibers without tissue damage, which can improve the symptoms of GSM.

On July 30th, 2018, the FDA sent out a warning against the use of energy devices (laser therapy) to perform “vaginal rejuvenation” because of worries about adverse events. Typically, the term “vaginal rejuvenation” applies to procedures that are primarily for cosmetic purposes. “Vaginal Rejuvenation” procedures are elective without a clearly defined medical purpose.

The FemiLift/Pixel CO2 laser system along with the Focusing and Pixel handpieces are cleared by the FDA under K103501 for laser “ablation, vaporization, excision, incision, and coagulation of soft tissue in medical specialties including: aesthetic surgery (dermatology and plastic surgery), podiatry, gynecology, neurosurgery, orthopedics (soft tissue), arthroscopy (knee).”

CO2 lasers are FDA-cleared as safe to use; however, they are not specifically FDA-cleared for treatment of GSM. Throughout the medical literature, therapy using CO2 lasers has been documented as an appropriate and efficacious treatment for GSM; therefore, this is currently an “off-label” use of a device. Within medicine, there are many drugs and devices that have shown to have medical benefit for “off-label” uses. More than 20% of pharmaceutical prescriptions are filled for “off-label” conditions. In addition, “off-label” use of medications and devices has often led to FDA-approval of new therapies (including the most popular class of erectile dysfunction drugs, which were initially studied as a treatment for high blood pressure and chest pain).

In a large case series by Filippini et al, 386 menopausal women with GSM were treated with 3 sessions of fractional micro-ablative CO2 laser. There was resolution of dryness in 60%, vaginal burning in 56%, dyspareunia in 49%, itching in 56%, soreness in 73%, and vaginal introital pain in 49%. These effects were reported after the first session and continued for 1 year after the final session. Most studies report only “minimal” risks, and the procedure is performed in an outpatient setting. The articles mention that most women report some slight redness, swelling, and/or “some discomfort” that disappears within 1 to 2 days. Currently on RealSelf.com, the FemiLift CO2 Pixel laser has a “Worth It” rating of 93%.

Unlike vaginal estrogen, the CO2 laser has additional benefits such as treating lichen sclerosus, potentially removing the need for chronic high-potency topical steroid use. In addition, the CO2 laser has shown promise in the treatment of overactive bladder symptoms and stress urinary incontinence. CO2 laser could create a low-risk alternative to surgery for women seeking other treatment options.

A few additional factors to consider are the specific laser and the type of provider. CO2 lasers should not be confused with radiofrequency (RF) devices, in which the energy waves are less focused and can cause more collateral damage and potential side effects. Also, seek out treatment by a board-certified physician, who can provide a thorough consultation about the risks, benefits, and side effects of this procedure. Adverse events are more likely to occur if the procedure is done in a non-medical setting by providers without enough experience in laser use.

It is important to note that the criteria for FDA device clearance are much less stringent than for drug approval, and that the clearance for the CO2 laser was as described above and not specifically indicated for use in GSM. FDA device clearance does not require the large, double-blind, randomized, placebo-controlled trials with established efficacy and safety endpoints required for the approval of new drugs. We agree with the FDA that these devices need continuing/longitudinal studies, development of clear indications, appropriately informed patients, and skilled and ethical physicians to be used safely.

This is an important time for women’s health, which has been hindered in the past by hesitance to openly address women’s reproductive and sexual health concerns. We do not want this FDA statement to limit the availability of innovative therapies, which when used correctly may benefit women’s reproductive health.

The FDA should not equate “vaginal rejuvenation” cosmetic procedures with innovative therapies that may improve women’s quality of life. The FDA was right to be looking out for women’s health, but we hope that the warning does not scare or deter women from seeking information about alternative therapies that could potentially help.

https://www.npr.org/sections/health-shots/2018/08/13/638348014/despite-fda-caution-doctors-say-lasers-may-help-with-vaginal-pain-and-dryness
http://www.poynorhealthnewyork.com/laser-rejunvenation/
https://www.realself.com/femilift
https://www.medscape.com/viewarticle/846960
https://urology.stanford.edu/content/dam/sm/urology/JJimages/publications/CO2-Laser-Treatment-is-Effective-for-Symptoms-of-Vaginal-Atrophy-No.pdf
https://www.syracuse.com/health/index.ssf/2018/08/syracuse_docs_who_provide_vaginal_rejuvenation_say_treatment_safe_despite_fdas_w.html


Our Office

Lloyd Dermatology Center

8060 Market Street
Youngstown, OH 44512

Phone: 330.758.9189Fax: 330.758.4487

Office Hours:

Monday – Friday
8:00 a.m. – 5:00 p.m.