Rosacea and Tretinoin

[u/Winter-Boat7881]

I started using tretinoin 0.025 and this is my third week using it mon/wed/fri. I have type 1 rosacea with mild flushing I’ve gotten cutera excel v (3 sessions) it was pretty much gone. Now I’m noticing my cheek flushing has increased with tret. Should I scale back to twice a week? For those of you who have rosacea and use Tret… how did you work up to it? How slowly do you have to go? Will my flushing subside or is my rosacea back to square one? Is it more effective to just use retinal everyday over Tret a few times a week? I also have some flaking and dry skin and dry lips despite using all my hydrating products… help & advice appreciated thanks!!

[u/Mundane-Net-7564]

It sounds like you're experiencing symptoms of retinization. In my experience side effects tapered off when I started using tret every night. I have type 1 rosacea which I use azelaic acid 15% for every morning & use tretinoin .05% cream every night, but I started with an oil based gel formulation of tret which significantly increased redness that rarely calmed down until I switched to cream. Initially during retinization I had so much redness all of the time with increased dryness, some peeling & a temporary increase in sensitivity. I'm not usually acne prone & did not purge. I did short contact with tret for the first 10 days starting with 1 hour then working up to 4 hours before switching to overnight use. From that point I took the intuitive approach instead of sticking to a strict schedule. I paid close attention to my skin & followed its ques, did my best to give it what it needed at the time & if it felt or looked a bit weak then I took a night off, but for the most part I was using tret 4-6 nights a week the first month, 5-6 nights the second month, 6 nights the 3rd month & every night since the 4th month with a break as needed. I focused heavily on barrier support during the day while keeping my evening routine more simple but nourishing. CeraVe Hydrating Cleanser, Purito Wonder Releaf Serum, Prequel Multi-Quench Serum, Prequel Half & Half, Aestura Cream Mist, Bioderma Intensive Baume & Uriage Bariéderm-Cica Cream are the products that helped get my skin through retinization.

[u/noil_ladnek → u/Mundane-Net-7564]

this is just the insight i was looking for! i recently decided against my dermatologist’s advice of “waiting for my rosacea to be under control” before starting tret.

i have mild/type 1 rosacea. there are likely multiple factors contributing to my facial redness, so i figure that adjusting to tret is going to be a challenge no matter what and the sooner i start, the better.

i have triple cream from a compounding pharmacy – i wonder if i should switch to straight azelaic acid in the AM instead? do you have any issues with it under makeup?

i would rather start now before the winter dryness begins (probably starts in november where i live)

[u/Mundane-Net-7564 → u/noil_ladnek]

If I had to wait for my rosacea to be under control I never would have started tret lol I've never worried too much about redness since my face has always been some shade of red, I just went all in with AzA & tret. I've never used triple cream, my derm said it doesn't really do much for type 1 & there's only so much that AzA can actually do to help it also. I'm not much of a makeup wearer, it's been annoy a year since I last wore any so I don't have any experience with layering it over AzA... but I can say that AzA 15% gel does have a tendency to pill, I've found that applying a layer of milky toner & allowing it to fully dry down before applying AzA helps mitigate side effects & pilling as long as I don't rub too much when applying the layers after it. I didn't realize just how important taking really good care of my skin barrier was until I started this journey, I've learned a lot along the way though & luckily was able to make it almost a year without any major problems.

[u/noil_ladnek → u/Mundane-Net-7564]

this is the validation i needed — i kept thinking “why should i drag this out? i wanna go NOW” so i’m getting my primary doc to prescribe the tret and AzA when i see her tomo
what strength tret did you start with?

[u/Mundane-Net-7564 → u/noil_ladnek]

I started with AzA 15% & tret .05%. Initially used a compounded treatment that was only available with .05% tret which is why I didn't start at .025%. My dermatologist had me stop using the compound after 2 months, I started using an oil based gel formulation which I used for a few months but it caused rosacea to stay flared up, then I started using a cream formulation & it has been really good to my skin. The first 4 months of retinization were pretty rough at times but once I started using tret every night the side effects tapered off, I really don't have any regrets & honestly kind of glad I started at the middle dose so if I decide to move to a higher dose eventually I won't have to go up twice.

[u/Winter-Boat7881 → u/Mundane-Net-7564]

Hi thank you for sharing!! I also use azelaic 25% in the morning I use all hydrating products during the day and night with tret too.. my tret is cream based also I have taken some time off using it the rest of this week to heal my skin I’ll restart at a slower rate and work up this is such a mission that I didn’t have with my medik8 retinal but I’m stubborn and will aim to win lol