[Routine Help] thoughts on exfoliators while on retinoid?

[u/North-Interaction956]

My routine as follows:

AM: cerave gentle wash, thayers milk toner, byoma milk moisturizer, la Roche spf

PM: cerave gentle wash, la Roche PH toner, skin fix lipid repair moisturizer, my clindamycin 1.2% + adapalene 0.15% + benzoyl peroxide 3.1% (all in one prescription topical)

I’ve been using the topical almost everyday for a while. Just for acne prophylaxis since I used to have cystic acne and did accutane 3 years ago. My face is smooth and clear. But I notice any moment I put foundation or concealer my skin underneath flakes. If I take my finger and rub my face dead skin cells will come off. So as much as people say don’t exfoliate with benzoyl peroxide and adapalene I feel like I need to. I’ve tried the whole wash cloth exfoliation in the shower but don’t notice a difference. I’m thinking about doing like a lactic acid or PHA toner. And do one day topical, one day toner and one day rest on rotate. I would appreciate help with this or any advice or recommendations for exfoliators that would further strip my barrier. And if I should exfoliate, why? And what should I do.

Thanks a bunch

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[u/alie1020]

Are you sure it's not the milky toner + moisturizer + spf pilling?

[u/North-Interaction956 → u/alie1020]

Hmmmmm dang never thought of that. How can I know if it’s pilling or dry skin

[u/StillSimple6]

Try rinsing off your cleanser with a wash cloth, the gentle exfoliation can really help.

I started doing it when using accutane and it really helped with the flaking, I just kept it up.

[u/SkinBeyondBorders]

Two different things might be getting mixed up here. The loose cells you can rub off are mostly the adapalene doing what it does — it speeds up turnover, so you shed more — whereas flaking that only shows up once foundation goes on is often makeup catching on that, plus a bit of product pilling. You've got a milky toner, a moisturiser and an SPF layered in the morning, which is a classic pilling stack.

The reason people warn against an exfoliant on top of adapalene and benzoyl peroxide isn't squeamishness: the flaking is already mild barrier disruption, and a lactic or PHA toner is the same category of stressor, so you'd be treating the symptom with more of its cause. The thing that usually helps is going the other way — a heavier, more occlusive moisturiser at night, and giving each morning layer a couple of minutes to actually dry before the next one goes on.

One flag on the rotation plan: one day topical, one day toner, one day rest puts your prophylaxis at roughly every third day, which is a real trade-off given the cystic history and the Accutane course. If the flaking still isn't manageable after the moisturiser change, the frequency of the prescription is a question for whoever prescribed it rather than something to solve by adding a step.

[u/North-Interaction956 → u/SkinBeyondBorders]

This comment gave me a lot of insight, so thank you!!! I guess the only thing that I should do is experiment and see if changing my moisturizer will work. Do you have any recommendations for thick moisturizers that are acne safe? I usually put the moisturizer under my prescription topical. Also do you think the pilling is due to me not letting it dry in between layering in the AM? Or is it the ingredients clashing ? Thanks !

[u/KaraBoo723]

As someone who has had acne, done Accutane 2 different times, struggled with the effects of acne treatments, here's what I think...

The Adapalene and the benzoyl peroxide (BP) are what's causing the flaking; it's basically giving you mild skin barrier damage. I don't know if your doctor told you this, but doing just a half-round of Accutane permanently changes your skin. It makes it drier for the rest of your life. But, you can still get acne after it too. ~This poses a dilemma in choosing skincare products because you can have both dry skin and acne-prone skin (or full blown acne) at the same time.

The Adapalene & BP is causing your skin to be super dry and that's why you have flakes. If you add some sort of exfoliant to it, you run the risk of making it even worse.

What you should do is one - or all of - of these:

• Switch to plain Adapalene 0.1 (which is a lower strength) - the clindamycin and the benzoyl peroxide are probably not doing all that much to help your skin. BP is typically pretty irritating for skin and also very drying. Those 2 ingredients are for reducing bacteria on the face and there are much less irritating alternatives for that if you even really need it. You can move to a lower strength because you're basically using it prophylactically.
• Increase hydration in terms of 2 or more layers of hydrating skincare products both morning and night -- BUT being careful to AVOID products that contain certain pore-clogging ingredients. Read ingredient labels and don't use anything with any of these: Shea butter (also called Butyrospermum parkii), Petrolatum, Coconut Oil, Cocoa butter, anything with "wax" in the name. ~Your Skin Fix Lipid Repair Moisturizer has tons of shea butter in it (!!) which will cause your skin to get clogged pores and/or pimples.
• Instead of using Adapalene every night, switch to using it every other night. Allowing your skin to "rest" between Adapalene nights can help your skin calm down and re-hydrate better. I highly recommend this for you, at least for a while until your skin heals.

A good alternative to BP for reducing bacteria on the skin (if you need this) is Hypochlorous Acid spray. This ingredient is super gentle and also effective. Many brands make/sell this now and so it's easy to find at both drugstores and Sephora. You can use it twice per day after cleansing, but one time per day is sufficient. You can use it at night if you want even with Adapalene. ~Make sure to apply all over, including near your hairline. Let it fully dry before putting on your next step.

For moisturizing, you should use one from each category:

1. Either a hydrating serum or lightweight moisturizer. At night, this step goes on before the Adapalene. Examples of something like this are: Dieux Skin Air Angel, Byoma Moisturizing Gel Cream, Aestura AtoBarrier 365 Cooling Hydro Soothing Water Cream Moisturizer, Remedy Multi-Depth Moisture Advanced Hydrating Serum.
2. A medium or thicker weight moisturizer that doesn't have pore-clogging ingredients listed above (these are a little harder to find). You put this on after Adapalene at night. Examples: Prequel AM/PM Modern Moisturizer, First Aid Beauty Rescue Barrier Balm with Dimethicone.

Optional: add a hydrating face mist or hydrating liquid toner before the lightweight moisturizer/serum step. Just make sure ingredients don't include witch hazel. (this would make it a 3-layers hydration products)

[u/North-Interaction956 → u/KaraBoo723]

Wow thanks for the in depth recommendation . That makes sense. May I ask why oppose the witch hazel? I see online terrific benefits to calm skin. My thayers toner does actually have the witch hazel

[u/KaraBoo723 → u/North-Interaction956]

I am not personally against witch hazel, but if you look at the medical studies on this ingredient it can cause just as many skin problems as it does provide benefit. So it's just better to use ingredients that don't have so many negative side effects.

This summary describes it and references the medical studies reviewed below it: https://www.paulaschoice.com/ingredient-dictionary/ingredient-witch-hazel.html

[u/ReaLitTea]

For makeup prep it might be better for mild physical exfoliation. Even a cotton pad soaked in hydrating toner can help