Man. Time sure flies when you’re taking your fine lines and sunspots to church with actives so powerful that only licensed medical professionals can provide them.
I’m now in my third month on Curology prescription skincare. I’ve gone from 0.012% to 0.02% to 0.05% tretinoin, one bottle at a time (with the first, weakest prescription being a 10ml introductory size). Enough time has passed since the company’s rebranding that I now almost always think of it as Curology, not as PocketDerm. Three months really isn’t that long, though, and tretinoin (and pretty much any other skincare active) takes time to show its full effects. That’s why I’m beyond elated that I can see as much improvement now as I do. Like seriously, Curology? You da best.
My current Curology anti-aging prescription
To recap, my first month’s prescription was 0.012% tretinoin, 5% Magnesium Ascorbyl Phosphate (MAP) vitamin C, 4% niacinamide. When I responded well to the initial dose, my Curology provider, Jasmin Chang, RN, AGNP-C (essentially: nurse practitioner with a specialization in aging, how appropriate), agreed to up my tret concentration. My second bottle contained 0.02% tretinoin but kept the 5% MAP and 4% niacinamide.
The third bottle is where I really wanted to get serious. I wanted more tret, and after reading the serenade to azelaic acid in this post on Snow White and the Asian Pear, I wanted azelaic acid, too. My interest in the active centered primarily around its effects on hyperpigmentation. My skin picks up sunspots and PIH very easily, and what Jasmin told me confirmed what I’d already read:
In cases of hyperpigmentation, azelaic acid appears to selectively target hyperactive melanocytes (pigment-producing cells), while having little effect on normal melanocytes. For this reason, it is a treatment of choice for hyperpigmentation in patients of all skin types.
In other words, it can slay excess pigmentation without causing strange things to happen to one’s normal skin tone. Sold. Jasmin and I agreed to go to 0.05% tretinoin, to switch my MAP out for 4% azelaic acid, and to keep the niacinamide as is, because I see pretty much no downside to stacking plenty of niacinamide in my routine.
Let’s take a closer look at that three-month B&A.
What I’ve concluded after squinting at these pictures for hours while putting this B&A image together is that the fine lines on my forehead have diminished visibly, and the sunspots on my cheekbones–some of them the last remnants of melasma from when I was pregnant and unprotected from the sun five years ago–have as well. The tretinoin, azelaic acid, and niacinamide are working just as they should.
What you can’t see from the “after” pic is that the day before I took that picture, I’d actually been sporting a couple of pretty righteous little purge blemishes. An intensive multimasking session and the accelerated skin renewal that my Curology prescription delivers took care of those little problems faster than I ever would have thought possible.
It’s pretty safe to say that I’m more in love with the Curology product and service than ever before. I give it a continuing thumbs up.
My Curology provider’s tips for preventing tretinoin dryness and irritation
If you read my previous Curology update, then you know one of my favorite aspects of the whole Curology experience is the access you get to a trained medical professional–either a dermatologist or specialized nurse practitioner like Jasmin–not just to discuss your prescription, but to hound with skincare questions whenever the questions come to mind, thanks to Curology’s patient/provider messaging system. After I blogged my tretface sample skincare routine a couple of weeks ago, I thought I’d ask Jasmin for her thoughts on my system. She was obliging and even gave me permission to quote her in this post!
One of the first things Jasmin did was give me a clear and easy-to-understand explanation of what, exactly, tretinoin does to the skin.
Tretinoin (and retinoids in general) slightly thin the outer dead layer of the skin (the stratum corneum), making it more soft and compact. This layer sheds old cells naturally and is constantly rebuilding. Tretinoin speeds up that shedding process for us, and this is a good thing because it is the stratum corneum that thickens and becomes slightly irregular with age and sun damage, resulting in skin that is rough, dull, and lacking in vibrancy.
At the beginning of one’s tretinoin journey, however, this accelerated shedding typically causes increased dryness (and the appearance of worsened fine lines and wrinkles as a result). It’s important, Jasmin told me, to keep skin hydrated and to prevent Trans-Epidermal Water Loss (TEWL).
I’d definitely heard about the notorious tret dryness before and was determined to prevent that from getting out of hand as much as possible. One of my main strategies for keeping my skin from totally losing its shit during the initial adjustment phase has been to stick to relatively mild and always low-pH cleansers. At this point, I’m proud to consider myself an underboss in the Low pH Mafia. Huehuehue. It was definitely a relief to hear that Jasmin agrees:
As you suspected, maintaining an appropriate pH is important for the integrity of the stratum corneum; this becomes all the more important when you add tretinoin into the mix, since that’s where tretinoin is working. (Also, with typical aging comes an increase in pH of the skin’s surface and rough, dull skin.)
I also detailed the rest of my intensively hydrating and moisturizing skincare wardrobe.
I’m gonna be totally honest here, I figured she’d probably tell me that it’s all unnecessary or something like that. I’ve heard of plenty of dermatologists and skincare professionals who look down on commercial skincare products or elaborate skincare routines. I laid it all out with an open mind, but I did have to brace myself for a response that might force me to rethink what I’ve been doing.
(Despite the fact that I haven’t been having any significant dryness or irritation issues with my much stronger new prescription, even though I YOLOed right into it without much more than some lip service about buffering.)
I explained the thinking behind many of my skincare choices, which I won’t go into much more, since I already covered that stuff in my tretface sample routine post. Anyway, I made Jasmin aware that my daytime skincare routine typically looks something like this:
And that I’ve got plenty of facial oils to make my nighttime routine look more like this:
Here’s Jasmin’s response:
The most important part of starting tretinoin is keeping skin hydrated, so I agree with your theory. Most of the products you mentioned sound very moisturizing, so you’re definitely protecting your skin, which is really why I think you’re tolerating the higher dose of tretinoin so well.
Initially, tretinoin makes skin dry, and wrinkles and lines can be more visible on dry skin; this is a temporary effect that goes away as you continue to use tretinoin and your tolerance builds. In the meantime, all those moisturizing ingredients help to keep transepidermal water loss to a minimum so that flaking and shedding is not apparent.
So there you have it. My tretface is doing very well and handling its new prescription overlord surprisingly calmly. At least some of the resilience my skin is showing has to be down to individual biology (YMMV, in other words), but I feel very comfortable attributing the rest of it to a skincare routine that’s heavy on the hydration and moisturization and as light as possible on the stripping and the drying during the cleansing.
I can’t believe I’m saying this after three months, but at this point, I feel happy enough with where my skin is at to consider myself on maintenance. I’m not sure I’ll be wanting to up my tretinoin dosage anytime soon, as I don’t see the need. I’ll just keep doing what I’m doing, sheet masks, oils, and all. And I can’t wait to see what my next progress pic will reveal.
If you want to learn more about Curology or give the service a shot, you can get your first month free using this referral link.
What are you doing for anti-aging? How is it working out for you?
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