How to Survive Tretinoin without Molting – a Dry Skinned Girl’s Guide to Curology (fka Pocketderm)!

You guys may have noticed that this blog has been neglected for a few weeks now. This is not because I’ve given up on skincare or blogging, but simply because both my skin and its care routine are under-going some changes right now. Namely, after a lot of pussyfooting around the idea of prescription skincare, I signed up for Curology (previously Pocketderm) and after TWO MONTHS they finally put me on tretinoin. Woot!

This post made me do it.

This post made me do it. When I mentioned my indecisiveness to OP, to which she responded:
Please, please go for it. For me, it took about 2 months of skin like the first 3 pictures before I went for it. If I’d gone for it sooner, that’s 2 more months of happiness I would’ve gotten.
This struck a chord. It’s easy to write off acne as something cosmetic, silly, and vain, but truth is acne had taken a toll on my happiness. To look in a mirror and see an unfamiliar, acne-ridden face is bad, but having to face the world with that face without being able to explain it to other people ate away at my confidence in a way not many things have.

This means two things:

  1. The routine I’ve been using for the past couple of months? It needs an update. It is severely lacking in moisturizing agents because summer has been strangely kind to my dry skin.
  2. Also, just like the doctor ordered, I’m off of AHAs and BHAs. Tretinoin has made my skin uncharacteristically sensitive so I imagine it’s going to take some time before I can reintroduce them. This has been a difficult adjustment, to say the least. Without BHAs keeping my acne in check, I’ve been dealing with more breakouts and longer lasting breakouts, operating on the faith that Curology / Pocketderm would take care of it, with mixed results.

What is Curology and My Experience So Far

Prescription 1 and prescription 2, hanging out with the new vanityrex mascot!

Curology is an internet dermatologist service that treats acne and aging. You are assigned a dermatologist and communicate with him or her purely through the built in Curology messaging service and by uploading photos. The scope of what they do is obviously very limited compared to an in-person dermatologist (you’re still going to need a real dermatologist for any skin cancer concerns or services such as cryotherapy) but where they win is accessibility. You can communicate with your doctor at any hours of the day by sending messages and, from my experience, you will receive a response quickly.

I realize I haven’t really mentioned my experience with Curology / Pocketderm very much up until now. There’s a good reason for this: my first prescription really didn’t do much.

I started using Pocketderm in July and my first prescription composed of 1% clinamycin, 4% niacinamide, and 4% azelaic acid. At the 7-8 week mark, my doctor took out the niacinamide, doubled the azelaic acid content to 8%, and added .018% tretinoin. I don’t know if 7-8 weeks is the usual amount of waiting time to get a stronger prescription, but I imagine my constant pestering, photo uploading, and question asking of my doctor might have something to do with it. My doctor, to her credit, was very patient and thorough in all of her correspondances with me. Even though my first prescription did not perform as I had hoped, I still think Pocketderm is worth every penny because having a doctor to freely email with skincare questions is really awesome. Who knew I had fungal acne and inflammatory lesions on my face? WebMD can’t diagnose that sh*t.

curology

I received my upgraded Pocketderm cream three weeks ago. My doctor suggested I start using it every three days while using the old prescription on my days off. After two weeks, I finally bumped up my frequency to every other day.

It’s too early to tell how effective this new prescription will be, but it’s definitely doing something. My face feels raw and even products that have been firmly established in my routine are now causing redness. It’s a little unnerving, but I’m excited to see what happens!

Btw, you can try one month of Curology for free by using my invite here. After that, it’s $19.95 a month. 

FLAKE-POCALYPSE Begins

With my first Curology prescription, there was virtually no change to my skin. I had no sensitivity (even though I kept using AHAs and BHAs in my routine), no changes in dryness, and also no changes in my acne. Two days into my new prescription, my skin started peeling off at an alarming rate!

My skin on tret. Source.

My skin was peeling in the way that skin peels a few days after a terrible sunburn. The parts of my skin that weren’t mid-flake looked like scales. This isn’t your normal dry-skin flakiness, this was my face shedding an entire layer of skin. The area around my nose and mouth looked the worst but the flakiness extended all the way up my cheeks.

Three weeks in, I have my flakiness mostly under control. It’s still an ongoing issue, but no longer a cause for social awkwardness! Here are the anti-flaking rules I’ve been following that have made all the difference:

Rules for Keeping Flaking at a Minimum:

1.) Forget ALL Chemical Exfoliants – No AHAs, No BHAs, and No LAAs

My assigned dermatologist had instructed I put a pause on using AHAs and BHAs because my skin may be too sensitive as it adjusts to tretinoins. However, another reason to avoid chemical exfoliants is because they make the flakiness so much worse. A few days into tretinoin, my skin was feeling sensitive enough that I thought reducing l-Ascorbic Acid (LAA) usage might be a good idea. This didn’t help with my new sensitivity issues, but it did reduce the flakiness I was getting by a significant amount. Even though it’s not as effective as an AHA or BHA, LAA does exfoliate at a low enough pH. It seems obvious in retrospect, but when your skin is flaking off at an alarming rate, it probably doesn’t need the assistance of additional chemical exfoliants.

2.) Get A Konjac Sponge STAT

Konjac sponges are so difficult to photograph. :(

Konjac sponges are so difficult to photograph. 😦

While chemical exfoliation is a definite no-go, gentle physical exfoliation can make a world of difference by preemptively removing loose skin before it starts to flake! Konjac sponges are the gentlest, least irritating way to physically exfoliate the skin. Gommage exfoliators such as the ever-popular Cure Natural Aqua Gel would probably work as well, but konjac sponges are cheaper, easier to use, and pose no risk of comedogenesis! I stock up on Konjac sponges when I place orders with Koreadepart. They are also available on amazon.

3.) DO NOT TOUCH Your Skin

It is really difficult to notice flakiness on your skin and not to brush it away, but trust me touching will only make things worse! Every time I touch my skin, more flakiness will magically appear, even if my skin looked stable before the touching. I now avoid looking too closely in mirrors when I am not at home and bring makeup remover wipes with me everywhere, so if I mess up and trigger more flaking, I can at least wipe the mess away and reapply makeup to patch things up.

4.) Is Your Current Moisturizer Satisfying All Your Needs? It’s Time To Get Serious About Hydration!

Moisturizing seems like a no brainer, but this is the time to ditch poor and mid-level performing moisturizers. As someone with dry skin, I can write an entire treatise on why most moisturizers suck, but that’s for another day. The point is you need a moisturizer that works. You aren’t necessarily looking for something super heavy – the dryness issues from tretinoin are internal so the goal here is different than say, protecting your skin from Chicago winters, but you do want something that can seal in hydration. My current go-to moisturizing products are the Neogen Dermatology Dual Layer Ceramide Oil and Caolion Mucin’s Cream Water.

The Neogen ceramide oil is bottle full of half essence and half oil. To use, you shake the bottle and then use the dripper cap to extract the product. The instructions say to use 4 drops, but I fill the entire dripper and use it all. Despite its high oil content, it does not leave my face feeling heavy, sticky, or greasy nor does it leave my face looking shiny. In fact, it dries matte. It also layers beautifully with other products and seals in moisture like a champ! I use this in the mornings after applying toner and essence and before sunscreen. No emulsion or other hydration steps needed!

Full review coming, but take a look at that ingredient list!

Full review coming, but take a look at that ingredient list! Purchased from eBay. Also available on Koreadepart.

Caolion Mucin’s Cream Water is a newer addition to my routine but it is one of the 5 snail creams I’ve been testing against each other (with the help of my water / oil analyzer!) and the one that moisturizes best by far. This cream is not heavy but it does leave a tacky (but not sticky) feeling on my skin, one that almost feels like a makeup primer. It feels more protective but less reparative than the Neogen ceramide oil, and I haven’t been using it as much right now but I imagine it will become my go-to moisturizer when things get colder and windier!

caolion mucin's cream water

Purchased from eBay.

When my skin is feeling especially dry, my go-to remedy has been sheet masks, but not just any sheet masks, horse fat sheet masks! Fiddy, the ultimate fairy snail mother, sent me with two Guerisson hydrogels and I immediately fell in love and purchased a bunch more plus some other horse masks that looked promising! On my skin, horse oil is pretty much magic. It hydrates / maintains hydration and makes my skin baby soft, all without feeling like I have anything on my face at all!

At the end of the day, there’s still a good amount of loose dead skin on my face, which becomes painfully obvious when I’m oil cleansing and I can feel it peel off and bunch up in the oil. When this first started happening, I excitedly thought that maybe I was getting grits, but alas, it’s just skin. It’s pretty gross but as long as it isn’t super visible throughout the day, I’m pretty happy!

Has anyone else had issues with flakiness after starting tretinoin? What are your tips for dealing with it?

Advertisements

16 thoughts on “How to Survive Tretinoin without Molting – a Dry Skinned Girl’s Guide to Curology (fka Pocketderm)!

  1. Fiddy Snails says:

    Oh man. My leveled-up Curology script (0.02% tret) gets here on Monday. I didn’t have any issues with my month at 0.012%, but now I’m nervous. Thank God I have a million heavy creams ready to go.

    Of course, I’m now craving the Neogen and Caolion products you mentioned anyway.

    Glad to hear you like the Guerisson masks!

    Liked by 1 person

    • V. Rex says:

      How exciting!! Have you been seeing results with the .012% prescription? I know retinoids take time to work but I’m so impatient! I wouldn’t be TOO concerned with flaking – it’s very possible my skin is abnormally sensitive to retinoids. A long time ago I tried using A313 (French drugstore retinol) and it caused uncontrollable itching, which apparently is a sign of the retinol absorbing too quickly / working too effectively. That was before my AHA/BHA days but A313 is advertised as being suited for sensitive skin and being not very potent!

      Btw, the Guerisson masks are so great! I think I sent you a message over reddit raving about them when I first got the masks. I haven’t tried the seaweed one yet – most of my masking has been during late nights (my sleep schedule is super out of whack right now) and I’m scared one of my roommates will wake up in the middle of the night and think I’m some sort of intruder. Maybe I’ll save it for halloween?! Seems appropriate!

      Liked by 1 person

      • Fiddy Snails says:

        I think I was starting to see some progress with the 0.12%. I was definitely getting grits every time I touched my face, anyway! Mostly I saw some improvements in skin tone evenness, and I think the area around my eyes was starting to smooth out. Unfortunately I ran out early and then I think my refill got held up as they made the transition from PD to “Curology” (uhhhhh….) so it’s been a couple of weeks since I had any 😦 I can’t wait for Monday!

        And it’s funny, the first time I tried a retinol product was some months ago, with the Neutrogena retinol eye cream. It made the skin around my eyes go red and itchy, so I stopped. Tried the stuff again more recently, and it’s so weak my skin doesn’t respond to it at all!

        Liked by 1 person

  2. Angela and Renee says:

    Good tips! I went through the same stages of flaming last fall after starting tret. I don’t think I’ve seen grits from oil cleansing either. All skin 😦 Have you tried the Goodal Waterest Water Oil and know how it compares to Neogen? –Angela

    Liked by 1 person

    • V. Rex says:

      How long did the flaking last for you? I’m so ready for it to be over with! I have tried the water oil earlier this year, before they reformulated! It’s one of my favorite hydrating products! The neogen ceramide oil has a thicker and creamier texture than the water oil. Neogen is also more occlusive and feels reparative (like it’s healing my dried out skin barrier) whereas the water oil is more strictly a boost in hydration. The most similar product to it that I’ve used to the Neogen oil is probably the Guerisson horse oil essence, with the Neogen being a bit more moisturizing.

      Like

      • Angela and Renee says:

        More reparative? ::swoons:: The flaking was at its worst for about 4 weeks and then just suddenly lightened up a lot. Even as recently as a couple of month ago though, I would occasionally get flaking around my nose and mouth. It’s as if they never fully adjusted to tret. Things got a lot better when I cut out acids (toners, peels) from my routine. Haven’t had flaking since then and even previously drying sunscreens do OK on my skin now.

        Liked by 1 person

  3. Julie (@pdxbeautiful) says:

    Thank you so much for writing this post!! I think it will be a fantastic resource for those suffering with skincare issues. I think Curology is a fabulous idea for those who cannot get to a dermatologist. I have medical insurance but it does not cover a “specialist” until I have met my yearly deductible….So I have to pay out of pocket for the entire apt. which is around 400$. I think I’m going to take you up on that invite and try out Curology 🙂 I have been under treatment for acne since April with my primary care and although I think she has been fantastic and my skin has improved, it is no where near where I want it to be after 6 months 😦

    I would love to see before, during, and after pictures of your progress!

    Liked by 1 person

    • V. Rex says:

      I’m working on a 3-month progress post that will have before and after pics! To be honest though, I was expecting my skin to have seen more improvements by now, based off of other people’s experiences. However, I’m hopeful with this new prescription! It seems to be tackling my PIH problems quite effectively. Dermatologists are expensive – a friend was trying to get me to see her dermatologist for awhile to get accutane so, as she put it, I can torch the acne, and I considered it for awhile but kept thinking: but with that money I could try Curology AND P50 AND all these other random products and try that instead. If you end up signing up, I would definitely tell the Curology seem everything you’ve tried before. I was able to get a lot of insight on what might be going on with my acne that way!

      Like

  4. Terri Gardner says:

    I have the same scrip you have now, after starting on the same 4-1-4 beginner scrip. As I have combo/oily skin, I just thought I’d chime in to say that the tips you give above also work for oily and combo skin! I barely took a break from my acids when I got the first prescription, but still feel like I’m not ready to go back to daily acid use since adding tretinoin! Ceramides and konjac sponges are LIFE. I’ve also found that sheet-masking as often as possible helps a lot, even with cheap sheet masks, as the deep penetration of moisture goes a long way to keeping skin looking “normalish.” I feel like after a few months the flaking has gone down a lot (and the burning!) but have been warned that it never really stops, so some of the changes to your routine may become permanent, but the changes I’m seeing are SO, SO worth it! My pores look so tiny and my PIH is fading crazy fast!

    Liked by 1 person

    • V. Rex says:

      I’m SO ready for my pores to be smaller!! I try not to expect too much, because oil cleansing and BHA use were no match for my pores, but tretinoin is definitely the most potent thing I’ve used on my face so I have hope!! Glad to hear things calm down eventually too.

      Like

  5. Plain Jane says:

    I just upped my tretinoin to .02% earlier in the month and boy am I experiencing flakes! I’m raining dandruff from my face 😦

    I’ve been using the Cure peeling gel to combat flakes. My skin personally hates konac sponges, but I don’t know why the peeling gel has been tremendously helpful even though I have to use it often or else the flakes come back haha

    Liked by 1 person

  6. css says:

    Your post was very informative! I am about to start using curology and I am so excited. Just a question, do you use the facemask after your curology treatment or at a whole different day?

    Liked by 1 person

    • V. Rex says:

      Omg it IS exciting!!! Because my skin is super prone to flaking, I will do one of two things with masks. Either, I will mask first, wait for my skin to dry, then apply Curology or, if my skin is feeling dry or dehydrated, I’ll apply Curology, wait 20 to 30 mins, and then use a mask. Hope this helps!

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s