When to Add Prescription Products to Your Skin-Care Routine
Why Add a Prescription Skin-Care Product?
There are many reasons why you may want, or need, to add topical prescription products to your regular skin-care routine. For example, if you have stubborn acne, prescription-only medications, such as topical antibiotics like BenzaClin or topical retinoids like Differin or Retin-A, can make a world of difference.
For wrinkles, Renova, the prescription-strength form of retinol, can be extremely beneficial. Topical medications for rosacea, including MetroCream, Atralin, and Finacea; cortisone creams for eczema; and medications such as Calicopotriene for treating psoriasis are often the only way to keep these irksome skin disorders under control.
Using Prescription Products with Your Skin-Care Routine
There is a great deal of research about how topical prescription products work to help different skin disorders and about their potential side effects, but there is surprisingly little information on how you are supposed to incorporate topical prescription products into your daily skin-care routine. After all, you still must clean your face, use a skin-healing toner, wear an effective sunscreen, apply moisturizers or serums appropriate for your skin type, and, for most skin types, exfoliate … but how are you supposed to do that and apply prescription products? How does it all work together? Can it work together?
Sadly, there isn’t any agreement among dermatologists as to what non-prescription skin-care products you’re supposed to use with your topical prescription-only medications or about the order in which to apply them. Even more shocking is the lack of consensus or suggestions about how to avoid some of the most typical reactions prescription medications can cause, such as redness, irritation, dryness, and inflammation.
To help you navigate the complicated world of using topical medications and still take the best possible care of your skin, the Paula's Choice Research Team pored through massive amounts of research to uncover tips on how you can assemble the most ideal skin-care routine for your skin type and concerns—and how to incorporate topical prescription medications into that routine.
What to Use, What Not to Use, and When to Apply Skin Care & Your Prescription
Below you will find a step-by-step guide on how to maintain your regular skin-care routine and incorporate your prescription product. The six steps are meant as helpful guidelines; if this information conflicts with your physician or pharmacist’s advice, please consult them before making any changes.
Step 1: Use only gentle water-soluble cleansers. Regardless of the medications you apply, everyone first needs to use a gentle water-soluble cleanser appropriate for their skin type. If the cleanser isn't gentle, it will cause irritation and dryness, which will only be exacerbated by the medication(s) you apply afterward. Remember—gentle cleansers, not bar soaps or cleansers in bar form.
Do not use abrasive scrubs with any topical prescription medications. Most scrub particles create tiny micro-tears on the skin's surface, which will aggravate the skin condition you have and increase the irritation from the medications you are applying. If you want a bit of extra cleansing, use a washcloth with your gentle water-soluble cleanser.
Caution: Think twice before using a prescription topical product and a cleansing brush like the Clarisonic. This combination can prove too irritating, especially if you're also using products like exfoliants, skin lighteners, and serums with retinol.
Step 2: Do use a great toner. Most toners are loaded with irritating plant extracts such as witch hazel along with alcohol and fragrance. In one word: Ouch! Do not use any product that contains irritating ingredients, especially not toners with those types of ingredients. On the other hand, toners loaded with beneficial skin-repairing ingredients can create the optimal environment on your skin for the medication(s) you will be applying.
Step 3: Use an AHA or BHA exfoliant. Most people's skin reaps incredible benefits from exfoliation. There is an enormous amount of research showing that sun damage, breakouts, wrinkles, blackheads, and skin texture improve significantly if you use a well-formulated BHA (salicylic acid) or AHA (glycolic or lactic acids) exfoliant. This is true even if used in combination with most topical prescription medications.
There is a risk of irritation from exfoliants, so you need to start slowly, initially applying a lower concentration exfoliant once (morning or evening) every three days to see how your skin does, and then increasing the frequency and/or concentration based on how your skin responds. If you experience irritation, and it continues, cut back on the frequency, reduce the concentration, or stop altogether.
In almost every case, you can apply your exfoliant prior to your prescription medication.
Step 4: Apply a serum filled with antioxidants and other beneficial ingredients. Young skin and skin that hasn't suffered from sun damage is stocked with a vast array of skin-protecting substances that promote healing, fight aging, diminish redness, resist forming brown and red marks, and create a smoother, softer surface. Even if your skin has been damaged through years of neglect or exposure, the more ingredients of this kind that you give your skin, the better it will be. Plus, these kinds of ingredients are compatible with almost any topical prescription product.
Note: Many people ask us about using an over-the-counter retinol product, such as a serum, and a prescription retinoid like Renova. It is fine to use both; generally, you should apply the over-the-counter retinol product first, followed by your prescription retinoid. Do you need both? No, but some people see greater benefit from the combination, or they simply like to alternate a stronger and weaker retinol product. As with any active ingredient, pay attention to how your skin responds and adjust your routine accordingly. Doubling up on retinol products is too much for some people's skin—more isn't necessarily better, and you never want to tip the scale in favor of irritation.
Step 5: Apply your prescription product. This is the best place in your routine to apply your prescription product, especially if it has a cream or lotion texture. If it's a liquid, apply it after step 3.
Step 6—DAYTIME: Never forget to apply a moisturizing, broad-spectrum sunscreen rated SPF 25 or greater every day. Protecting your skin from the sun not only prevents signs of aging, but also helps repair the skin and helps heal many skin disorders by reducing the underlying inflammation. So, unless your physician says otherwise (which may be the case for those with severe psoriasis), always apply sunscreen. Regular sunscreen use also protects the skin's immune cells from damage that can lead to a host of health problems down the road.
Step 6—NIGHTTIME: Apply a skin-repairing moisturizer and/or serum every night. As mentioned above, when skin is young and healthy it is stocked with a vast array of skin- protecting substances that promote healing, fight aging, and so on. Moisturizers and serums work effectively with almost any topical prescription; choose one or both based on your skin type and personal preferences, and apply it around the eyes, too. You don't need a separate eye cream.
Combining Specialty Skin Treatments with Prescription Products
Skin-lightening products: You can use skin lighteners with prescription products, depending on the formula of the skin lightener. Generally, hydroquinone-based skin lighteners are a bit too much for problem skin, even without a prescription medication. If "problem skin" describes you, it's preferable to consider skin-lightening products that contain vitamin C, azelaic acid, ascorbyl glucosamine, niacinamide, or forms of licorice extract such as glycyrrhetinic acid.
If you're using a prescription product that contains hydroquinone, you do not need to combine it with an over-the-counter hydroquinone product; however, you can apply the prescription-strength hydroquinone product and follow with a skin-lightening product that contains other active ingredients, such as vitamin C. Doubling up on hydroquinone increases the risk of irritation.
Scar-reducing treatments: There should not be a problem using any topical prescription medication with most scar treatments we've seen. The best in this category contain anti-inflammatory ingredients along with other skin-repairing ingredients, which can work great, regardless of the skin disorder. If the prescription product is being applied over the area of skin that has a scar you're treating, apply the prescription first, and follow with the scar treatment.
Retinol-based moisturizers: Retinol, the name for the entire vitamin A molecule, is well-known for its youth-enhancing properties. Retinol in non-prescription skin-care products is similar to the retinoids (like tretinoin) that are present in prescription products. Some people like to use both over-the-counter and prescription retinol products, while others find it best to use one or the other because using both proves irritating. Which way to go? Generally, if you are using a prescription form of vitamin A, then you won't gain much additional benefit by also using serums or moisturizers that contain retinol, especially those with concentrations greater than 0.5%, as this combination increases the chance of side effects. However, using skin-care products with low amounts (0.1% or less) of retinol along with a prescription form of vitamin A can be fine, and you may see enhanced benefits without redness or flaking.
Over-the-counter acne medications that contain benzoyl peroxide: The question of whether or not to use an over-the-counter benzoyl peroxide product with prescription medications is best answered by your physician. Generally, this is considered fine to do; there's no definitive research proving that this combination renders either the benzoyl peroxide or the retinoid ineffective.
Note: Don't think you must use a benzoyl peroxide product every day to see results. For some, applying benzoyl peroxide only a few days a week is plenty to reap great benefits, and doing so further enhances the ability to incorporate topical medications into your skin-care routine.
How to Keep Your Skin from Reacting Badly
Even with the best skin-care routines, adding prescription medications might cause your skin to react negatively; that is, redness, flaking, dryness, increased sensitivity, and breakouts. We cannot stress strongly enough the need to use only gentle skin-care products that contain no irritating ingredients, as this can reduce the possibility and/or severity of a negative reaction. Adding products that contain irritating ingredients to the mix dramatically increases the risk of your skin reacting badly when you add a prescription medication.
Use only products that are best for your skin type. If a prescription medication is causing dryness, you don't have to change every product you are using; in fact, doing so can cause an entirely different set of problems. You may merely need to use a slightly more emollient moisturizer or a different serum, either for daytime or, even easier, at night.
You must avoid hot water, scrubs, microdermabrasion, saunas, hot tubs, highly fragranced products, and anything that can increase irritation.
Be sure the sunscreen you're using contains only titanium dioxide and zinc oxide as active ingredients. Synthetic sunscreens work great, but for some they present a risk of a sensitized reaction, whereas titanium dioxide and zinc oxide have minimal risk of causing irritation. This can be especially helpful as your skin acclimates to a prescription retinoid product, and is a must if you're treating rosacea.
Simplifying your skin-care routine is another option. Paring down to the basics, which would include a cleanser, your prescription medication, sunscreen during the day, and a nighttime moisturizer or serum before going to bed, may be the best way to see how your skin does. You can then add one product at a time, such as an exfoliant, skin-lightening product, or other targeted treatment, to see how your skin tolerates each when combined with the prescription product.
A lot of experts suggest you mix your topical prescription medication with your moisturizer to minimize the risk of dryness or irritation. That's an option, but it's unlikely to make a big difference; applying your prescription product first and then applying your moisturizer or serum essentially does the same thing. (However, with regard to mixing products, you should not mix any skin-care product with a sunscreen, because diluting a sunscreen with a serum, moisturizer, or prescription product decreases the sunscreen's effectiveness.) Sunscreen should always be the last step in your skin-care routine, regardless of the prescription product.
You can always talk to your physician about cutting back on how frequently you apply the topical medication you've been prescribed, but if you cut back too much you won't get any benefit. If you are using your prescription product less than three times per week, and it still causes irritation, you should talk with your physician about using a different medication or trying a lower dose, which your skin may tolerate with daily or every-other-day application.
In our research and personal experience, we’ve noted that there are doctors who recommend prescription and over-the-counter products and usage steps that don’t seem to make sense, at least to us to and likely not to you, either—we hear from a lot of people who are dissatisfied with their doctors’ advice. Despite these issues, however, you must follow your doctor’s recommendations; either that or get a second opinion from another medical doctor or pharmacist. For simple issues, such as applying a product during the day versus at night, it’s probably not a big deal, but when in doubt, getting a second medical opinion is the path to follow.
Skin Care Isn't Easy
Taking great care of your skin in this millennium is rocket science because what we know about skin today is far more comprehensive and far complex than ever before. Don't worry, though: Once you get the hang of a great routine, it becomes much easier.
The mysteries of how to keep skin healthy, problem-free, and young are becoming clearer every day. All the steps and tricks we've listed here will help you take the best possible care of your skin, and avert problems along the way. Of course, if you have questions, we’re here for you, but this pretty much sums up everything we know about how to incorporate the use of prescription topical products into your regular skin-care routine!