[Routine Help] Hive mind: What should I add next?

Hello glorious humans! I need your advice!

I'm 49, have Erythematotelangiectatic Rosacea (Type 1), KP, am prone to dermatitis, am in peri, and I'm using Rx actives as well as OTC stuff.

I'd love a review of my routine, and recommendation on which of the paired actives I should add next. Or should I stay with the current routine? I get antsy not changing things around, but that might be the way to go...

Because my skin is so reactive, I'm not able to use blended products (except for those from Holy Snail, which I hope revives some day, pretty please???).

Major culprits for me are soy, wheat (Azelaic Acid, anyone? grrr), Xanthan, any kind of paraben, any kind of gum, plus dextrin, dextrase, dextrose, and maltodextrin. All of these make my skin blister (acute contact dermatitis).

I also avoid any kind of tocopherol as it always gives me cystic acne. My derm says that's probably because the tocopherols are cut with soy oil in the manufacturing process.

My AM routine:

  • 2% Salicylic acid, let sit for 2 minutes while I brush my teeth.
  • 60s wash with Vista Prep (contact lens soap that is clean rinsing).
  • 4 drops 100% Hyaluronic Acid to face, neck, and decolletage that has been blotted 3x.
  • 2 drops 100% Matrixyl 3000, spread over face, neck, decolletage.
  • 8 drops of Cold-pressed Rosehip Seed Oil -Ph balancing, fights redness & melasma while hydrating & healing the moisture barrier. It also regulates sebum, and provides everything (except C) that skin needs to heal.
    • I add *either*:
      • 2 drops of 5% Pycnogenol: Anti-oxidant, anti-redness, deeply soothing, anti-aging, anti-melasma. Pyc transforms used Vitamin C that has oxidized into useable Vitamin C. Turns my Rosacea flares off 10 minutes after application.
      • 2 drops of 12% Ascorbyl Glucoside: Stable Vitamin C that becomes active in the skin, does not have the burn or the combative properties of l-ascorbic acid. Pro-collagen, anti-melasma, anti-oxidant.
    • This combo is applied to my face, neck, and arms (for KP). Because the serums have a glycerine base, they combine with the rosehip seed oil nicely. RSO is low in Vitamin C, but has everything else the skin needs to heal, so this combo has been life saving for me.
  • Vanicream (in the tub- so the cream version, not the lotion). 1-3 layers patted on, depending on how fast my skin absorbs it.
  • Vaseline around eyes, mouth, apples of cheeks (where my skin gets dry, basically).
  • Breakfast, then add Sunblock & pressed powder.
  • Also, oral supplements: 600mg HA w/ 32 oz water in 1st half of day, 30g hydrolized collagen, 1000mg Polypodium Leucotomos Extract (protects against sun damage), and the usuals: C,D3,K,B12,Selenium, Iron, etc.

PM routine:

  • Splash with water, pat 3x.
  • 1 drop 100% HA, spread over face, because otherwise my skin screams at me for letting it dry out.
  • Tretinoin .05, let sit for 60-90 minutes, depending on how long before bed I started. *I can't find any solid info on how long Tret takes to absorb- I've seen Derms say 10 minutes, 20, 30, even 60. If anyone has a good data source, I'd appreciate the link! I use this for anti-aging, as well as for it's ability to decrease immune reactions in teh skin (Rosacea, KP, dermatitis).
  • 60s wash with Vista Prep.
  • 4 drops 100% Hyaluronic Acid to face, neck, and decolletage that has been blotted 3x.
  • 2 drops 100% Matrixyl 3000, spread over face, neck, decolletage.
  • 8 drops of Cold-pressed Rosehip Seed Oil -Ph balancing, fights redness & melasma while hydrating & healing the moisture barrier.
    • 2 drops 22% Nicinamide + 2% Zinc added to RSO.
  • Estradiol topical, entire face, throat, and back of my hands.
  • Vanicream.
  • Vaseline everywhere.

As you can see, this is focused on hydrating, calming, healing, and preventing redness & melasma. My hydrating routine is sufficient that I was able to start Tret .05 daily with no problems, just a little purging, and I've peeled lightly at the tip of my nose on 2 occasions.

I'm thinking of adding the following pairs of actives, and would love advice as to which to add first. Obviously anything would be added slowly and carefully! Here are the pairings I'm thinking about:

  • Beta-Glucan & Glycolic Acid 7%: BG is a hydrating anti-inflammatory anti-oxidant that heals the moisture barrier, and is possibly more effective than HA at hydrating skin. Like Tretinoin, BG moderates skin's reactivity. I would like to add GA 7% back in- I removed it to start Tret. I would swap GA 7% for 1 of the AM 2% Salicylic Acids, skip Tret that night, and work up to using GA 2x per week, then work up to using Tret in the evening routine on those 2 days. Eventually, I would like to build up to GA 12%, as it can remodel scars. I have some (moderate to minor) icepick scars on my chin, nose, and forehead.
  • Copper Peptides & Bentonite Clay mask: CP is pro-collagen & pro-elastin, an anti-inflammatory that remodels scarring, and can help hide telangiectasia from Rosacea, one of my biggest cosmetic issues. The BC is the best solution I've found for them. I had to stop the BC as it was too drying while starting Tret, but I think I could add it back in now. I might add the BG as well to this pairing.
  • ECGC & Red Light Therapy. I am mostly considering adding this in as both are very gentle, and it would give me something to mess with while waiting to add in the other active pairs. The ECGC is anti-oxidant, anti-aging, and regulates sebum. The Red Light unit I purchased is recommended for redness, and tightening skin (which is not a huge issue for me yet).

I keep going in circles, so I really appreciate your thoughts!

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u/Beginning_Butterfly2 — 8 hours ago

My Derm didn't know. Hoping the hive mind has an answer? Tretinoin buffering questions!

Thanks, everyone, for taking the time to read this. Context: I've just started Tretinoin .05, and my skin loves it. I did one week of every other day, then transitioned to daily use 2 weeks ago. I've only had slight peeling on the tip of my nose and my forehead, and the light purging (2-3 clogged pores pushing debris out per day) on my forehead, nose, chin, and occasionally, at my jawline.

I have very sensitive, highly reactive skin, and have been working on my moisture barrier for years, as well as weeding out dietary & skincare triggers for my rosacea, KP, eczema, and HS. I think that this is part of why I've had such a smooth onramp with Tret.

But I have questions, and can't find anything on the NIH database that is relevant, and my Derm said he doesn't know. Hoping that you'll have answers for me.

  1. I use 100% Hyaluronic Acid on very wet skin, then 100% Matrixyl 3000, 8 drops of cold-pressed Rosehip Seed Oil with 2 drops of 22% Niacinamide + 2% Zinc, let it dry down for 30 minutes, and then apply Tretinoin.

Presumably this is buffering my skin from the Tret irritation. But is it preventing Tret from reaching full efficacy, as well?

  1. HA supposedly facilitates deeper absorption of actives. Does it also allow for deeper absorption of Tretinoin? Does the water HA absorbs block the Tret? Or facilitate the Tret?

  2. Should I not be using the Matrixyl 3000 before the Tret? Could that be blocking the Tretinoin cream?

  3. Is the Rosehip Seed Oil plus 2 drops of 22%Niacinamide+2%Zinc a barrier to Tretinoin cream?

My Dermatologist said that if it's working, I should keep doing it, so I am. I'm purging, so the Tret is reaching my skin to some degree. But having such reactive skin means that it feels odd to use something most have trouble adjusting to, and having my skin be completely unruffled.

I'd like to understand if I'm blocking benefits by putting so much effort into protecting my moisture barrier. I could ease back at night, if that would be beneficial? Or am I receiving full benefits, just without the irritation?

In case it's relevant, I'm 49, in peri, have Ehlers-Danlos, Rosacea, KP, HS, and eczema. My daily routine is:

Evening: I wash for 60s (gentle massage to exfoliate) with Vista Prep, a clean rinsing soap intended to for contact wearers to use before putting in contacts. I use the HA, Matrixyl 3k, RSO&NC+Z, wait 30 minutes, apply Tret, top with topical Estradiol, then pat on Vanicream. 20-30 minutes later I add more Vanicream, and top that with Vaseline anywhere that feels tight/stingy/dry.

Morning: I splash with water for 30 seconds, then apply HA, Ascobyl Glucoside,Tocopheryl Acetate & ECGC, RSO+NC+Z, and Vanicream. I eat breakfast, then apply Glysolid, 50 SPF Sunblock, and then a SPF 30 sunblock setting powder.

Mid-day: Splash with water, reapply RSO &Vanicream (and Vaseline if dry).

I'd also be happy to hear if you think I'm missing something that should be included, or using something that seems superfluous. Thank you in advance for your help with this!

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u/Beginning_Butterfly2 — 8 days ago

Question for long-time Tret users: Is there any benefit to maintaining daily use after the 12 month mark? Derm says no, 3x per week is sufficient, but I'd like to hear your experiences.

Do you use Tret 5x per week, or 7 days? Did you drop down to 3x per week? What changes did you see? Did you go back up, or hold steady?

What are your thoughts on swapping in other actives like Estradiol/Estriol or Glycolic acid? Do you feel a need for them after being on Tret for over a year, or no?

Do you have any favorite skin care ingredients that you cannot live without?

Looking forward to hearing your experiences!

In case it's of interest to anyone, my current (very boring 😂) routine is:

Daily PM:

  1. Vista Prep (Clean rinsing, non-detergent, fragrance free cleanser)
  2. 100% Hyaluronic Acid (Love this stuff)
  3. 22% Niacinamide + 2% Zinc
  4. Matrixyl 3000
  5. Cold-pressed Rosehip seed oil patted over everything
  6. Dinner
  7. Tretinoin .05%
  8. Estradiol topical .01%
  9. Vanicream (tub) patted over everything
  10. Vaseline layered on dry spots
  11. Bedtime: Fresh pillowcase on pillow (Ridiculously helpful for my seasonal allergies, despite my hepa air filters).

Daily AM:

  1. Vista Prep
  2. 100% Hyaluronic Acid
  3. 22% Niacinamide + 2% Zinc
  4. Vitamin C serum with Ginseng
  5. 50 spf Sunblock
  6. Breakfast
  7. Glysolid (better base for powder than Vaseline, dries matte)
  8. 30 spf pressed powder, eyeshadow, etc.

I'm fairly new to Tret, and don't yet have a sense of whether or not I'll want to add Glycolic acid or Azelaic acid once I've adjusted to daily use.

Otherwise, I'm pretty happy with the hydration and calmness this routine provides. It's gotten my skin through starting Tret with minimal disruption, despite my rosacea, eczema, and tendency towards dermatitis whenever my moisture barrier is challenged.

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u/Beginning_Butterfly2 — 15 days ago