Is there a right way to use Stieva A?

Stieva-A is a tradename for Retin-A, aka Tretinoin. A simple google search of any of these words "Stieva A", "Retin-A" or "Tretinoin" will lead to various articles on how this chemical treats cystic acne.

Cystic acne occurs due to clogged pore which leads to build up of oil/sebum within the pore which gets inflamed with bacteria. See diagram on the right.

How Stieva-A works is that it opens up clogged pores and increases the production of skin cells in the outermost layer of the skin (epidermis). But it does not remove acne. All it does is to make the "already inflamed" skin surfaces up and reduce changes of other pores being clogged.

There are two downsides to Stieva-A:

1. It stimulates both the healthy and inflamed skin which can cause the skin near the cysts to generate more sebaceous glands that produces oily sebum. This results in new ports clogging as old cysts open. 
2. It thins the skin before thickening the skin. This results in the skin more prone to sunburn and sensitive. 

I am trying to make sense to the creams which Niks Maple Clinic provided and here are some of the synergistic relationships.

1. Glycolic Acid + Stieva-A: Glycolic acid acts as a skin peel which increases the absorption of Stieva A into the skin
2. Clindamycin (Antibiotics) + Stieva-A: Using antibiotic will get rid of 10-20% more pimples by killing acne bacteria as they are being released from deep pores

In the past, I screwed up a lot by being really greedy with using Stieva-A, thinking that applying a thick layer, twice daily and 7 days a week will increase the changes to speed up recovery. However, I was so wrong. My skin got really dry, flaky and burning sensation.

Understanding the mechanism of how Stieva-A helps to understand the best way to use it. Since Stieva-A does not cure acne and simply opens up clogged pores, with possibility that leads to generation of more sebaceous glands, it is important to apply on clean skin and with topical antibiotics to reduce chances of healthy skin being inflammed. It is not advisable to apply too thick a layer as the skin takes time to unclog the pores and stimulate new cells to grow. A very small amount and thin layer will do. The reason why it is recommended to be applied at night is that it is chemically unstable and degrades when exposed to sunlight, resulting in ineffectiveness.

The human skin has 4 key physiological loss-prevention processes to moisturize the skin.

1. Sebum production - Sebum has high triglyceride content which acts as a emollient that reduces Transepidermal Water Loss (TEWL) 
2. Natural Moisturizing Factor (NMF) production - NMF has high free amino acid content which acts as humectant to hold on or draws moisture. The amino acids are produced when the proteins in the skin's stratum corneum are broken down. If NMF occurs, it means that your skin is already in quite a bad state.
3. Desquamation - Natural skin shedding which happens when the skin's stratum corneum is well hydrated. However abnormal desquamation is not good either.
4. Formation of intercellular lipids as skin barriers - Intercellular lipids have high ceramides which prevent TEWL and loss of NMF. 

I found this diagram which very well depicts the regeneration of new skin. It takes about a month for cells to multiply and make their way through the various layers of the skin to the epidermis layer. During the process, dead skin cells that are awaiting to be exfoliated can be prone to breakouts if it clogs the skin, along with sebum and bacteria. Besides fighting excessive "oiliness", it is important to keep dead skin cells from collecting on the skin and keep the underlying skin cells moisturized for natural desquamation.

Besides advising "less is more" for Stieva-A, the last advice I have is to be patient. It takes time for skin to go back to healthy state. Drink more water and be diligent in skin care routine.