Dr. Dray Warns Facial Retinoids Trigger Neck Barrier Breakdown

Dr Dray

Neck skin contains fewer oil glands than the face, requiring users to reduce retinoid concentration and application frequency to prevent chronic dermatitis.

AI-assisted summary of Can You Use Retinoids on Your Neck? — original source. Check the original for full context.

Source published: 2026-09-08

Key ideas

The neck is significantly more prone to retinoid dermatitis than facial skin due to a thinner epidermis and fewer sebaceous glands, requiring patients to introduce retinoids at a maximum frequency of once weekly. (0:34)
Clinical trial evidence demonstrates that topical 0.025% tretinoin improves hyperpigmentation in acanthosis nigricans as effectively as 0.05% formulations, while outperforming 10% urea and 15% TCA peels. (4:58)
Topical retinoids demonstrate inconsistent results for poikiloderma of Civatte and cannot reverse cutis rhomboidalis nuchae, leaving in-office energy devices like IPL and vascular lasers as the preferred corrective options. (7:34)
Skincare users can rationally practice site-specific retinoid pairing—such as prescription tretinoin on the face and gentler cosmetic retinaldehyde on the neck—provided multiple vitamin A products are not layered over the same anatomical area. (11:07)

Detailed notes

## Background Published on YouTube on September 8, 2026, by dermatologist Dr Dray, this video explores whether and how topical retinoids can be safely utilized on the neck. According to the page description, Dr. Dray breaks down why neck skin is particularly sensitive compared to facial skin, discusses clinical research surrounding acanthosis nigricans and sun-induced conditions like poikiloderma of Civatte, and explains how to introduce retinoids without inducing severe barrier irritation.

## TL;DR Dr. Dray explains that neck skin is uniquely vulnerable to retinoid dermatitis due to its thin epidermis, sparse sebaceous glands, and constant mechanical friction. While topical tretinoin demonstrates solid clinical efficacy for acanthosis nigricans and mild photoaging, it offers limited benefit for poikiloderma of Civatte and cannot erase deep structural folds like cutis rhomboidalis nuchae. Viewers seeking to treat their neck are advised to start conservatively with once-weekly applications, choose lower-strength formulations or gentle cosmetic retinaldehydes, and avoid stacking products on the same area. Emphasizing daily broad-spectrum sunscreen, rich hydration, and avoiding direct fragrance application on the neck often delivers safer, more reliable improvements than aggressive retinoid regimens.

## Atmosphere & style The presentation is clinical, measured, and refreshingly pragmatic, steering viewers away from aggressive anti-aging fads in favor of gentle barrier preservation. Dr. Dray balances rigorous medical citations with candid, self-deprecating personal anecdotes, admitting that even after a decade of daily facial retinoid use, she remains a 'wimp' whose own neck experiments frequently backfire. The pacing feels grounded and reassuring, providing viewers with actionable permission to simplify their routines and respect the limits of their skin.

## Bulletin - [00:34](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=34s) The neck is significantly more prone to retinoid dermatitis than facial skin due to a thinner epidermis and fewer sebaceous glands, requiring patients to introduce retinoids at a maximum frequency of once weekly. - [04:58](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=298s) Clinical trial evidence demonstrates that topical 0.025% tretinoin improves hyperpigmentation in acanthosis nigricans as effectively as 0.05% formulations, while outperforming 10% urea and 15% TCA peels. - [07:34](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=454s) Topical retinoids demonstrate inconsistent results for poikiloderma of Civatte and cannot reverse cutis rhomboidalis nuchae, leaving in-office energy devices like IPL and vascular lasers as the preferred corrective options. - [11:07](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=667s) Skincare users can rationally practice site-specific retinoid pairing—such as prescription tretinoin on the face and gentler cosmetic retinaldehyde on the neck—provided multiple vitamin A products are not layered over the same anatomical area.

## Key takeaways - [00:34](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=34s) Human skin anatomy varies considerably across anatomical sites, and the neck's thin epidermis and scarce sebaceous glands make it exceptionally vulnerable to retinoid dermatitis. - [01:47](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=107s) Retinoids should be introduced to the neck no more than once weekly initially, as delayed irritation can deceive patients into accelerating application frequency too quickly. - [01:47](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=107s) Lower retinoid concentrations achieve identical biological endpoints to higher strengths over time while substantially mitigating the risk of skin barrier breakdown. - [03:33](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=213s) Acanthosis nigricans presents as dark, velvety plaques caused by hyperinsulinemia-induced keratinocyte proliferation, requiring systemic metabolic evaluation rather than aggressive scrubbing. - [04:58](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=298s) Clinical trials show tretinoin 0.025% is as effective as tretinoin 0.05% for clearing acanthosis nigricans pigmentation, and matches adapalene 0.1% and 1550 nm fractional lasers. - [04:58](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=298s) Treatment-limiting barrier irritation represents the primary reason patients fail or discontinue topical retinoid therapy for acanthosis nigricans. - [07:34](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=454s) Poikiloderma of Civatte presents with skin atrophy, telangiectasias, and dyspigmentation, but exhibits limited and inconsistent responses to topical tretinoin. - [07:34](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=454s) Energy-based treatments such as IPL and targeted vascular lasers offer superior outcomes for poikiloderma of Civatte by clearing pigment and telangiectasias without barrier injury. - [09:22](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=562s) Cutis rhomboidalis nuchae manifests as deep geometric creases on the back of the neck from chronic UV exposure and serves as a diagnostic sign for concurrent skin cancers elsewhere. - [09:35](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=575s) While topical retinoids and alpha hydroxy acids stimulate dermal collagen, they cannot erase established deep structural folds resulting from decades of ultraviolet damage. - [11:07](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=667s) Long-term tolerance of high-strength retinoids on the face does not ensure neck tolerance, making gentle cosmetic retinaldehyde or retinol serums a practical neck alternative. - [11:07](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=667s) Layering multiple vitamin A products onto the same facial area adds unnecessary irritation, but deploying different formulations across separate anatomical sites is safe and practical. - [13:24](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=804s) Adequate moisturization normalizes epidermal desquamation and plumps fine surface lines on the neck, delivering visible cosmetic benefits without irritation. - [13:24](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=804s) Spraying perfume directly on the neck can cause photo contact dermatitis and chronic dyspigmentation due to UV-activated fragrance sensitizers. - [13:24](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=804s) Consistent daily application of broad-spectrum sunscreen across both the anterior and posterior neck is essential to prevent cumulative elastosis and poikiloderma.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=0s) Why Is the Neck So Sensitive to Retinoids?

Many skincare enthusiasts using cosmetic retinol, retinaldehyde, over-the-counter adapalene, or prescription retinoids like tretinoin, trifarotene, and tazarotene for acne or visible skin aging inevitably wonder whether they should extend those treatments down past the jawline. However, common advice—including Dr. Dray's own—frequently warns people away from doing so. The central problem is that human skin is not a "uniform sheet from head to toe"; its anatomy changes drastically depending on the anatomical region. While the thick stratum corneum on the soles of the feet can endure aggressive exfoliation, areas like the eyelids, upper chest, and neck are exceptionally thin and delicate.

The neck is particularly susceptible to retinoid dermatitis because, beyond its thin epidermis, it houses significantly fewer sebaceous (oil) glands than facial skin. Because retinoids are notoriously irritating when first introduced into a skincare regimen, applying them to oil-depleted neck skin often triggers pronounced barrier damage. Dr. Dray shares her personal experience as a cautionary tale: despite having used topical retinoids on her face daily for ten years, whenever she experiments with bringing them down onto her neck, it almost always "backfires into a dry, itchy, flaky mess" that she cannot persevere through.

[01:47](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=107s) How to Introduce a Retinoid to the Neck Safely

For those already using a facial retinoid—such as tretinoin 0.05%—who still wish to experiment with applying it to their neck, an extremely conservative approach to application frequency is critical. Even if a patient tolerates daily application on the face with zero issues, they should never jump into daily application on the neck. Instead, the process must begin with applying the product just once a week to test tolerance, slowly stepping up over several weeks to twice a week, and eventually three times a week at most.

```mermaid flowchart LR accTitle: Retinoid Neck Introduction Protocol accDescr: Step-by-step frequency progression for applying retinoids to neck skin. subgraph Progression["Introduction Schedule"] A["Week 1-2:<br/>Once Weekly"] --> B["Week 3-4:<br/>Twice Weekly"] B --> C["Maintenance:<br/>Max 3x Weekly"] end subgraph Strategy["Formulation Strategy"] D["Lower Retinoid Concentration<br/>(e.g., 0.025% vs 0.05%)"] end ```

Patience over multiple weeks is required because retinoid side effects tend to sneak up insidiously on delicate neck tissue rather than showing up on day one or two. This delayed onset frequently tricks people into becoming "overconfident, overzealous very quickly" with products they assumed were gentle, only to end up intensely uncomfortable and "clawing at your neck." Furthermore, patients should consider dropping down to a lower percentage formulation specifically for the neck. A lower concentration is not ineffective—it accomplishes the exact same biological endpoint, just over a slightly longer timeframe, while significantly sparing the skin barrier from unnecessary irritation.

[03:33](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=213s) Acanthosis Nigricans and What the Clinical Trials Show

Topical retinoids can offer genuine therapeutic benefits on the neck, with one of the most thoroughly researched indications being acanthosis nigricans. This condition presents as dark, velvety, thickened plaques that commonly develop on the neck, axillae (armpits), and sides of the face. Sufferers frequently mistake this presentation for poor hygiene or post-inflammatory hyperpigmentation, scrubbing their necks under the impression that they simply "forgotten to wash" or are dirty. In reality, the presentation has nothing to do with dirt or melanin pooling; it is true epidermal thickening (acanthosis) driven by systemic hyperinsulinemia. High circulating insulin stimulates epidermal keratinocytes to hyperproliferate. Dr. Dray stresses that addressing the metabolic root cause must take immediate priority over any topical cream, as uncontrolled insulin resistance can rapidly advance to type 2 diabetes and major systemic complications.

While managing underlying insulin resistance stops acanthosis nigricans from progressing, existing velvety plaques often linger stubbornly. Fortunately, topical retinoids have demonstrated clear clinical efficacy:

* **Systematic Review Findings**: A systematic review evaluating six randomized controlled trials (RCTs) covering approximately 172 patients confirmed that topical tretinoin significantly improves acanthosis nigricans discoloration. * **Concentration Comparisons**: Tretinoin 0.025% proved equally as effective as tretinoin 0.05% at clearing discoloration. * **Active Comparators**: Tretinoin 0.025% outperformed both 10% topical urea and 15% trichloroacetic acid (TCA) chemical peels, and yielded results comparable to 0.1% over-the-counter adapalene. * **Laser Interventions**: When compared against a 1550 nm fractional erbium laser, the laser achieved superior smoothing of skin texture, but 0.05% tretinoin delivered an equivalent reduction in dark pigmentation. * **Chemical Peels**: A separate RCT demonstrated that 0.05% tretinoin produced superior clinical responses compared to high-strength, in-office 70% glycolic acid peels.

Despite this robust evidence, Dr. Dray cautions against self-diagnosing and haphazardly treating darkened neck skin with retinoids. Neck hyperpigmentation can stem from other etiologies, such as post-inflammatory hyperpigmentation secondary to contact dermatitis or eczema, where applying a retinoid would worsen the underlying inflammation. Furthermore, severe retinoid-induced skin irritation remains the primary reason patients fail or discontinue treatment for acanthosis nigricans.

[07:34](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=454s) Poikiloderma of Civatte and In-Office Alternatives

Another frequent source of neck discoloration and textural alteration is poikiloderma of Civatte, an acquired condition stemming from cumulative, chronic ultraviolet radiation damage. It is defined clinically by a classic triad of cutaneous findings: 1. Epidermal and dermal atrophy (thinning of the skin) 2. Telangiectasias (prominently dilated superficial blood vessels) 3. Dyspigmentation (mottled, irregular hyper- and hypopigmentation)

Although topical tretinoin has extensive clinical literature supporting its use for generalized facial photoaging, the evidence specifically supporting retinoids for poikiloderma of Civatte is limited and largely anecdotal. Systematic literature reviews report highly erratic and inconsistent results, showing at best only modest improvements in pigment while leaving the vascular telangiectasias entirely unaffected.

For patients dealing with poikiloderma of Civatte, in-office energy-based therapies provide far more predictable outcomes. Vascular- and pigment-targeting technologies, such as intense pulsed light (IPL) and targeted vascular lasers, directly address both the erythema/telangiectasias and the melanin deposits without inducing chronic barrier irritation. Because neck skin is already vulnerable, trying to treat poikiloderma with aggressive topical retinoids frequently causes intense inflammation. While retinoids do not alter the skin's minimal erythema dose (MED) to cause direct phototoxicity, early retinoid dermatitis heightens general skin sensitivity, making strict daily sun protection on the neck mandatory.

[09:22](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=562s) Chronic Photoaging: Cutis Rhomboidalis Nuchae

Chronic, long-term ultraviolet exposure can also lead to a distinct structural condition on the neck known as cutis rhomboidalis nuchae. This presentation is classically identified in older adult Caucasian men who have accumulated substantial histories of occupational or recreational outdoor sun exposure, resulting in deeply furrowed, leathery skin across the posterior neck.

[09:35](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=575s) Cutis Rhomboidalis Nuchae and Chronic Sun Damage

Cutis rhomboidalis nuchae appears on individuals with extensive, long-term sun exposure, classically seen in outdoor laborers such as farmers. It presents as prominent solar damage on the back of the neck, etched with deep creases that intersect into distinctive geometric, rhomboid patterns. While there is cosmetic interest in treating this condition using alpha hydroxy acids or topical tretinoin—both of which stimulate collagen synthesis to soften wrinkle depth—topical retinoids cannot completely erase deep, structural folds caused by decades of ultraviolet radiation.

From a clinical standpoint, dermatologists do not view cutis rhomboidalis nuchae primarily as an aesthetic flaw requiring collagen stimulation. Instead, it serves as an immediate diagnostic warning sign of severe cumulative solar radiation. The primary clinical concern is uncovering occult skin cancers elsewhere on the patient's body. If the textural changes do not cause personal distress, treatment is entirely optional: "If it's not broken, in other words, why fix it? Save yourself the hassle of attempting to treat it."

- Cutis rhomboidalis nuchae manifests as deep, rhomboid-shaped creases on the posterior neck caused by heavy sun exposure. - Alpha hydroxy acids and prescription tretinoin can increase dermal collagen and soften wrinkle depth, but will not erase established, deep lines. - The condition serves as a clinical marker indicating high risk for concurrent cutaneous malignancies elsewhere on the body.

---

[11:07](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=667s) Facial Retinoids vs. Neck Skin: Formulation Matching and Layering Rules

Long-term tolerance of a facial retinoid does not guarantee that the neck will tolerate the exact same product. The neck requires a dedicated acclimation period. Even after using facial retinoids consistently for ten years, Dr. Dray describes herself as "the biggest wimp" regarding retinoid use on her neck and upper chest. Those unable to tolerate prescription-strength tretinoin on the neck often succeed by using gentler over-the-counter cosmetic vitamin A derivatives, such as a retinaldehyde serum (notably one by Purito).

```mermaid flowchart TD accTitle: Retinoid Application Strategy by Body Site accDescr: Diagram illustrating allowed versus discouraged ways to apply prescription and cosmetic retinoids across different facial and body zones.

subgraph Discouraged["❌ Stacking on the Same Area"] FaceStack["Face"] FaceStack -->|"Do Not Combine"| PrescFace["Prescription Tretinoin"] FaceStack -->|"Do Not Combine"| RetFace["Cosmetic Retinol"] Risk["Result: Excess Irritation & Wasted Product"] end

subgraph Recommended["✔ Site-Specific Matching"] Face["Face"] -->|"High Tolerance"| RX["Prescription Tretinoin"] NeckChest["Neck & Upper Chest"] -->|"Thin, Sensitive Skin"| Cosmetic["Cosmetic Retinaldehyde / Retinol"] end ```

A common misconception is that different retinoid formulations should never be owned or used simultaneously. The clinical rule is to avoid layering multiple vitamin A products onto the *same* anatomic area—such as stacking prescription tretinoin over an over-the-counter retinol cream on the face, which provides zero additive benefit while raising irritation risk. Conversely, using different formulations across separate anatomical sites—such as applying prescription tretinoin to the face while using a gentle cosmetic retinaldehyde on the neck and chest—is safe, rational, and tailored to local skin tolerance.

---

[13:24](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=804s) Supporting the Neck Barrier: Hydration, Sunscreen, and Fragrance Precautions

Basic barrier care produces significant standalone benefits on neck skin without introducing retinoid dermatitis: 1. **Moisturizers:** Adequate hydration normalizes epidermal desquamation, plumps fine surface lines, and optimizes light reflection to soften the visual contrast of hyperpigmentation. 2. **Broad-Spectrum Sun Protection:** The neck possesses thinner skin that readily undergoes solar elastosis and cutaneous atrophy, accelerating poikiloderma of Civatte. Diligent, daily sunscreen application to both the anterior and posterior neck is critical. 3. **Fragrance Avoidance:** Applying perfume directly to the neck can trigger photo contact dermatitis. Fragrance components can act as photosensitizers when exposed to UV light, driving post-inflammatory hyperpigmentation, persistent eczema, and long-term poikiloderma. Scented body lotions, creams, and aftershaves on the neck carry similar risks, and chronic sensitization can contribute to chronic actinic dermatitis in outdoor workers.

To avoid fragrance-induced photo-sensitization, perfumes should be sprayed onto sun-shielded zones like the waist rather than the neck.

---

[15:37](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=937s) Bottom Line and Product Recommendations

Neck skin represents a distinct physiological challenge compared to the cheeks, forehead, or nose. While sharing structural similarities with thin eyelid skin, the neck is subjected to unique mechanical stresses—constant friction from clothing collars and jewelry—alongside heavy environmental UV exposure. These factors make it significantly more prone to barrier breakdown from both prescription and cosmetic vitamin A formulations.

Retinoids can be used on the neck, but they require a cautious, conservative strategy. For those needing a formulated cosmetic option specifically suited to the area, Dr. Dray highlights the Anua Gua Sha Retinol Neck Cream, an over-the-counter option she personally tolerated without developing irritation.

## Notable quotes > [00:00](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=0s) human skin is not a "uniform sheet from head to toe" — Dr Dray

> [00:00](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=0s) backfires into a dry, itchy, flaky mess — Dr Dray

> [01:47](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=107s) retinoid side effects tend to sneak up insidiously on delicate neck tissue rather than showing up on day one or two — Dr Dray

> [01:47](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=107s) overconfident, overzealous very quickly — Dr Dray

> [01:47](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=107s) clawing at your neck — Dr Dray

> [03:33](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=213s) forgotten to wash — Dr Dray

> [03:33](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=213s) severe retinoid-induced skin irritation remains the primary reason patients fail or discontinue treatment for acanthosis nigricans — Dr Dray

> [09:35](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=575s) If it's not broken, in other words, why fix it? Save yourself the hassle of attempting to treat it. — Dr Dray

> [11:07](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=667s) the biggest wimp — Dr Dray

> [11:07](https://www.youtube.com/watch?v=Z9W1W3X4BZA&t=667s) The clinical rule is to avoid layering multiple vitamin A products onto the same anatomic area — Dr Dray

## Mentioned Dr Dray, Tretinoin, Retinol, Adapalene, Trifarotene, Tazarotene, Retinaldehyde, Acanthosis nigricans, Poikiloderma of Civatte, Cutis rhomboidalis nuchae, Purito TXA Retinal Niacinamide, Anua Gua Sha Retinol Neck Cream, Trichloroacetic acid, Glycolic acid, Intense pulsed light

## Video description Can you use retinoids on your neck? Dermatologist Dr. Dray explains why the neck can be much more sensitive to tretinoin, retinol, adapalene, and other retinoids than the face, and how to introduce a retinoid without causing unnecessary irritation, redness, peeling, or burning.

In this video, Dr. Dray discusses retinoids for neck aging, including how topical retinoids may improve signs of photoaging, fine lines, wrinkles, and texture. Clinical research has also investigated topical tretinoin for acanthosis nigricans, a condition that commonly causes darker, thicker, velvety skin on the neck.

The video also covers poikiloderma of Civatte and cutis rhomboidalis nuchae, two conditions associated with chronic sun damage that can affect the appearance and texture of the neck.

Dr. Dray explains how to start a retinoid on the neck, why a lower concentration or less frequent application may be appropriate, how moisturizer can help with tolerability, and why more irritation does not mean a retinoid is working better.

In this video:

• Can you use tretinoin on your neck? • Retinol vs. tretinoin for neck aging • Why the neck is more sensitive to retinoids • How to introduce a retinoid to the neck • How often should you use retinoids on your neck? • Tretinoin for acanthosis nigricans • Retinoids for poikiloderma of Civatte • Cutis rhomboidalis nuchae and chronic sun damage • How to minimize retinoid irritation • Why sunscreen is essential for neck aging • When dark or thickened neck skin should be evaluated by a dermatologist

Timestamps:

0:00 Introduction 0:34 Why Is the Neck So Sensitive? 1:47 How I Would Introduce a Retinoid to the Neck 3:33 But Can Retinoids Actually Help the Neck? 4:58 Tretinoin for Acanthosis Nigricans 7:34 What About Poikiloderma of Civatte? 9:22 Cutis Rhomboidalis Nuchae 11:07 So Should You Put Your Facial Retinoid on Your Neck? 13:24 One More Important Point About the Neck 15:37 Bottom Line

Suggested skincare:

Purito TXA Retinal Niacinamide: https://amzlink.to/az05CcW6aokLX

Anua Gua Sha Retinol Neck Cream: https://amzlink.to/az0gEx7p5uQ2L

Topical tretinoin has established evidence for photoaging, while clinical trials have also found benefits from topical tretinoin for acanthosis nigricans. Recent research continues to explore how topical retinoids affect aging and pigmentation in different areas of the skin.

Disclaimer: This video is for educational purposes only and is not a substitute for individualized medical advice. Prescription retinoids should be used according to the directions provided by a qualified healthcare professional.

#Retinoids #Tretinoin #Retinol #NeckAging #Skincare #Dermatologist #AcanthosisNigricans #NeckWrinkles #AntiAgingSkincare #DrDray FTC: This video is not sponsored. Links are commissionable, meaning I may earn commission from purchases made through links.

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Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Content provided on this Youtube channel is for informational purposes only. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. Information on this Youtube channel should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose, treat, cure or prevent disease.

[Source](https://www.youtube.com/watch?v=Z9W1W3X4BZA)

中文简报

Dr. Dray 警告：面部维A酸类产品可引发颈部皮肤屏障受损颈部皮肤的皮脂腺少于面部，使用者需降低维A酸类浓度与使用频率，以防发生慢性皮炎。 Dr. Dray 解释称，由于表皮较薄、皮脂腺稀少且常受机械摩擦，颈部皮肤格外容易发生维A酸皮炎。虽然外用维A酸（tretinoin）对黑棘皮病和轻度光老化具有明确的临床疗效，但对西瓦特氏皮肤异色症（poikiloderma of Civatte）效果有限，且无法消除如项部菱形皮肤（cutis rhomboidalis nuchae）等深层结构性褶皱。建议希望护理颈部的使用者从每周一次的保守频率开始，选择低浓度配方或温和的护肤级视黄醛，并避免在同一区域叠加使用多种维A类产品。坚持每日涂抹广谱防晒霜、充分补水保湿并避免在颈部直接喷洒香水，往往比激进的维A酸方案能带来更安全、更可靠的改善。由于表皮更薄且皮脂腺较少，颈部比面部皮肤更容易发生维A酸皮炎，患者最初建立耐受的频率最多应为每周一次。 (0:34) 临床试验结果表明，外用 0.025% 维A酸改善黑棘皮病色素沉着的效果与 0.05% 配方相当，且效果优于 10% 尿素和 15% TCA 化学剥脱。 (4:58) 外用维A酸类药物对西瓦特氏皮肤异色症的效果不稳定，且无法逆转项部菱形皮肤，因此 IPL（强脉冲光）和血管激光等院内光电设备仍是首选的矫正方案。 (7:34) 护肤者可以合理采取分区搭配维A类产品的做法——例如面部使用处方级维A酸，颈部使用更温和的护肤级视黄醛——前提是不要在同一解剖区域重叠涂抹多种维生素A类产品。 (11:07)

Source quotes

[0:00] Dr Dray: human skin is not a "uniform sheet from head to toe" [0:00] Dr Dray: backfires into a dry, itchy, flaky mess [1:47] Dr Dray: retinoid side effects tend to sneak up insidiously on delicate neck tissue rather than showing up on day one or two [1:47] Dr Dray: overconfident, overzealous very quickly [1:47] Dr Dray: clawing at your neck [3:33] Dr Dray: forgotten to wash [3:33] Dr Dray: severe retinoid-induced skin irritation remains the primary reason patients fail or discontinue treatment for acanthosis nigricans [9:35] Dr Dray: If it's not broken, in other words, why fix it? Save yourself the hassle of attempting to treat it. [11:07] Dr Dray: the biggest wimp [11:07] Dr Dray: The clinical rule is to avoid layering multiple vitamin A products onto the same anatomic area

Original transcript

[0:00] Well, hey guys, welcome back. If you're [0:01] new here, I'm Dr. Dray, I'm a [0:02] board-certified dermatologist. So, can [0:05] one use a retinoid on their neck? If [0:08] you're using a cosmetic retinol, [0:10] retinaldehyde, maybe you're using [0:11] over-the-counter adapalene, or you've [0:13] been prescribed tretinoin, trifarotene, [0:15] tazarotene for any number of [0:18] indications, maybe even for improving [0:20] the visible signs of skin aging. You may [0:22] be curious to try it on your neck, and [0:23] maybe you've even come across advice, [0:26] including from me, cautioning about, [0:28] "Might not want to do that." [0:30] So, can you? Should you? Is it ever [0:32] okay? When can you do it? Here's the [0:34] thing that a lot of people just don't [0:36] realize is that your skin is not a [0:39] uniform sheet from head to toe. It [0:41] varies a lot depending on the location. [0:43] Facial skin is much different from, [0:46] well, skin on the rest of your body. For [0:48] example, the skin on the soles of your [0:50] feet, very, very thick, can tolerate a [0:52] lot more in terms of stuff that maybe [0:55] exfoliates or works at the top dead [0:58] layer of the skin. Whereas, the skin on [1:01] your eyelids, the skin on your neck, the [1:03] skin on your upper chest is a lot [1:06] thinner. On the neck in particular, not [1:08] only is the skin thin and delicate, but [1:10] it has fewer oil glands. Hence, the [1:13] cautionary note around using topical [1:16] retinoids or cosmetic retinol, [1:18] retinaldehyde to the neck because if you [1:21] know anything about these ingredients, [1:22] they're notoriously irritating when one [1:24] first introduces them into the routine. [1:27] However, they're a lot more likely to be [1:30] more irritating on delicate neck skin. [1:32] I've been using topical retinoids on my [1:34] face for 10 years now, and to this day, [1:37] if I happen to experiment with using [1:39] them on my neck, it almost always [1:41] backfires into a dry, itchy, flaky mess, [1:44] and I'm never able to persevere through [1:46] that. Now, if you have been using a [1:48] topical retinoid, say tretinoin 0.05% [1:52] for a while now, and you're kind of [1:54] wanting to dabble with putting it on [1:56] your neck. When it comes to deciding [1:58] that you are going to use these [2:00] ingredients on your neck, what's a good [2:02] way to introduce them? I suggest being a [2:05] lot more conservative in terms of the [2:07] frequency. For example, if you have been [2:09] using your topical retinoid as intended [2:11] daily on the face, I wouldn't [2:13] necessarily jump into using it daily on [2:15] the neck. I might instead start with [2:17] using it once a week just to see how you [2:20] tolerate it and gradually increase to [2:22] twice a week, maybe going up to three [2:25] times a week. Use this for a couple of [2:27] weeks at these lower frequencies because [2:30] what I have found, especially with the [2:32] cosmetic forms, is that the dryness, the [2:35] peeling, and the irritation, they sneak [2:38] up on you. They don't always happen in [2:40] the first couple of days of using it. [2:42] So, you can get overconfident, [2:44] overzealous very quickly, and then all [2:47] of the sudden that retinol or [2:49] retinaldehyde that you were led to [2:51] believe is so, so gentle, which they [2:53] generally are. It'll It'll come back and [2:56] bite you, and the next thing you know, [2:58] you're going to be clawing at your neck, [3:00] which I I don't want you guys to [3:01] experience because it is very [3:02] uncomfortable. So, go slow, and keep in [3:06] mind that you may be using a high [3:08] percentage of retinoid on your face and [3:11] tolerating that just fine. Maybe it's [3:13] 0.05, which is kind of middle of the [3:15] road. Instead, you might be better [3:16] served with a lower percentage of that [3:18] retinoid. Lower does not mean [3:20] ineffective, it just means gentler, [3:22] okay? Less likely to be irritating, but [3:25] at the end of the day, they all do the [3:26] same thing. Sometimes it takes a little [3:28] bit longer to get there with the lower [3:30] percentages, but when we're talking [3:31] about delicate neck skin, it's very, [3:33] very different. What are the benefits of [3:35] using retinoids on your neck? One of the [3:37] best examples of why someone might elect [3:39] to use a retinoid on the neck is a [3:41] condition known as acanthosis nigricans. [3:44] This is a condition where the skin [3:45] becomes thickened, dark in appearance, [3:47] very velvety, not only on the neck, but [3:50] also under the arms, can happen on the [3:52] sides of the face. People mistake this [3:54] for either hyperpigmentation or have I [3:56] just forgotten to wash my face, am I [3:58] dirty, what's going on here? But it's [4:00] not actual dirt for sure, and it's not [4:03] melanin pigment like post-inflammatory [4:05] hyperpigmentation. It's actual areas of [4:07] the skin that have become thick, [4:09] acanthotic. The reason for this is [4:12] underlying insulin resistance. High [4:14] levels of insulin affect the epidermis, [4:16] cause it to hyperproliferate in certain [4:18] areas, and that leads to skin [4:21] thickening, acanthosis nigricans. As I [4:23] pointed out in my videos on skin warning [4:26] signs never do ignore, you don't want to [4:27] ignore this. The thought of putting a [4:29] retinoid on this should take a backseat [4:32] to your mounting growing insulin [4:34] resistance issue because that can lead [4:36] to diabetes and a lot of serious medical [4:39] problems. It needs immediate attention. [4:41] But then we are left with what to do [4:43] about the acanthosis nigricans because [4:46] while controlling the insulin resistance [4:48] does slow down its accumulation and [4:50] prevents it from getting more severe, it [4:52] doesn't always go away. And treatments, [4:54] they're hit or miss. Topical retinoids [4:57] have been shown to help this condition. [4:59] A recent systematic review looked at [5:01] clinical trials that specifically [5:02] evaluated tretinoin for acanthosis [5:04] nigricans. The review included six [5:06] randomized controlled trials with [5:08] approximately 172 patients. Overall, the [5:10] evidence was very encouraging. Tretinoin [5:12] 0.025% [5:14] and tretinoin 0.05% [5:17] were equally effective at improving the [5:18] appearance of acanthosis nigricans, [5:21] specifically with regards to reducing [5:23] the discoloration. Interestingly, [5:25] tretinoin 0.025% [5:27] was more effective for improving [5:29] acanthosis nigricans than 10% urea. And [5:32] it was more effective than 15% [5:34] trichloroacetic acid. It also performed [5:36] similarly to 0.1% adapalene, which you [5:40] can buy over the counter without a [5:41] prescription here in the United States. [5:43] It's a retinoid that specifically often [5:45] used for the treatment of acne, but can [5:47] be effective for the other things that [5:49] retinoids are effective for. Another [5:51] study actually compared 0.05% tretinoin [5:54] with a fractional 1550 nanometer erbium [5:57] laser, and although the laser performed [6:00] better when it came to just improving [6:02] the overall texture of the skin, the [6:04] 0.05% tretinoin actually produced a [6:07] similar reduction in just the overall [6:09] pigmentation. So, it seems like topical [6:11] retinoids for acanthosis nigricans are [6:13] particularly helpful for improving the [6:15] discoloration. A newer randomized [6:17] control trial though that wasn't [6:20] included in that earlier systematic [6:22] review, it compared 0.05% [6:25] tretinoin with a 70% in-office glycolic [6:29] acid peel for acanthosis nigricans. So, [6:31] that's very different than like your [6:33] glycolic acid toner or product you can [6:35] buy in the store. It's very, very [6:37] strong. It's very intense. You're not [6:39] going to be able to reproduce these [6:41] results yourself in other words at home. [6:43] That particular in-office peel was not [6:46] as good actually in terms of the [6:47] clinical response as tretinoin. So, [6:50] there's legitimate clinical trial [6:52] evidence for topical retinoids like [6:54] tretinoin, adapalene for improving the [6:57] appearance of acanthosis nigricans. But, [7:00] I want to emphasize something here that [7:01] that does not mean that you have if you [7:04] have a darkened neck, you should go [7:05] self-treating it right away with the [7:07] topical retinoid. Because if it's [7:08] post-inflammatory hyperpigmentation, say [7:10] from an eczema that was due to maybe a [7:14] contact allergy or something of that [7:16] sort. Well, you know, this could [7:17] backfire for sure. And if you have a [7:20] darkened neck, darkening on the neck has [7:22] many possible causes in other words. [7:24] But, unfortunately, one of the main [7:25] limitations of using a retinoid to the [7:27] neck for acanthosis nigricans is that a [7:30] lot of times patients develop too much [7:32] irritation and are unable to tolerate [7:34] it. Then, there's another neck skin [7:35] condition that I know a lot of you guys [7:37] struggle with. It's called poikiloderma [7:38] of Civatte. This is actually thought to [7:40] be a form of chronic sun damage, and it [7:42] presents with a culmination of a few [7:44] different specific skin findings. One of [7:46] them is atrophy, the other is the [7:48] presence of telangiectasias, which are [7:50] dilated blood vessels, and the third [7:52] feature is uh dyspigmentation. So, [7:54] people have looked at topical tretinoin [7:57] given its role in improving the [7:58] appearance of sun damage for this [8:00] particular condition, which is thought [8:02] to be caused by cumulative sun damage. [8:04] And it's interesting because the [8:06] evidence for retinoids specifically [8:09] treating poikiloderma while they're [8:11] great for sun damage in general. For [8:12] poikiloderma, the evidence is actually [8:14] pretty limited, and the studies that we [8:16] do have um actually shows that it [8:19] modestly improves pigmentation, and a [8:22] lot of the reports of improvement are [8:24] actually anecdotal. Many reviews of use [8:27] of topical retinoids for this condition [8:30] report inconsistent results. Whereas, if [8:32] you have this, you're a lot more likely [8:34] to get predictable results from an [8:36] in-office laser-based or light device [8:39] like intense pulse lights, certain [8:41] lasers. They have a lot better evidence [8:43] for treating poikiloderma of Civatte [8:45] because you're going to target either [8:46] the pigment specifically, or they're [8:48] going to target those telangiectasias, [8:50] the blood vessels. So, that would be a [8:52] lot more reliable as far as improving [8:55] things. And again, the neck is very [8:57] sensitive, and so you can easily run [8:59] into the situation where you just [9:01] develop too much irritation. Retinoids [9:03] can make your skin very sensitive in the [9:05] beginning, and that includes to the sun. [9:06] They don't increase your risk of a [9:08] sunburn per se by changing the minimal [9:10] erythematous dose that required to be in [9:12] burning your skin, but you can become a [9:14] bit more sensitive. And given the photo [9:17] damage feature of this, you want to make [9:19] sure you are protecting your neck from [9:22] from the sun. Speaking of neck and sun [9:24] damage, there's another neck skin [9:26] condition, cutis rhomboidalis nuchae. [9:28] And this is something we actually tend [9:30] to see in older adult Caucasian men in [9:33] particular have a history of a lot of [9:35] sun exposure, maybe they worked [9:36] outdoors. You often will see it in like [9:38] farmers, for example. Prominent sun [9:40] damage on the back of the neck with [9:42] these deep wrinkles that kind of usually [9:44] take on the geometric shape of a [9:46] rhomboid, hence the rhomboidalis. It's [9:48] essentially a manifestation of severe [9:51] sun damage, and there is, you know, some [9:53] interest just cosmetically speaking in [9:54] improving the appearance of this with [9:56] things like alpha hydroxy acids or [9:58] tretinoin because, depending on the [10:00] formulation of the alpha hydroxy acid, [10:02] and of course with tretinoin, you can [10:03] improve collagen production in the skin, [10:05] which can diminish wrinkle depth. While [10:07] topical retinoids may improve the [10:09] appearance of this, though, they're not [10:10] going to erase those deep wrinkles. One [10:13] of the most important things, though, [10:14] about cutis rhomboidalis nuchae is that [10:17] it's kind of like a clue that you've had [10:19] a lot of sun exposure, and you're [10:20] probably someone who's going to be [10:22] making skin cancers. So, when [10:23] dermatologists see it, you know, they [10:25] don't necessarily think, "Oh, we got to [10:27] boost the collagen in this right away [10:29] and get it smoothed out." They think, [10:30] "Okay, I need to look everywhere cuz [10:32] there's likely a skin cancer lurking [10:33] somewhere on this body I don't want to [10:35] miss." So, in other words, if it doesn't [10:37] bother you cosmetically, like, you're [10:39] like, "Whatever, I don't care." You [10:40] don't need to treat it, okay? Which is [10:42] often an option in dermatology, okay? [10:44] Many of the things that people come to [10:46] the dermatologist for are not [10:48] life-threatening, and they don't [10:49] actually require any treatment [10:51] whatsoever. And while it's fine to treat [10:54] them, especially if they bother you and, [10:56] you know, are affecting your quality of [10:57] life, they're not It's not always [10:58] necessary. So, if it's not affecting you [11:01] negatively, you know, if it's not [11:03] broken, in other words, why fix it? Save [11:05] yourself the hassle of attempting to [11:07] treat it. So, coming back to the [11:09] original question about putting the [11:11] facial product on your neck, whether it [11:13] be a cosmetic or the prescription stuff, [11:15] should you just go doing that? I [11:16] wouldn't assume, if you have been using [11:18] a retinoid to your face for years, that [11:20] you're going to tolerate it equally as [11:22] well on your on your neck. Your neck is [11:24] going to have to get accustomed to it. [11:26] And I Like I said, I know this first [11:28] hand because I have personally used [11:30] topical retinoids to my face for 10 [11:31] years now and to this day I am like the [11:34] biggest wimp when it comes to using them [11:36] on my neck. Also a big wimp when it [11:38] comes to using tretinoin on my upper [11:40] chest, but recently I have discovered [11:42] over the past year a retinaldehyde serum [11:44] that works really well there for me from [11:46] Purito. Um so in other words, you might [11:49] choose to use a different form of [11:52] vitamin A on your neck that is less [11:53] irritating. Like rather than use your [11:55] prescription tretinoin to your neck, you [11:57] might find like me that you get along [11:59] better in these more sensitive areas [12:01] with a cosmetic, which notoriously are a [12:03] lot gentler. Now normally in my videos I [12:06] caution about using multiple forms of [12:08] topical vitamin A, but when I caution [12:10] about that, I'm cautioning specifically [12:12] not to stack to the same area different [12:15] ones. In other words, I don't recommend [12:17] applying tretinoin to your face and a [12:20] cosmetic retinol cream to your face [12:22] because you don't get any added perk [12:24] from doing that. It just increases the [12:26] likelihood of irritation and wastes your [12:28] time and resources. Whereas it's fine [12:31] and maybe best for you actually to use, [12:34] for example, a topical tretinoin cream [12:37] to your face and your cosmetic [12:39] retinaldehyde to your neck or to your [12:42] upper chest. That's what I do and that [12:44] works out really well for me, but [12:46] sometimes it confuses people cuz they're [12:48] like, I thought you said there was no [12:49] point using multiple different forms of [12:51] vitamin A. There's no point in using [12:53] multiple forms of vitamin A to the same [12:55] area. But using them, mixing and [12:58] matching in different body sites [12:59] depending on the nature of the skin [13:01] there and what it tolerates is more than [13:03] fine and helpful actually if you're [13:05] motivated to do so. It does get to be a [13:07] lot to keep up with, okay? Because now [13:09] I've got to do my face, then I got to [13:11] get, you know, I don't mind because I [13:12] kind of enjoy it and it doesn't take me [13:14] that long to put that serum on my chest. [13:16] I'm really noticing a lot of benefit [13:18] doing it. Some people just cannot be [13:19] bothered. They don't want to go through [13:21] all this hassle. They don't have the [13:22] time. I totally understand that as well. [13:25] One more important point that I want to [13:26] emphasize about the neck is that if [13:28] you're concerned about the appearance of [13:30] things on your neck, whether it be aging [13:32] skin, post-inflammatory [13:33] hyperpigmentation you developed from [13:36] maybe some neck irritation, don't [13:38] underestimate other things that can help [13:40] here. Moisturizing alone can help [13:42] improve the natural turnover processes [13:44] of the skin and smooth out the skin of [13:46] the neck helping to plump and firm and [13:49] slightly diminish, very slightly [13:51] diminish, wrinkle depth and also help [13:53] through light scattering cut down on the [13:55] appearance of unwanted hyperpigmentation [13:57] discoloration. Also, please do not [14:00] neglect sun protection. This is an area [14:02] that people tend to forget sunscreen. It [14:04] gets a lot of sun exposure and it's very [14:06] vulnerable to sun damage. It's thinner [14:09] skin. So, when you atrophy it further [14:11] with unprotected sun exposure, you know, [14:14] it's any wonder that you develop these [14:16] adverse changes of poikiloderma. Also, [14:18] another thing I want to point out [14:20] getting back to the poikiloderma, the [14:22] post-inflammatory hyperpigmentation from [14:25] like a neck eczema that a lot of people [14:26] don't realize the thing to do to spray [14:29] perfume on your neck. Well, perfumes [14:32] contain ingredients that can make the [14:35] skin a bit more sensitive to the sun. [14:37] They can photosensitize. In theory, they [14:40] don't contain these because they've [14:41] been, you know, kind of processed out. [14:43] So, that is known as a photo contact [14:47] dermatitis and perfume is thought to be [14:49] a culprit here and potentially drives [14:52] the development of unwanted pigmentation [14:54] as well as poikiloderma of Civatte. Now, [14:57] is that to say that if you've been [14:59] putting perfume on your neck your whole [15:00] life, you're going to develop these [15:02] things? No, but you might rethink it. I [15:05] actually recommend spraying it on your [15:06] waist. It works well there in my [15:09] experience. Your waist is usually not [15:10] exposed to the sun throughout most of [15:12] your day. Can I also suggest avoiding [15:14] scented lotions, creams, aftershaves in [15:16] this area for the same reason. The [15:18] fragrance can potentially rock the boat [15:21] when it comes to unwanted changes later [15:23] on on the neck. Not a definitive thing, [15:25] but definitely something that we see in [15:28] a lot of outdoor workers, for example, a [15:30] type of chronic it's called chronic [15:31] actinic dermatitis. Thought to be [15:34] related to some sort of sensitization to [15:36] a topical product, maybe fragrances. [15:38] Bottom line, yeah, you can use a [15:39] retinoid on your neck, but do so [15:41] cautiously and understand you're dealing [15:43] with a completely different beast here. [15:45] Neck skin is not the same as your cheek, [15:47] it's not the same as your forehead, it's [15:49] not the same as your nose. It's a little [15:51] similar actually to eyelid skin, but you [15:54] don't have the blinking thing to to [15:57] further aggravate things that. But you [15:59] do have frictional forces, just like you [16:01] have in the eye, I guess, because you [16:02] have necklaces rubbing, collars, and you [16:06] have a lot more sun exposure on the [16:08] neck. So, it's got its own host of [16:10] things to deal with and therefore can be [16:12] a lot more vulnerable to unwanted side [16:14] effects from topical forms of vitamin A, [16:16] whether it be the prescription stuff or [16:18] the cosmetic retinol retinaldehyde. All [16:20] right, y'all. I hope today's video was [16:21] helpful in clarifying this topic with [16:23] regards to the use of topical forms of [16:25] vitamin A on the neck, we'll say, and [16:27] answered your questions. Let me know in [16:29] the comments below, are you someone who [16:31] tolerates it like a champ there and [16:32] you've been using it successfully? Are [16:34] you someone like me who's a neck wuss [16:37] when it comes to these things and you [16:39] know, needs a gentler approach? If you [16:40] guys enjoyed today's video, on the end [16:42] slate I'm going to put my recent video [16:44] on cosmetic retinols and retinaldehydes [16:47] that I have been really loving this past [16:49] year. Sort of an updated recommendation [16:51] of three that I have discovered that I [16:53] think are particularly worth [16:54] considering. One is specifically [16:56] marketed for the neck from Anewa. You [16:59] can use it elsewhere, of course. That [17:01] one I love and adore and actually [17:03] tolerated on my neck just fine. So, you [17:06] might give that a go if this is [17:07] something you're motivated to try. I'll [17:09] link that down below as well. It's quite [17:11] good here, but if you want to watch the [17:13] full review, go ahead and check out the [17:14] video on the end slate. If you enjoyed [17:16] today's video, give it a thumbs up, [17:18] share it with your friends, and as [17:19] always, don't forget sunscreen and [17:21] subscribe. I'll talk to you guys [17:22] tomorrow. Bye. [17:28] >> [music] [17:44] [music]