A Primer on Retinoids: What to Know Before You Start
As a practicing dermatologist with two decades of experience helping people achieve their best skin, I know how to address our shared concerns about the emergence of wrinkles, dark spots, dull tone and dryness as we age. This post is all about retinoids. One form of retinoids, retinoic acid (tretinoin), has over 50 years of scientific research confirming its ability to reduce the signs of aging by diminishing fine lines, brightening complexion, clear acne, and smooth the skin’s texture. Once you are ready, check out this blog or a step-by-step guide.
What Is Retinol vs Retinoid?
In 1943, the first study using retinoic acid for the treatment of acne was published. Retinoic acid is a variant of Vitamin A. Since this first study, many forms of topical vitamin A have been developed, which are all collectively referred to as retinoids. Retinoids need to be converted to retinoic acid to be effective.
Here is a summary of the main retinoids used in skincare:
-Retinyl Palmitate (Least Strong): Needs to be converted to retinol first, then retinaldehyde, then retinoic acid. Also known as vitamin A palmitate. A milder derivative commonly used in night creams, serums, and eye products for wrinkles and acne.
-Retinol (Stronger): Needs to be converted to retinaldehyde first, then retinoic acid. One of the most popular OTC retinoids. Available in strengths from 0.01% up to 1% in various anti-aging serums, creams and oils. Less irritating than prescription retinoids. Extremely unstable when exposed to air or sunlight.
-Retinaldehyde or Retinal (Even Stronger): Needs to be converted to retinoic acid.
-Retinoic Acid (Strongest): Able to bind receptors in the skin (Retinoic Acid Receptor and the Retinoid X Receptor). Synonymous with tretinoin (Altreno®, Atralin®, Avita®, Refissa®, Renova®, Retin-A®, Tretin-X®).
-Bakuchiol: Bio-retinol: Although bakuchiol is not a retinoid, it has similar anti-aging effects. It is derived from the seeds and leaves of the babchi plant. It stimulates collagen and cell turnover, plus it has antioxidant and anti-inflammatory properties. It functions in skin through the retinoic acid receptor and other biological pathways to improve skin. It is emerging as a hot new skin care ingredient given its ability to reduce wrinkles, improve tone, and target acne with less side effects than what is typically seen with retinoids. This is why I chose to include it in my Night Repair Treatment.
How Retinoids Work
-Reduce Wrinkles and Fine Lines: Of all the virtues of retinoids, collagen production generates the most excitement. Beginning in our 20s, we lose about 1% of collagen annually. This inevitably manifests as sagging skin, wrinkles and crepiness. Retinol can help offset some collagen loss by signaling its production. Once converted to retinoic acid in the skin it binds with cellular receptors activating fibroblasts to make more collagen. It also blocks the degradation of collagen due to UV.
Multiple double-blind, randomized-controlled studies consistently demonstrate significant reductions in wrinkle severity after regular use of retinol creams. Retinoids also increase the production of elastin fibers.
-Improve Dark Spots and Hyperpigmentation: Sun exposure stimulates excess pigment production (melanin), resulting in brown age/liver spots. Retinol promotes cell turnover to exfoliate away uneven pigmentation and damaged surface skin to reveal healthy cells beneath. With sustained, regular use, those age spots fade and complexion becomes more even. Clinical photography and expert grading reveal significant improvements in dark spots and hyperpigmentation, tone, and texture after daily retinol use.
-Unclog Pores & Prevent Acne: Pores serve an important role - allowing secretion of oil and sweat vital to skin health to emerge. Yet they can become clogged, dilated or infected. Retinol lifts away dead skin cells and sebum decreasing the risk of obstruction. Additionally, retinol regulates oil production which helps prevent new congestion and breakouts as well as decreasing the appearance of pores. Reductions in inflammatory and non-inflammatory acne lesions have been observed with retinol in randomized studies. Histologically, decreased microcomedone formation is noted. Retinol is shown to directly reduce comedogenic compounds.
-Increase Smoothness and Texture: Retinoids lead to increased epidermal proliferation and increased epidermal differentiation that improve the smoothness and texture of skin.
Here is an article I wrote for Men’s Journal that highlights some of the benefits of retinol.
How Long Does It Take Retinol to Work
It will take several weeks (8-12) before you see improvement in the look and feel of your skin because it takes that long for your body to build new collagen. In fact, your skin may even look worse at first as it adjusts to the new regimen. According to one study, a “significant reduction” in wrinkles was seen in participants who used a retinol for 12 weeks. Another study from 2019 found that wrinkles around the eyes and on the neck improved in individuals after eight weeks.
Common Side Effects of Retinol
-Irritation: While the FDA approves retinol use, irritation can occur, especially when initiating new products. Common symptoms involve dryness, redness, peeling, and itchiness. These are collectively dubbed “retinization” or (when severe) “Retinol Burn.” To minimize discomfort, I coach patients to start using retinol slowly, just two nights a week, incrementally working up to nightly application while ALWAYS following it with a moisturizer. This blog walks you through all the steps of starting a retinol regimen to minimize unwanted irritation.
-Hyperpigmentation: If your skin tans easily and becomes irritated when using retinol, you can develop unwanted pigmentation and hyperpigmentation. This is another reason to start slow and always use your sunscreen. This is more common in people with darker skin tone. Stop immediately and contact your healthcare provider.
-Photosensitivity: Retinoids increase your risk of sunburn according to several studies. To reduce such risks, wear mineral-based sunscreen everyday and skip the retinol step when on sunny vacations. You can also check out this blog that highlights the differences between mineral and chemical sunscreen.
-Retinol for sensitive skin: Some people still have difficulty adding retinol to their routine even when doing the above steps and using low percentage retinol. One approach involves “buffering” by mixing an amount smaller than the typical ‘pea size’ and diluting it with a heavy moisturizer to create an even LOWER percentage product with added hydration.
Another option is to use a different ingredient that also promotes cell turnover.. I cannot tolerate retinoids and have switched to bakuchiol and alpha hydroxy acid which are well studied, effective and less irritating than retinoids that is why I’ve included it in my Night Repair Treatment. Additionally, new sensitive skin formulas feature ‘encapsulated retinols’ that release gradually over hours.
-Long Term Side Effects of Retinoids: This has been looked at extensively. There appears to be no downside risk to long term use. Long term use of retinol leads to healthier skin with improvement in clinical signs of photoaging like fine wrinkling, coarse wrinkling, sallowness, and mottled hyperpigmentation.
Who Should Not Use Retinol
All people with very sensitive skin should proceed with caution when considering adding retinol to their skin care regimen. It should be avoided during active rosacea or eczema flares and on healing skin. People with very sensitive skin can use very low percentages a few nights a week or alternatives like bakuchiol and alpha hydroxy acid. Also, if you are going to be spending a lot of time in the sun without sunscreen, do not use retinoids.
Using Retinol While Pregnant or Nursing
I'm often asked if retinol can be used safely during pregnancy and breastfeeding. Retinol is not recommended for women who are pregnant or breastfeeding because of the concern of elevated vitamin A levels causing birth defects as seen with Accutane. Retinol has not been studied in pregnant women and this recommendation comes from an abundance of caution. Also when you are pregnant your skin is more sensitive and the likelihood of unwanted irritation is elevated. This is also what the American Academy of Dermatology recommends. For more information about safer products for pregnancy check out Sorette.
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