Beginner’s Guide to Retinoids: What, Why, and How
Heard of retinoids? Know that you probably should be using one, but aren’t sure exactly what they are and how to use them?
Well, this is the place for you. In this blog post, I will review what retinoids are, why you should use them, and how to start using them.
Retinoids are the holy grail of skin care, one of the most effective, tried and true compounds in the struggle against UV damage, photo-aging, and acne. If you only use one thing, this is the thing to use.
So, what is a retinoid, exactly?
This is a family of vitamin A molecules that has been used for the skin since the 1970s. It works on a cellular level to affect how your skin cells (keratinocytes) divide and proliferate, as well as modulates inflammation and repairs collagen. This molecule has decades of data to support its role as the cornerstone of any acne treatment regimen and for its effectiveness in combating sun damage.
Via PubChem
Retinoid is the umbrella term for this family of molecules which include tretinoin, adapalene and retinol.
Retinol, retinal aldehyde, adapalene (a.k.a. Differin) and retinyl esters are all available in over-the-counter products, while tretinoin is available by prescription.
Should I be using a retinoid?
You should be using a retinoid if you:
Have acne — Retinoids are the most effective treatment for acne. It helps to reduce clogged pores, as well as reduce inflammation and oil production.
Go out in the sun — Chronic UV exposure can lead to thinning of the epidermis (the top layer of the skin), as well as damage the underlying collagen. Retinoids have been shown to combat the wrinkling and crepiness associated with photo damage by increasing epidermal thickness and stimulating new collagen formation. It also can help fade hyperpigmentation.
Like having a smoother, more even complexion — Not only do retinoids increase collagen and fade hyperpigmentation, but studies have shown that use increases hyaluronic acid production which contributes to a smooth, supple appearance of the skin.
Should I use an over-the-counter retinol or a prescription retinoid?
All retinoids, whether it is retinol from the drug store or prescription-strength tretinoin, have all been shown to improve photoaging and treat acne.
Prescription-strength tretinoin, a type of retinoic acid, can directly enter the nucleus of keratinocytes (skin cells) to regulate cellular mechanisms. This makes it about 20x more potent than retinol, which is a precursor molecule to retinoic acid and requires a conversion step before it can exert any anti-photo-aging activity on your skin cells.
This makes retinols generally much more gentle and tolerable than tretinoin, but less effective overall.
OTC retinols are readily available in many products, so there's no barrier to entry like a visit to the physician or a prescription. I personally like the Roc Retinol Correxion Deep Wrinkle Night Cream: it’s effective and at a great price point.
Multiple studies have shown minimal redness or irritation with use, unlike tretinoin. Because it is both accessible and gentle, I think of it as a gateway retinoid.
If you stopped seeing improvements and you can tolerate OTC retinol every night, you are ready to try a more potent prescription-strength retinoid like tretinoin. Schedule a consultation with your friendly neighborhood dermatologist to see if it is an option for you!
What should I use if I have acne?
The best OTC retinoid is for acne is adapalene (also known as Differin). It has great efficacy data for acne (it used to only be available by prescription) and it is much more gentle and tolerable than tretinoin. If you are using adapalene for a few months and are still getting breakouts, time to see your dermatologist for a customized treatment regimen.
How do I start using a retinoid?
Retinoids make you work for results and can be a bit difficult to get used initially. Many people quit before they can see the benefits of this magical active ingredient. The following tips are the key to successful long term retinoid use.
BE PATIENT — The most important thing to remember is that a retinoid does not work overnight. If you have acne, it does not treat your active pimples but prevents them from developing. For acne, it takes at least 6 weeks to notice an improvement. Remember, you must use it all over, not just as a spot treatment. For fine lines and photodamage, give it at least 6 months. It’s a long term commitment, not a one night stand.
USE AT NIGHT — UV light breaks down retinoids, so it's best to apply it at night after washing your face.
APPLY TO DAMP OR DRY SKIN — There are differing opinions out there, but IMO, it doesn't matter much. If you find that your skin is sensitive to the retinoid, you may want to apply it to dry skin (wait 5-10 min after washing) to reduce penetration.
APPLY A MOISTURIZER — Retinoids inherently cause irritation and flaking of the skin, so use of a thicker moisturizer can help minimize those effects.
DON'T USE OTHER IRRITATING ACTIVES SIMULTANEOUSLY — Hold your AHAs and other potentially irritating products the nights you use your retinoid to reduce irritation.
USE EVERY 2-3 DAYS — Go slow. Your skin will get used to it over a few weeks, but start using it every few days at first. Once you aren't noticing as much irritation, you can increase how often you use it.
TAKE BREAKS — If you are experiencing significant irritation and dry skin, it's okay to stop using the retinoid until your skin gets back to normal. Practice gentle skincare to support your skin as it heals.
So, it’s been about a week or two since you started using a retinoid and you’re noticing your acne is getting worse. What is happening?!
I get a lot of people telling me that they are concerned about their "acne getting worse" as the reason for not starting a retinoid. But like many things in life, it will get worse before it gets better. And if you understand WHY it's happening, it feels less scary.
This is colloquially known as a retinoid “purge.”
This is a phenomenon that occurs in the initial weeks of starting a retinoid where some may experience a surge of new acne lesions. This may lead many people to write off retinoids as making their acne worse and stop before it has a chance to work.
Why does this happen?
Retinoids help regulate how fast your skin cells divide and shed. As it increases the rate of turnover in the initial stages of treatment, preexisting clogged pores will become even more packed full of dead skin cells and evolve into actively inflamed acne lesions.
In addition to an increased number of acne lesions, retinoid newbies will experience redness, flaking, and irritation.
How long will it go on for?
Remember, no pain, no gain. Once you get through this initial super-breakout, you will begin to notice a reduction in acne lesions and gradual improvement in skin texture. Your skin will self-regulate and achieve a state of an overall reduction in clogged pores, whiteheads, blackheads, and actively inflamed acne.
It may take several weeks, so push through. I promise, it will be worth it.
It's important to note that not everyone experiences this. In my clinical experience, only about 20% of patients report "purge" symptoms.
What can I do to take care of my skin during a purge?
Be gentle! Do not pick or squeeze your acne and avoid aggressive scrubbing. It will not resolve faster if you scrub your face like a dirty tub.
Use a topical acne treatment, like salicylic acid, or even a zit patch while it heals.
Do use a moisturizer. A moisturizer can help support your skin barrier function and reduce any irritation. If you feel on the drier side, you may want to use a thicker moisturizer.
Retinoid myths
You may still have some hesitations about retinoids, based on old wives’ tales and myths that are floating around. Just because your Aunt Pam told you something, doesn't mean it's true. There are a lot of myths floating around retinoid use that come up pretty often and the time has come to debunk them.
MYTH #1: RETINOIDS THIN YOUR SKIN.
This is probably the most common concern about retinoids and it's FALSE.
It is true that there is enhanced thinning and exfoliation of the uppermost layer of skin, the stratum corneum, when you first start using it. Hence, the flaking and sexy beard of dry skin.
However, long term use of retinoids actually leads to thickening of the entirety of the epidermis, which is one of the ways it combats aging. Sun damage thins the epidermis over time and what gives the aging skin a crepe-like quality.
MYTH #2: RETINOIDS INCREASE RISK OF SUNBURN.
Retinoids break down in sunlight, which is the reason why it's recommended to be used at night.
However, there is no data that using a retinoid actually increases the risk of sunburn. The minimal erythema dose (MED), which is the amount of UV light exposure your skin needs to burn, is unchanged when you're using a retinoid.
So, bottom line, you don't need to stop using retinoids in the summer! Hurrah!
MYTH #3: DON'T USE RETINOIDS AROUND YOUR EYES.
Actually, do use retinoids around your eyes!
Since the skin around the eyes is so thin and more susceptible to UV-induced damage, retinoids will help combat photo damage and slow the appearance of crow's feet. The skin around your eyes isn't more sensitive to retinoids than the rest of your face, just be careful not to smear it on your eyeballs.
If you do notice some irritation, make sure to apply moisturizer on top or take a break for a few days.
MYTH #4: RETINOIDS WORK BY EXFOLIATING YOUR SKIN.
Yes, you will experience some skin peeling from increased skin cell (keratinocyte) turnover and irritation from using the medication, but that's merely a side effect.
Retinoids are such a powerhouse because they actually affect alter gene expression and increase the production of collagen in the skin.
I hope this comprehensive beginner’s guide to retinoids helped with any retinoid-related anxiety. This is a must-use active ingredient that will give you the biggest bang for your buck for your skin, so I want to make sure that you have the tools to successfully use it! Go forth and prosper!
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References:
Elias PM.Retinoid effects on the epidermis. Dermatologica. 1987;175 Suppl 1:28-36.
Kong R. A comparative study of the effects of retinol and retinoic acid on histological, molecular, and clinical properties of human skin. J Cosmet Dermatol . 2016 Mar;15(1):49-57.
Mukherjee S, et al. Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Clin Interv Aging. 2006 Dec; 1(4): 327–348.
Slade HB. Reappraising the phototoxicity of tretinoin: a report of four controlled clinical trials.
Photodermatol Photoimmunol Photomed . 2009 Jun;25(3):146-52.