Retinoids: The Complete Guide
The Retinoid Family
Retinoids are a big family of compounds that are derivatives of vitamin A that are made naturally or synthetically. Over-the-counter versions are commonly labeled "retinol" but also retinyl palmitate, retinaldehyde, and retinyl acetate. Prescription strength is retinoic acid, tretinoin, and isotretinoin. I will explain all the differences shortly.
It was first discovered in milk in 1912 by a man named Frederick Gowland Hopkins. In 1943, the first study using retinoic acid to treat acne was published. By the end of the 1950s, retinoic acid started being prescribed by dermatologists for acne patients. In 1983, a study was published recognizing the anti-aging benefits.
Our bodies require vitamin A for a strong immune system, healthy vision, and bone growth. We don't produce vitamin A naturally so it's important to eat foods that contain it. However, like anything we consume our skin is the last part of our bodies to reap the benefits. Since it has to travel through our acidic digestive tract and breaks down, with a topical application you reap the most benefits. So what are these benefits?
Skin Benefits
The use of retinoids has long been studied and there are tons of benefits. Out of all of the anti-aging "miracle" creams and ingredients available on the market today, retinoids are the only ones scientifically shown to work on a molecular level in turn dramatically changing the skin. Some of these benefits include:
Encouraging skin cell turn over
Plumping, smoothing, and evening skin tone
Evens out and lighten hyperpigmentation from sun damage or post-inflammatory hyperpigmentation left from acne
Stimulates collagen production
Reduces the appearance of fine lines and wrinkles
It's great for certain types of acne - specifically blackheads, whiteheads, closed comedones, and clogged pores
One of the only ingredients to actually minimize pores
Reduces the amount of oil in the skin for oily skin types
Unclogs keratin plugs in the hair follicle or sweat gland
Side Effects
Without a doubt, there is some not so desirable side effect that can happen when first using a retinoid. Dryness, peeling, tightness, redness, and irritation. If used too close to the mouth area your lips may even become chapped. Most of these side effects usually subside within a few months depending on the skin type, skin conditions and climate one lives.
Prescription vs. Non-Prescription Strength
Retinol (non-prescription strength) works slower is much weaker and has fewer side effects than prescription strength. Studies have shown it's about 20 times weaker than prescription strength. Retinol is the precursor to retinoic acid (prescription strength) and has to convert on the cellular level of the skin to retinoic acid. This process can take 3-6 months and up to 12 months to see full effects on the skin. It is a good starting point for newbies.
Retinoic acid (prescription strength) is much more potent and works significantly faster than non-prescription strength because there is no conversion in the skin that needs to occur - it's already retinoic acid. You will start to see some anti-aging benefits in the 6-8 week mark and usually with acne much sooner.
Percentage Strength + Formula
As far as strengths go, many think it’s best to just jump right into the strongest formula thinking it's better. This is usually not the case and doing so will likely have some undesirable side effects. Building a tolerance will create better results. Think of it as if you took up running, you wouldn't start with a marathon, would you? When getting a prescription from your healthcare provider they will decide the best percentage strength, formula, and frequency for your skin type and conditions.
As for the non-prescription strength of retinol, the most potent is around 2% which is the highest concentration available without a prescription.
The following is the order from the weakest, most gentle, and with the least side effects to the strongest, most aggressive, and result-driven. Just know you will eventually peak at the same results by using a less potent strength but just at a slower rate with fewer side effects. Patience is key!
Creams vs. Gels - Creams are great for anti-aging, dry or sensitive skin types because they are more creamy and emollient. While gels are preferred for oily and/or acne-prone skin. Gels are also thinner than a cream so they penetrate faster making them more effective and stronger. But stronger also means more side effects. This is really trial and error, depending on the individual and per your doctor's advice.
At what age is appropriate to start using retinoids?
Retinoids for the use of treating acne are often prescribed as needed during the teenage years.
If you are interested in preventative for aging or treating wrinkles, fine lines, pigmentation, etc. then your mid to late '20s is a great age to start. This is around the time when the body starts to lose 1% of its collagen per year. It also depends on your lifestyle and how much sun damage you have accumulated in those years.
What about Differin?
The brand Differin (adapalene) is part of the retinoid family but works slightly differently than retinol/retinoic acid. It slows the process of hyperkeratinization or excessive growth in the lining of pores, and it also desensitizes the skin to inflammation. It is synthetically made and was once a prescription and is now an OTC product used to treat acne. Studies indicate that Differin has less irritating side effects than other retinoids and why it's so great for acne since a large part of acne is associated with inflammation and redness.
Is It A “Safe” Ingredient?
In the world of beauty and with apps like Think Dirty and Environmental Working Group (EWG) there are a lot of conversations on if retinoids are considered to be a "safe" ingredient. This is when truly educating yourself with factual information is super important so you can make an informed decision for yourself.
For example, the Think Dirty app ranks retinol as a 9 out of 10 being the worst. However, it's only a guide and you must read between the lines and understand why. The top concerns are reproductive toxicity and irritation to the skin. Okkkkk, so don't use it while pregnant or breastfeeding and follow your healthcare provider’s instructions for PROPER usage to minimize irritation. It’s really not that difficult.
Proper Usage + Tips
Before getting a prescription through your dermatologist or purchasing non-prescription retinol, here are my ultimate tips and guidelines as an esthetician and prescription retinoid user.
It’s recommended to not use it if you are trying to conceive, currently pregnant, or breastfeeding. Please, follow your healthcare provider’s instructions.
Prescription-strength will come in a metal tube for the most part, but in non-prescription formulas look for an opaque bottle/tube as the exposure to sun, heat, and air breaks down the formula making it unstable and less effective.
It's recommended to use retinoids at night as the sun decreases the effectiveness. (Plus, there are so many other great actives to use in the daytime!)
Wearing sunscreen daily is a must as retinoids make your skin more susceptible to sunburn and honestly it would be counterproductive not to! (The #1 cause of aging is sun damage.)
A gradual approach is best so your skin has time to acclimate. I can not emphasize this enough! I recommend starting with every other night/every third night or per your doctor's instructions.
More is not better! Use a pea-size amount on dry skin to avoid directly under the eye area. Damp skin can interfere with how much is absorbed which can result in irritation. Because retinoids move underneath the skin you will still receive benefits for fine lines around the eyes even without direct application to that area.
For dry and sensitive skin types you may apply a thin layer of moisturizer first followed by the retinoid or mix moisturizer with the retinoid. You could also start with an OTC retinol and work into prescription strength.
Retinoids work amazingly well when followed with niacinamide, ceramides, or hyaluronic acid moisturizer to pull water back into the skin.
Since the skin will be drier, I recommend switching to a more nourishing sensitive, or hydrating skin cleanser.
Sorry, no facial waxing/sugaring while using retinoids. I realize you are not applying the product around your eye area where you may get an eyebrow wax, however, the product does move underneath the surface of the skin and can result in getting a layer of skin ripped off. Tweezing or threading are options while using retinoids, but if you must wax stop usage 7 days prior to your waxing appointment.
You can use retinoids on other parts of the body too! Do you know those tiny little bumps or "chicken skin" on the back of your arms? That's called keratosis pilaris which are clogged follicles and using retinoids on those areas helps to alleviate those bumps.
My Retinol Picks
ALASTIN Skincare Renewal Retinol in .25 and .ALASTIN Skincare Renewal Retinol in .5 strengths
Medik8 makes four percentage strengths, Medik8 Retinal 1, Medik8 Retinal 3, and Medik8 Retinal 6, and Medik8 10
Paula’s Choice Clinical 1% Retinol Treatment Lotion
#babeonabudget friendly - The Inkey List Retinol Serum, Versed Press Restart Gentle Retinol Serum, and Cerave Skin Renewing Retinol
Alternatives to Retinoids
If you don't want to use retinoids for any particular reason or another or are pregnant/breastfeeding the good news is there are natural and comparable alternatives that yield many of the same results as retinoids.
Bakuchiol has been shown to have similar results to retinoids without the side effects and is pregnancy safe.
Vitamin B3 (Niacinamide) has been shown to be just as effective as hydroquinone (skin bleach) and prescription-strength retinoids for lightening pigmentation. It also boosts collagen production reducing fine lines and wrinkles and is safe during pregnancy/breastfeeding.
Glycolic acid is wonderful for dissolving dead skin cells and unclogging pores, lightening discoloration from UV rays or post-inflammatory pigmentation leftover from acne, and softening fine lines and wrinkles. Since this acid is made from sugar cane it is safe to use during pregnancy.
