Although they’ve been around for decades, the vitamin A derivatives known as retinoids remain the gold standard for treating acne and wrinkles, with the skin-care and pharmaceutical industries continuing to develop and manufacture new products featuring them. Retinoids — including the most commonly known, retinol — are found in both prescription medications and over-the-counter formulations in a variety of strengths and product types.
But despite their longevity and proven results, these compounds retain the potential for undesirable side effects, such as peeling skin and sun sensitivity. It’s important, therefore, to understand the various types of retinoids and the safest ways to incorporate them into a skin-care regimen.
Attempts to use retinoids to treat acne date to the mid-20th century, when tretinoin, a derivative of vitamin A also known as retinoic acid, was studied in Europe for treating skin disorders including acne and skin cancer.
American dermatologist Albert Kligman was determined to find the optimal dosage for acne treatment. In the 1960s, he notoriously tested tretinoin on inmates at Holmesburg Prison in Philadelphia until he found a dosage that could be tolerated. This led to tretinoin’s approval by the Food and Drug Administration in 1971, subsequently marketed under the brand name Retin-A.
In 1986, after adult patients using tretinoin to treat acne reported that the product was also reducing their wrinkles and improving their complexion, Kligman and his associates conducted a study on 400 adult women, concluding that topical tretinoin is capable of at least partly reversing the structural damages of excessive sunlight exposure and may be useful in decelerating the photoageing process.
Since Kligman’s 1986 work, there have been thousands of studies on tretinoin, making it one of the most researched anti-ageing ingredients in dermatology.
Tretinoin is considered the gold standard in skin care, because of the extensive body of research that supports how well it works at increasing cell turnover. This boost in cell turnover helps increase collagen production, unclog pores (how it helps to treat acne), smooth fine lines, reduce the appearance of sun damage and manage dark spots.
The ability of retinoids to vanquish acne and wrinkles, however, has been accompanied by their reputation for painful side effects, such as peeling, flaking, redness, sun sensitivity, irritation and, for some skin types, hyperpigmentation. That means knowing what strength retinoid to start with and how often to apply is very important.
Retinoids are usually categorised by where they fall in the conversion pathway to retinoic acid, which is the strongest and the most likely to cause irritation. For example, tretinoin is retinoic acid, so it’s much more potent than over-the-counter versions, because there is no conversion necessary before it has a biological effect on the skin. The packaging on over-the-counter items should clearly state which kind of retinoid is in the product; one of the most commonly seen is retinol.
Prescription-strength retinoic acid (tretinoin, Retin-A) is the strongest, as there is no conversion necessary. Retinaldehyde (retinal) it’s only one conversion away from retinoic acid; retinol is two conversions away; and retinoid esters (retinyl palmitate, retinyl acetate and retinyl linoleate) the weakest of the retinoids and usually best tolerated.
Retinoids can treat acne and hyperpigmentation in people with darker skin tones. But if overused, they can cause further hyperpigmentation and dark marks from the peeling and inflammation. Pale lighter skin types tend to get red, dry and flake.
After the first two to four weeks of usage, the skin goes through a process called retinisation, where your skin adjusts to the application of the product. And this can lead to redness, dryness, burning, stinging, peeling. If you develop irritation, you need to put your foot on the brakes, use the retinoid less frequently and combine it with a moisturiser to help your skin tolerate it.
Another side effect, particularly in people with active acne, is new outbreaks known as skin purging. Purging is typically a sign that there was acne underneath the surface of the skin, and that the rapid skin-cell turnover from the retinoid is forcing the acne to the surface, making the acne appear worse before it gets better.
When considering incorporating a retinoid into your skin-care routine, be mindful that retinoids are contraindicated for pregnant women and women planning a pregnancy. Also, you should avoid other products that exfoliate.
Be aware of also starting on other active skin-care ingredients, such as benzoyl peroxide, hydroxy acids or vitamin C, when incorporating a retinoid. You may add too many actives at the same time.
- Allow skin time to acclimatise.
- Do a patch test and wait 48 hours to assess outcome.
How to Apply Retinol for Best Results.
As effective as retinol is when it can come with some issues with initial use, how you apply it can affect the results you see. Because this product can cause skin to dry out and sometimes turn red, it’s best to talk to your dermatologist or well-trained skin therapist before starting a retinol regimen. It is advised to start with products that contain a low concentration (0.3%) of the ingredient first and see how your skin reacts before moving to higher concentrations.
Here’s how to incorporate retinol into your skin care routine:
Step 1: Wash your face and apply eye cream. An eye cream will help protect the delicate skin around your eyes. You can add cream to corners of nose or around lips to protect more reactive sensitive areas. You can apply a moisturising cream first and then apply your retinol. If needed you can also apply a moisturiser -on top of your retinol i.e., a layer of moisturiser under and over the retinol.
Step 2: Wait a few minutes until your skin is completely dry. This is important, because if your skin is at all damp, the retinol will be able to absorb more deeply into your skin and might cause irritation. It is good to apply moisturisers and serums to slightly damp skin, but never retinol.
Step 3: Take a pea-size amount of your retinol and, starting at your chin, apply with your fingertips in upward and outward motions. Avoid lips and eye lid. Be careful with the neck area in the initial period of use.
Step 4: Finish with your moisturiser.
Step 5: Remember to apply a broad-spectrum sunscreen the morning after, to protect renewed skin cells from UV damage. Use a decent amount of SPF. A light layer will only offer a light protection.
Remember that it takes several weeks for your skin to adjust to the product, so it’s best to use it sparingly at first and gradually increase your use as time goes on. If your skin becomes dry or irritated, reduce application to every third night or even once per week. As with most skin care products, three months is required to see improvements in textural changes to start to become visible.
The Best Skin Care Products to Use with Retinol
When first starting a retinol regimen, or if your skin is sensitive, it’s best not to combine retinol with other potentially irritating ingredients, such as alpha or beta hydroxy acids or physical exfoliants and scrubs. The best product you can use in conjunction with retinol is a good moisturiser, which can help hydrate skin and reduce the risk of irritation from retinol. Some people prefer to mix their retinol with a moisturising cream to dilute it in the beginning.
If you want to use other active ingredients (such as vitamin C) as part of your skin care routine, consider using them at a different time of the day than when you apply your retinol product. Use your vitamin C in the morning to fight free radical damage and retinol, peptides, ceramides etc at night.
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