Retinol, Retin A, tretinoin…are they all they same? Are they different? Do they have to make you dry and flaky? Let me attempt to de-mystify what is, in my opinion, the second most important skin care product for basically every facial skin concern.
First, some science. “Retinoid” is the name of a group of compounds, either vitamin A or derived from vitamin A. There are lots of different versions of this vitamin A compound. To further confuse things, when a person is discussing a particular retinoid, they may be referring to an ingredient (like adapalene or tretinoin) or a brand name (such as Differin gel or Retin-A). As an analogy, a person might say, “I like vodka.” Or someone might say, “I like Grey Goose.” In this analogy “vodka” could be replaced by: adapalene, retinol, retinoid acid, tretinoin, and retinoid esters. “Grey Goose” could be replaced with Retin A, Differin, Altreno, Retin A Micro.
So what does this vitamin A derivative actually do? Retinoids increase cell turnover. It is a misunderstanding to say that retinoids “exfoliate” the skin. While that isn’t completely incorrect, it is incomplete. When we use a retinoid, whether it’s a prescription, over the counter, or medical grade, we actually slough off old dead skin cells and grow in new skin cells at a faster rate. One of the things that happens as we age is that our cell turnover slows. So I’m in my mid 30s, it takes me about 30 days for an old skin cell to slough off and a new healthy skin cell to take its place. I’ve read that when an individual is regularly using a retinoid, that time is cut in half to somewhere around 14 days.
So the prescription stuff works the best, right? Well, we know for sure that it does work. And it works for all kinds of fantastic things.
A 1996 paper found that pre-treatment of UV irradiated skin with tretinoin led to a decrease in collagen breakdown. You don’t want collagen to break down. Collagen is part of what I’m trying to replicate when I place injectable fillers to support tissue and decrease the appearance of aging. So something you can put on your skin to help decrease collagen loss is a great thing.
A 1990 paper showed increased epidermal thickness after using tretinoin 0.05% for 3 months. This is an interesting one because there’s a circulating myth that retinoids thin your skin over time. That’s related to the misunderstanding of how retinoids work. Yes, there is a noticeable sloughing off of old skin cells. The importance thing to remember is that there is a concurrent increase in the number of healthy, new skin cells that are surfacing. So rather than our skin thinning out with retinoid use, study after study shows that just the opposite is happening. That natural, dreaded thinning of the skin that increases with aging can actually be improved with retinoids.
A double-blinded study in 1991 showed that after 6 months of 0.5% tretinoin a statistically significant improvement in fine wrinkling, hyperpigmentation, roughness, laxity (sagging), and epidermal thickness occurred. There are multiple studies showing that dermal thickness actually increases starting after around 12 months of use. So somewhere between 3 and 6 months the very top layer begins to show signs of increased thickness, around 12 months the layer just underneath that also begins to demonstrate increased thickness. That’s the tough sell of retinoids. They are *not* a “quick fix.”
So that’s it, right? Why aren’t we all just on 0.05% of tretinoin? Well, I can answer that for myself. When I put 0.05% tretinoin on my skin, my face molts. Even 0.025% tretinoin, heck even just over the counter differin gel makes my face melt off. Luckily, there is another way for those of us who have a delicate flower for facial skin. (Or in my case atopic dermatitis, otherwise known as eczema.)
In a 48 week double blinded study in 1995 they actually discovered that 0.025% tretinoin seemed to have similar efficacy as 0.05% and even 0.1% with significant fewer side effects. So researchers have just continued to push the low-dose retinoid envelope ever since.
A 1997 paper showed that retinol similarly decreased UV damage, and increased collagen production with less transepidermal water loss, erythema and irritation than tretinoin. The only downside? Retinol is unstable, so the packaging and vehicle starts to matter. Retinol derivatives such as retinyl acetate, retinyl propionate, and retinyl palmitate have been developed in an attempt to remedy this issue. Unfortunately, a 1998 double-blinded study showed that retinol derivatives demonstrated no significant benefit over placebo (ie don’t work).
The last thing I’ll mention is a question I get all the time: “do retinoids make me more sensitive to the sun?” The answer is yes and no. There’s not some magic molecule in retinoids that makes your skin more likely to burn. It’s the natural result of the way retinoids work. You are asking your skin to please shed the gross, old top layer of dead skin cells. When this happens, your beautiful, glowing, healthy skin cells emerge. They’re just babies. They haven’t been crumpled and darkened by the sun. So if you don’t want them to turn out just like the skin cells you’ve been sloughing off, you do need to invest in some of the first most important skin care product - sunscreen.
(SKIP TO HERE IF YOU DON’T CARE ABOUT SCIENCE)
OK, so cliff notes? Retinoids can decrease wrinkles, hyperpigmentation (freckles, dark spots), roughness, laxity, and retinoids can increase collagen production and dermal thickness. You can get this effect potentially faster but with increased irritation by using a prescription strength retinoid like tretinoin. Or you can use an over the counter version and likely get similar results with fewer side effects but you’ll have to wait longer. That’s where I’ve found “medical grade skin care” to come in handy for me. I’ve used products like Neutrogena rapid wrinkle repair, and Olay retinal24, both of which my reactive skin tolerated and I enjoyed. But I used them for a couple months and didn’t notice significant improvement in measurable things like hyperpigmentation. I am confident that if I were patient to wait 12 months or more even those low strength retinol products would begin to show noticeable improvement. However, when I use a medical grade retinol I’m able to use a slightly higher percentage with less irritation, presumably because they’re adding fancy things to help mitigate the irritation. So if you know that your skin is not very sensitive/reactive, basically look at the ingredient list and find a retinoid product that lists “retinol” higher up in the ingredient list. I literally turned over a bottle of some retinol at the drugstore the other day and fragrance was listed higher in the ingredient list than retinol. (If you didn’t know, the higher up an ingredient is the more of it is in the actual product.) If you have more sensitive skin or don’t want to deal with irritation, either purchase a retinoid that lists retinol lower in the ingredient list, or adds soothing ingredients to help calm down potentially associated irritation.
TLDR: pick a retinoid and put in on your face.
Be well and love your face,
Kari Knight FNP-C DCNP