Retinol, Retin-A, Retinoids, oh my…
RETINOL, RETIN-A, RETINOIDS – WHAT’S THE DIFFERENCE?
Retinols have long been touted as one of the most effective treatments for increasing collagen in the skin, reducing fine lines and wrinkles, fighting acne and evening out pigmentation. They are the best-studied and most-evidence-backed topical medications for reducing the visible signs of aging due to sun exposure. They are often touted as the gold standard of anti-aging skincare.
Retinoids stimulate collagen synthesis. The more collagen we have, the younger we look. Now there are other benefits of retinoids such as reducing acne, improving hyperpigmentation, unclogging pores, exfoliating the skin, reducing fine lines and wrinkles (and many more!).
WHAT ARE THE DIFFERENT TYPES?
The term “retinoid” is an umbrella term – it refers to anything in the vitamin A derivative family. Retinol is a retinoid. Retin-A is a retinoid. Tretinoin is a retinoid. You get the point. Retinoids come in many different forms and strengths, which is the part that can get confusing. Below is a chart listing the retinoid hierarchy. The lower the strength, the less collagen stimulation. The higher the strength, the more collagen stimulation. The more collagen stimulation, the younger your skin looks with less fine lines and wrinkles.
SHOULD I BE USING THE HIGHEST STRENGTH RETINOID?
Retinoids can be very irritating to the skin if not used properly. The higher the strength, the more skin irritation (redness and peeling), the lower the strength, the less skin irritation. So, then it becomes a balancing act – finding the highest strength that causes the least skin irritation. The best way to start on a retinoid is to start at the bottom and gradually work your way up. I suggest starting with a retinaldehyde.
RETINOL
The lowest (and thus least effective) type of retinoid is retinol. This is what you will find “over-the-counter” - if you’re buying products from Sephora, Blue Mercury, Ulta, or any other store that isn’t a provider’s office, it will be a retinol. It usually comes in a couple of strengths - commonly 0.5 and 1.0 - but is still less potent than any other retinoid on the market. Surprisingly, many people still get skin irritation from retinol, even though it’s a very low dose.
RETINALDEHYDE
One step up in strength from retinol is retinaldehyde. If you are not currently on a retinoid, I suggest you start here. Retinoic acid is the ONLY form of vitamin A our skin can actually use. For examples, if you have a product which contains retinol, it needs two rounds of conversion before it turns into retinoic acid (first to Retinaldehyde and then to Retinoic acid) and one for Retinaldehyde. During the conversion, it is not clear as to how much of the retinol was eventually converted in the oxidation process (i.e. the retinol may not be 100% converted into retinoic acid). Therefore, the fewer the conversion steps it takes to get to retinoic acid, the stronger the retinoid.
RETINOIC ACID
The strongest type of retinoid is retinoic acid. It is associated with the most collagen stimulation but the highest potential for skin irritation. For this reason, retinoic acid is considered a drug by the FDA and requires a prescription to obtain, with the exception of Differin (the lowest form of retinoic acid) which was approved to sell OTC a few years ago. There are several forms and strengths of retinoic acid including adapalene (Differin), tretinoin (Retin-A), and tazarotene (Tazorac), among several others. There is a big difference in strength between these forms, so being under a provider’s supervision is key.
WHERE DO I START?
If you’re unsure of where to start, I recommend starting with SkinBetter Science AlphaRet Overnight Cream. This product contains ethyl lactyl retinoate (a proprietary blend of lactic acid and retinoids that exfoliates and boosts collagen production); 10% glycolic acid, squalane, niacinamide, ceramides, and fatty acids (moisturize). This is a great option for dry skin, sensitive skin, reactive skin, and/or those suffering from rosacea. Not only does it feel amazing, but you will no doubt notice an improvement in your skin tone and texture. Just trust me on this one!
AlphaRet Overnight Cream also comes in Intensive if you’re wanting more bang for your buck with 18% glycolic and AlphaRet Clearing Serum for oily and acne prone skin with salicylic acid.
If you are currently on a retinoic acid such as tretinoin 0.025% a few nights a week, you can gradually increase frequency as tolerated. Once you’re able to tolerate it every night with no irritation, I recommend bumping up to the next strength, in this case tretinoin 0.05% a few nights a week, and so on. If you are interested in starting on tretinoin or another retinoic acid product, your primary care doctor or dermatologist can prescribe it at your next office visit.
FREQUENTLY ASKED QUESTIONS:
When should I apply my retinoid? Retinoids should be part of your nighttime routine and are not meant to be used during the day. The sun’s UV rays inactivate retinoids, so using it during the day is a waste of the product as it will be ineffective. Since your retinoid is likely your most active product in your routine, it is best if applied first thing at night 10-15 minutes after cleansing.
How much should I use? Only use a pea size amount of retinoid should be used and should fit on the tip of your pinky finger. Using more than this will just cause more skin irritation.
Are there any products that can’t be used with retinoids? It is a common misconception that you can’t use retinoids with other products such as AHA/BHAs, vitamin C, hyaluronic acid, etc. Retinoids can be used with all other skincare products - including glycolic acid, salicylic acid, vitamin C, hyaluronic acid, and everything else you may want to use.
Can I use my retinoid on other parts of my body such as my neck? YES! I highly recommend it! Any skincare you apply to your face, I recommend also applying to your neck, chest, and hands. There’s no point in your face looking 30 if your neck looks much older.
Can I use my retinoid around my eyes? Yes - however due to the thin skin surrounding the eye, most retinoids can be too harsh for this area and cause significant irritation. I always recommend using SkinBetter EyeMax AlphaRet Eye Cream on the eye area, even if you’re using a stronger retinoid on the rest of your face. SkinBetter EyeMax is more potent than retinol eye creams and tolerated much better.
What age should I start using a retinoid? Because retinoids are the #1 product for treating acne, many teens are put on retinoids at a very young age which means they are also getting the anti-aging benefits of it, too. Anyone 20 years and older can benefit from a retinoid.
Do retinoids cause your skin to purge (break out)? Products that increase the rate of exfoliation are often associated with purging - these types of products include hydroxy-acids (glycolic and salicylic acid) and retinoids. All the junk in your pores is being pushed out all at once instead of slowly over many months. While this may be unfavorable in the short term. once you get past the purging process, your pores will be junk free and your skin will be better than ever! This phase typically lasts anywhere between 2-6 weeks but can last up to 8 weeks in some individuals.
Do retinoids thin the skin? They actually do the OPPOSITE! Some think that since retinoids exfoliate the epidermis they must be thinning the skin, but the fact is retinoids thicken the dermis due to new collagen growth.
Can I use a retinoid if I am pregnant or nursing? Most OB-GYNs recommend coming off your topical retinoid while pregnant or nursing. While you're pregnant, you can use Bakuchiol as a retinoid-alternative since it has very similar effects as retinoids but is safe for baby!
Do I need to take a break? Absolutely not! You already went through an adjustment period when you acclimated to your retinoid the first time, coming off and restarting would only start that process all over again! There is no reason you should do a “retinoid break”.
What if my skin is too red and irritated? If your skin is inflamed (red, hot, tender, irritated, etc), I recommend holding off on using it again until the irritation has subsided and start back up a couple of times a week and work up to every night again. However, if your skin is just dry and flaking and you’re fine to “push through” the peeling process, there is no need to take any nights off between use.
Should I come off of my retinoid in the summer? The most important part of using a retinoid is also using an SPF. Retinoids can make your skin more sensitive to the sun, so wearing your sunscreen is very important. If you are wearing a hat and sunscreen, you should have no problem continuing your retinoid during the summer months.