Everything You Need to Know About Retinoids
Retinoids are a family of vitamin A derivatives that influence how skin cells grow, mature, and communicate. They're among the most studied topical treatments for acne, photoaging, and pigmentation. All retinoids are not equal with some barely making an impact in the texture, tone, clarity, and plumpness of the skin.
How Do Retinoids Work?
Retinoids bind to receptors in the skin and change the way genes are expressed. The evidence suggests that retinoids:
Increase skin cell turnover: Dead skin cells are shed at a rate closer to how young skin does, helping prevent clogged pores.
Reduce acne: Prevents microcomedones (the earliest signals of acne) from forming.
Stimulate collagen production: Helps improve the appearance of fine lines and skin texture over time by replacing lost scaffolding.
Normalize pigmentation: Helps fade post-inflammatory hyperpigmentation (PIH) and some forms of hyperpigmentation.
Most retinoids work by way of their conversion to retinoic acid. As the number of steps required for this progression increases, efficacy decreases.
Retinyl Esters → Retinol → Retinal (Retinaldehyde) → Retinoic Acid (Tretinoin)
Each conversion step reduces potency because the skin must metabolize the compound.
Retinol
Retinol is widely available and is often considered the introduction to retinoids, as it is less irritating than prescription strength options. Retinol has a conversion pathway in the body of: Retinol to Retinal to Retinoic Acid, and it takes several weeks longer to work than Retinal and Tretinoin. This mild strength retinoid is easier to tolerate, is readily available (in stores and online, no prescription needed), and is often considered a good starting point for beginners looking for less visible fine lines, hyperpigmentation and a smoother texture. Retinol is not known to be effective for treating acne. Users can expect mild results in two months.
Retinal
Retinal, also known as retinaldehyde, is stronger than retinol and weaker than tretinoin. It undergoes only one conversion step from Retinal to Retinoic Acid/Tretinoin. Although this molecule is less studied than Tretinoin, it is hailed as a great option for those who want a similar result to Tretinoin but do not want the often troublesome side effects. Some evidence suggests antibacterial activity against acne-causing bacteria with continued retinal use. With regular use, results are noticeable in about four weeks.
Adapalene
Adapalene stands on its own as a molecule that is not Tretinoin and does not require any conversion in the body. This synthetic retinoid is primarily used to treat acne because it works differently than all others listed here. It is very available to purchase, but it is not proven to aid in the treatment of fine lines, wrinkles, and pigmentation. Adapalene is very much designed to target acne alone, unlike other retinoids. Results are often seen after a month.
Tretinoin
Tretinoin is prescription only and not available over the counter at any strength. This is the active retinoid that requires no conversion in the body to work. It is considered the gold standard among the retinoids, as it is the most effective topical retinoid for photoaging and acne. Tretinoin is the most evidence-backed retinoid and produces the strongest long-term skin remodeling, but it can be irritating. Typically, a pea-sized amount is applied to the skin a few times a week as the initial dose, and the frequency is slowly titrated over several weeks. Results can be seen in as few as six weeks for acne or as long as a year or more for collagen remodeling.
What is Retinoid Purging?
With retinoid use comes increased cellular turnover, and microcomedones develop in acne-prone areas that typically break out. This process can last four to eight weeks. The stronger the retinoid, the more significant the purge tends to be.
To minimize irritation from retinoids, consider the following tips:
Always apply to dry skin, even when layering retinoids with other products.
Spacing out usage by initially using one to two times weekly and slowly increasing frequency based on skin behavior.
Sandwich retinoids by first applying a moisturizer, then the retinoid, and then an additional layer of moisturizer.
Avoid using other exfoliating or harsh ingredients when introducing retinoids. This includes glycolic acid, lactic acid, salicylic acid, and scrubs. Or consider using acids on alternating nights. Be sure to follow your clinician’s instructions.
Avoid the sun when possible. Wear a hat and sunglasses.
Apply the appropriate amount. More is not better. A pea-sized amount should be sufficient for face and submental areas.
Slow and steady increases in frequency and dose are the best route for skin retinoid acclimation (retinization).
Retinoids are a component of most well-thought skincare routines. Whether a 16-year-old boy is struggling with resistant acne or a perimenopausal woman desires the skin of her youth, retinoids can be the answer.
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