All About Retinoids: Why You Want Them, How They Work and How I Use Them

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All About Retinoids:  Why You Want Them, How They Work and How I Use Them

Over the years I've written a series of posts on this site about skincare that I refer to over and over, and one of my most referenced posts, all about retinoids and how they work, has somehow become sadly out of date. I can't believe it's been 8 years since I wrote that post! Somehow the blog is almost 10 years old, and time has flown by.

I had already decided that it was definitely time for an update when I was asked by RoC Skincare if I would partner with them to write a post to help educate about retinoids. Here's where I disclose that yes, I'm a RoC Ambassador (they send me products and I have access to education about skincare, I don't get paid for this), and they're sponsoring this post. But I also want to disclose that the reason I agreed to become a RoC Ambassador is that it's the retinoid cream I use myself. Even before I became an Ambassador, I had been buying their products for years, they were recommended to me by a dermatologist friend as a great over the counter retinoid, and it works great for my sensitive skin. So, I've been one of their Ambassadors for years, and yes, I do still spend my own money on their products.

So, the big question is "why is everyone always so excited about retinoids?"

There's a good reason. They're really considered the Gold Standard for a topical, anti-aging skincare product. In study after study, retinoids are the ingredients that have helped reverse fine lines, wrinkles, even out skin tone and they even help acne. They have the most evidence, and their results are better than other active ingredients.

"Retinols and retinoids are BY FAR the best ingredients in dermatology, and especially when it comes to anti-aging. They stimulate increased cell turnover and remove the excess debris that clog pores. I like to refer to this as the 'detoxing' phase of skin rejuvenation. Benefits include evening out skin tone, decreasing acne, shrinking pores, decreasing redness, improving hyperpigmentation, increasing cell turnover, and most importantly, stimulating collagen which improve the appearance of wrinkles. Bottom line - everyone should use them!"
-Dr. Dhaval G. Bhanusali, a dermatologist in New York City.

Read on to learn more about how retinoids work, things to watch out for, and how I incorporate this magical active ingredient into my skincare routine.


retinoids
Image: WikiMedia

What are Retinoids?


Retinoids aren't just one ingredient, instead it is a huge collection of ingredients that are chemically related (and can often interconvert amongst themselves once on the skin). Initially, they were all derivatives of Vitamin A, but as the compounds have become more advanced a retinoid has come to mean any compound that can act through the retinoic acid receptor (which is a naturally occurring Vitamin A metabolite).

Some names you might recognize:

• Beta-Carotene
• Retinol
• Retinoic acid
• Retinyl Palmitate
• Retinyl Esters
• Retinaldehyde

Some of these forms are only available via prescription from your doctor. The most common forms you'll see available over the counter are retinol and retinyl palmitate, both of which are converted in the skin to all-trans retinoic acid before they are active. Retinol generally does this a bit easier than retinyl palmitate, which is part of the reason why it is thought of as a bit stronger, both in terms of efficacy and side effects. Retinol has also been found to penetrate into the skin more easily than other over the counter retinoids.

How Retinoids Work


What is perhaps the most interesting thing about retinoids (at least to me) is that they don't work just one way. No. They like to be complicated and do a ton of things to your skin. I'll go over some of it here, but if you want to cut to the chase then skip down to the next headline, Long Story Short.

What Happens at the very Micro Level:
1.) Through the Retinoid Receptor
It's easy to say that there's a retinoid receptor, but the real story is that there are many retinoid receptors, and they're in fact divided into two major categories, the retinoic acid receptors (RARs) and the retinoid X receptors (RXRs), and from there they are further subdivided into types.

In general, what happens is that the retinoid compound binds with a protein, cellular retinoic acid binding proteins I and II (CRABP I and II) or cellular retinol binding protein (CRBP), and then in turn those together act on the receptor, and then the whole thing works to affect how the cells behaves. In general, they either increase the activity of certain genes or decrease the activity of certain genes.

2.) Via Matrix Metalloproteinases (MMPs)
MMPs are enzymes found in the skin that break down collagen and other structural skin molecules, and they are increased in the skin after exposure to UVB waves from the sun. In addition to increasing the amount of degrading enzymes in the skin, UVB radiation directly decreases the skin's production of collagen within 24 hours.

With application of a retinoid, the skin produces less MMPs after sun exposure. And pretreatment of the skin with a retinoid also prevents the decrease in collagen production. So, skin continues to make collagen at the same rate and won't make as much of the degrading MMPs.

What this Means for the Skin:
It's easy to say that the retinoids act upon the cells to turn certain genes on and off, but what are the overall results of those changes? And what does that mean for your skin's overall health and appearance?

Retinoids cause the cell to increase your thickness of the epidermis, increase collagen production and decrease collagen break down through decreased production of those MMPs. They increase cell turnover as well, so your skin is better able to exfoliate on its own, but it also produces more new skin cells. This in turn helps to even out skin tone over all. The skin also decreases sebum production.


How Retinoids Work: Long Story Short


Once again, we should just read what Dr. Bhanusali had to say, "they stimulate increased cell turnover and remove the excess debris that clog pores. . . Benefits include evening out skin tone, decreasing acne, shrinking pores, decreasing redness, improving hyperpigmentation, increasing cell turnover, and most importantly, stimulating collagen which improve the appearance of wrinkles. Bottom line - everyone should use them!"


Things to Watch Out For


Almost everyone gets side effects from using a retinoid, but the good news is that they can be managed, and over time they seem to decrease as your skin adjusts to using the retinoid. As well, newer retinoid compounds seem to have less severe side effects, and over the counter retinoids tend to be easier to tolerate (though it can take a little longer to see benefits).

The main issues will be skin irritation, with dryness, scaling of the skin and even redness. This is especially true with higher concentrations or more effective forms. You can combat this by decreasing your use of the retinoid, think using it every other day or even on an every third day schedule. Let your skin tell you what it can handle.

"Retinols and retinoids can certainly take some time getting used to. I generally have my patients use them every other night to start with copious moisturizer use before and after application. Over 3-4 weeks, I have them start increasing it to nightly as tolerated but again, with aggressive use of moisturizer applied directly before and about 20 minutes after, as well as every morning, with an spf 30," says Dr. Bhanusali.


 photo how-to-use-skincare-retinoid.jpg

How I Incorporate Retinoids Into My Skincare Routine


I've been pretty open here on the blog about my rosacea. I haven't always had it, but now that it's here, I do need to be careful with the products I use on my skin. I easily develop redness, irritation and that leads to added blemishes for me. For most people with rosacea, using a retinoid is a big no-no. However, my rosacea is rather mild, and I've found that my skin can tolerate RoC's Retinol Correxion line without any issues. I use a combination of the regular products (my AM lotion with SPF) and the Sensitive line.

What I currently use:
• RoC® RETINOL CORREXION® DEEP WRINKLE DAILY MOISTURIZER WITH SPF 30 (at CVS or Walgreen's)
• RoC® RETINOL CORREXION® Sensitive Eye Cream (at CVS or Walgreen's)
• RoC® RETINOL CORREXION® Sensitive Night Cream (at CVS or Walgreen's)

I'm currently using the Deep Wrinkle Daily Moisturizer and Sensitive Eye Cream each am right after I wash my face. I typically let them sink in a bit, and then apply a BB Cream over the top for added SPF coverage and as my foundation coverage. At night, I wash my face, apply my rosacea prescription medication, and then the Sensitive Eye Cream and Sensitive Night Cream. Once those have had a few minutes to absorb into my skin, I apply moisturizer over the top.

Because of my rosacea, I pay very close attention to the level of redness and irritation in my skin. There are a lot of things that can trigger a flare in my skin, such as too much time out in the sun. If I'm noticing that my skin is irritated, I back off on all of my RoC products to every other day, and within a day or two I've noticed that my skin is back to normal.


Additional Things to Know


There are a few additional points that I want you to know about retinoids, but they didn't necessarily fit into the categories above very easily.

1) You need sunscreen: In the past, the traditional teaching was that retinoids make your skin more sensitive to the sun and you need to be sure to protect it by using a daily sunscreen. There have been a few studies that found this wasn't the case, but many dermatologists still teach this to their patients. Because even if the retinoids aren't making your skin more sensitive to the sun, you shouldn't be using that as an excuse. You're using the product to fight aging, and one of the best things you can do to prevent further aging is to use a sunscreen. So use one!

2) Retinoids aren't just for anti-aging: Retinoids were actually first being studied to treat acne, and their anti-aging benefits were found somewhat by accident. According to Dr. Bhanusali, retinoids "help for hyperpigmentation, acne, and sometimes I have my patients with psoriasis mix it into their treatment plan to help improve recalcitrant lesions." So, those retinoids have a lot of great benefits!

3) When to skip the retinoid: I just got done telling you how wonderful they are and how we should all use retinoids, but there are some times you shouldn't be using them. If you're pregnant, or trying to become pregnant, you should avoid them. If you're undergoing laser treatments or if you're waxing, you should skip retinoids before your treatments for a week or so.

4) Retinoids are fragile things: Retinoids are pretty easily inactivated. That's actually one of the reasons I like RoC, it was created in France by a pharmacist and dermatologist, and they were the first create a stable retinoid and a package to keep it that way. Retinoids are inactivated by exposure to light, air, and temperature extremes. I always look for a tube to apply product rather than a jar, and it needs to block out all light. Be sure to replace your skincare after a year if you have any left, it likely is no longer active at that point and you need a fresh tube of retinoid cream.

5) One step isn't better: I'm all for saving time, and whenever I can I will use 1 product that can multi-task and do a couple of tasks. The exception is my retinoid. Since my skin is sensitive, I do sometimes need to skip days with my retinoid. Especially in the spring and fall, when the change in season means I'm using my retinoid every other night or every third night, it is much easier to have my retinoid as a separate product from my nightly moisturizer. I use the retinoid or I don't use the retinoid, I don't need to readjust all of my other products.


Product Sent for Review, Sponsored Post, I Bought It
Lots of disclosures were mentioned in the post, but I'm going to mention it again. I'm a RoC Ambassador (they send me products and I have access to education about skincare, I don't get paid for this), and they're sponsoring this post. But I also want to disclose that the reason I agreed to become a RoC Ambassador is that it's the retinoid cream I use myself. I had already been buying their products for years, they were recommended to me by a dermatologist friend as a great over the counter retinoid, and it works great for my sensitive skin. So, I've been one of their Ambassadors for years, and yes, I do still spend my own money on their products!

4 comments

  1. Since it's sort of a retinoid... Would you be willing to do a post about Differin becoming available OTC? I used it successfully in my 20's but I wonder about its suitability for my middle-aged hormonal acne and clogged pores. Could you also talk about combining it with AHAs/BHAs and vitamin C? Thank you!

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  2. Thanks for the post. I'm a skincare junkie and science geek so this information was very interesting.

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  3. @Rebecca Since I work pretty much only in the ICU, Differin isn't a med I've used in about 10 years or so (that's when I was a gen peds resident and would sometimes prescribe it for acne). I asked a good friend to ask her husband about it (he's derm) when we found out it was going OTC. Because there are so many different retinoids out there, and they all vary so much in their efficacy, there isn't a way you can easily compare a %of this vs a % of that... So, the derm said he thinks that it will be helpful for acne, but not so much for anti-aging. Differin is low on the strength spectrum, so it can be good for acne, but not so much for aging. And of course it all depends on your skin, how much you're able to handle.
    As for combining with other ingredients, retinoids and AHA/BHAs aren't always a good combination. They can inactivate each other, but if they don't then you also need to worry about too much skin irritation as all of those ingredients can be irritating to the skin. A small amount of AHA/BHA in your night cream for example shouldn't be an issue, I usually do a weekly at home peel and do that on a retinoid "off night". Vitamin C can be mixed in there pretty much wherever you want as far as I know, nothing really convincing that in actual use it needs to be spaced out from the others.

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  4. This is a super helpful resource. Thanks for sharing!

    ReplyDelete

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