What are retinoids and how do they work?

What are retinoids and how do they work?

Retinoid is the family name for all vitamin A derivatives, both prescription versions such as tretinoin and adapalene, as well as over the counter (OTC, non-prescription) versions.

Three of the best-known non-prescription retinoids are retinol (vitamin A), retinaldehyde (retinal) and retinyl-palmitate (an ester of Vitamin A).

Retinyl-palmitate is the most commonly used retinoid in skincare, as it’s easiest to formulate. But it’s also my least favourite, as clinical effects are less good as with other vitamin A derivatives.

Both retinol and retinaldehyde are highly effective (and in contrast to prescription retinoids less irritating) over-the-counter alternatives to tretinoin and I often recommend them to patients.

Retinoids encourage collagen production and cell renewal and thus improve skin elasticity, firmness and fine lines. They also help reduce irregular pigmentation and refine skin texture, leaving the skin smoother and with a more radiant and even complexion. Retinoids also help repair past sun damage. Last, but not least, they can help regulate overproduction of oil, reduce breakouts and improve the appearance of pores.

Retinoids are among the best-investigated anti-ageing skincare ingredients on the market and ideally, everyone over 30 should be using one to support collagen production and a healthy dermal matrix.

However, while most skin types over 30 years of age would benefit from using a vitamin A derivative, its use can be limited due to tolerance issues, as these ingredients can be irritating for the skin. My tip is therefore to start slowly.

Start with just twice per week (preferably in the evening) and then gradually increase frequency of use, as tolerated. Be aware that any irritation might appear with a delay of a few days, so don’t increase to quickly!

People with more robust skin can tolerate them every day, once their skin got used to it, while people with very sensitive skin might just tolerate them twice per week, both of which is fine.

Vitamin A derivatives should not be used in pregnancy and breastfeeding.

Do retinoids thins the skin?

There is a misconception about retinoids, fearing that they may thin the skin. This is not true.

Retinoids do not thin the (living layers of the) skin. In fact, they have been shown to thicken the dermis, where our collagen and elastin live.

The misconception that retinoids thin the skin comes from the fact that they cause exfoliation, which means thinning of the stratum corneum, ie the horny layer (a dead cell layer on top of the skin). So, they only thin the dead skin layer on top, not the living skin (they thicken the living skin layers!).

Which are the best retinoid products?

My favourite prescription retinoid is tretinoin (for example in Ketrel cream).

The best OTC products depend on skin type and condition. Choose gentle products for dryer skin (eg Avene’s Physiolift Night Balm), medium ones for uncomplicated and combination skin (eg Medik8’s R-Retinoate) and stronger ones for oily skin (eg Skinceuticals’ Retinol 0.3-0.5%).

Which other skincare ingredients do retinoids work in concert with?

I always recommend to use vitamin A derivatives in combination with topical vitamin C product and a sun protection moisturiser with SPF30-50.

I try to integrate these three key ingredients (vitamin C, vitamin A and SFP 30-50) in all of my patients’ tailored skincare regimes. They are all three in my opinion absolute must-have ingredients for skin preservation, and thus keeping your skin beautiful and youthful looking.

Vitamin C is a true multitasker and must-have ingredient for everybody, as it is a great antioxidant and should be used every morning in any adult age! It neutralises reactive oxygen species, regenerates vitamin E, stimulates collagen production, reduces collagen-degrading enzymes and helps protect our skin from sun and pollution damage. Vitamin C is also a vital cofactor required for making the triple helix structure of collagen.

SPF filters protect from acute (sunburn) and cumulative (eg premature skin ageing and skin cancer) sun damage caused by ultraviolet A and B irradiation. If you’re committed to preserving your beautiful complexion, wear a broad-spectrum, SPF 30-50 sunscreen every day, even in the winter, there is no way around it for best skin preservation.

Normal UV filters however do not protect from infrared or visible light, which we now know can also harm the skin (that’s why adding topical antioxidants such as vitamin C is important).

Are there any active ingredients that retinoids shouldn’t be combined with?

That really depends on the skin type. Vitamin A derivatives are potentially irritating, so combining them with other potentially irritating ingredients such as glycolic acid or salicylic acid may push the skin too hard and may cause an irritant contact dermatitis.

However, having said that, if the skin is robust (eg in oily skin) and the ingredients not in too high concentration for that particular skin type, then it may be fine for certain skin types. So, it’s all very individual. Best to ask your cosmetic dermatologist to put together a tailored regime for you.

What in-clinic treatments can be added to further strengthen the skin?

Monthly regenerative treatments go really well with retinoid home use. These are treatments to help the skin to help itself. They encourage the skin to increase matrix components such as collagen and elastin, thus thickening the ‘backbone’ of the skin, the dermis.

Regenerative procedures help keep your skin beautiful and youthful looking. Having regular regenerative procedures is like joining a ‘skin gym’ to keep it fit and well long term.

Regular regenerative treatments keep the skin ‘happier’ on a cellular level, as they enable cells to behave more youthfully. This will ultimately slow down the ageing process by tackling the causes of premature skin ageing from the inside.

Popular regenerative treatments here at Eudelo are for example PRP and Exokine Needling, Carboxy Facials and no-downtime Laser Facials. Come and see us for a complimentary discovery consultation to find out more!

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Whether you have a medical skin condition which needs treatment or simply want to look your very best, our specialised dermatology team will help you achieve the very best result.