I basically called my mom for help. Except when I say mom, I mean an esthetician.
A couple of weeks ago, we talked about how a lot of the anti-aging cosmetics we see in stores are just moisturizers. However, that doesn't mean that true anti-aging ingredients don’t exist. There are a few products that can really go beyond prevention of signs of aging and actually reverse the aging of the skin.
I like to call the big anti-aging actives “the triumvirate,” or “the troika” if I’m in a Soviet mood. These three actives are retinoids, alpha-hydroxy acids, and vitamin C derivatives.
The most established of these anti-aging actives are retinoids, a group of compounds derived from vitamin A. This group includes tretinoin (brands like Atralin, Avita, Retin-A, Retin-A Micro, Renova), tazarotene (Avage, Tazorac), and adapalene (Differin).
First approved by the FDA as a treatment for acne 40 years ago, it quickly became apparent that retinoids went beyond acne treatment to make the skin as a whole significantly smoother, brighter, and less wrinkled.
Over the decades, retinoids have been the subject of well-designed medical studies that showed all kinds of uses for these compounds. They can reduce the number and depth of fine lines and wrinkles. They can prevent acne. They can fade hyperpigmentation and acne scars. They can unclog pores and reduce the appearance of pores. They can treat psoriasis and keratosis pilaris. And they are even used to treat certain types of skin cancer and precancerous cells.
Used correctly, retinoids can make a big difference in skin health and well being for a lot of people. Here’s what you need to know about how they work, the different kinds that exist, if they’re right for you, and how to use them.
How Retinoids Work
The group of compounds known as retinoids consists of slightly different types of retinoic acid, an acid already found in the human body. When used as a pharmaceutical, retinoic acid binds itself to switches inside of skin cells called retinoid receptors. This triggers the receptor to change how genes in the cell express themselves.
All kinds of stuff starts to change inside the cell, including how it grows, how much protein like collagen and elastin it makes, how much sebum it squirts out, and even the cell’s lifespan. Also, retinoids fight against a type of enzyme called matrix metalloproteinases (MMP) that run around eating collagen and elastin.
So retinoids “reset” the cell to make it start acting normally again, if it’s been off doing something stupid like producing too much oil or making the skin wrinkle.
If you zoom out of the cell and look at the skin as a whole, you can see the visual effect of this reaction. These changes on the molecular level have convinced the skin to break off its messed up outer layer and reveal healthier, better functioning skin underneath. This gets rid of ugly stuff on the surface like age spots, scars, and wrinkles.
This renewal is also happening faster than before, meaning that there is no time for sebum to sit around creating problems like acne or keratosis pilaris.
The Different Types of Retinoids
There are different types of retinoids that target slightly different cell functions.
- Tretinoin (Retin-A) is a first generation retinoid and is the best established all-purpose wrinkle/acne/pigmentation treatment.
- Isotretinoin (Accutane) is taken orally and is extraordinarily effective against acne, although it has serious side effects.
- Third generation retinoid tazarotene (Tazorac) may actually be a better wrinkle reducer than tretinoin, although more research is needed.
- Adapalene (Differin), also a newer retinoid, is a less irritating acne-fighter than tretinoin, although it may not be as effective against wrinkles.
The variation between different retinoid products doesn’t stop there, either. Another consideration what kind of goo it comes in. It can come in a gel format, which is less likely to clog oily skin. It can also be in a cream format, which can contain various levels of emollients.
The retinoid product might be a name brand, which can mean a higher quality cream or gel to prevent irritation or help better deliver the retinoid to the skin. Or it can be a generic product, which means cheaper prices.
All retinoid products are available at a wide range of concentrations. The concentration can influence how effective the product is, although there is not necessarily evidence that a stronger product works better. However, the concentration of a retinoid product will certainly influence the amount of irritation experienced as a side effect.
Vitamin A Ingredients In Cosmetics
There are also other ingredients derived from vitamin A, such as retinol, retinaldehyde and retinyl palmitate. These ingredients are a cosmetic ingredients, rather than pharmaceuticals. Their efficacy is not validated by the FDA like for retinoids.
The difference between retinol-type ingredients and retinoids is that retinol ingredients are not already in retinoic acid form. They have to be turned into retinoic acid by enzymes on the skin before they can trigger all the cool cell action we talked about earlier.
How much retinol-digesting juice you have on your skin is totally dependent on your personal body chemistry. If you have enough, these ingredients will work just like tretinoin. If you don’t, they won’t work at all. It’s kind of a crapshoot and really hard to predict.
Are Retinoids For Me?
As cool as they are, retinoids are not a product for everyone. They can cause a lot of irritation to the skin, especially right at the very start of treatment. They can make skin red, flaky, and sensitive. They can increase sensitivity to the sun. They can exacerbate other skin conditions like rosacea, and they may not be safe for pregnant or nursing mothers.
In the beauty world, we can get so excited by the cosmetic effects of retinoids that we can forget that they are medicine, not cosmetics. Whether or not you use a pharmaceutical like a retinoid should be entirely a discussion between you and your primary care doctor or dermatologist. The decision should be based on your skin health and nothing else.
For example, one of the major reasons why the medical establishment takes acne so seriously is because it represents a chronic irritation to the skin. Chronic irritation is bad news anywhere in the body and just as detrimental to skin health.
But if you were to start using retinoids to treat your acne and instead they just majorly freak your skin out, you’re just suffering from a different type of irritation now. The chronic irritation is just no longer from acne, it’s from your acne treatment. So it’s a zero sum game for your skin health.
If you are interested in retinoids, talk to your doctor. You shouldn’t try to use them without that initial consultation and suitable follow-up.
How To Use Retinoids
So let’s say that your primary care doctor or dermatologist thinks that a retinoid could help you treat your acne, acne scars, keratosis pilaris, wrinkles, or another skin problem. Hopefully he or she gave you a good idea on how to use it. If not, here are some tips on how to use retinoids.
The goal is to maximize the positive benefits of your retinoid treatment while minimizing irritation. Remember your stratum corneum, or horny layer?
Your retinoid is going to start eating away at that outer layer of your skin from the first time you apply it. It’s going to get the skin underneath ready to meet the world quicker, but you’re still going to be dealing with a broken-up stratum corneum.
This means flaking. Lots of it. Especially right at the start of your treatment.
To prevent excess flaking and to keep yourself from looking like a monster, you might want to ease into your retinoid application. You can play around with the frequency of application; maybe every other night, or every third night, until your skin can tolerate it without too much irritation.
No matter what you do, you need to apply your retinoid only at night. The reason is that retinoids are really photosensitive, which means they break down quickly in sunlight. They just won’t work if you use them in the daylight, which is just a waste of good product.
You should also be washing your face with a very gentle cleanser before you apply your retinoid. You can even just wash with water. The idea is to get rid of any excess sebum that would block the retinoid from getting down into the skin cells to work its magic.
Also, you should experiment with letting your skin dry after washing it and before applying your retinoid product. Waiting 10 to 30 minutes after washing will keep your skin from absorbing too much product. This should cut down on irritation.
Some people even suggest using a moisturizer right after washing, then waiting a good half an hour before applying the retinoids. This could be a good way to reduce irritation, especially if you use a light moisturizer low on occlusive agents so that the retinoid can still pass through to the skin cells. If you instead apply moisturizer after your retinoid, wait a few minutes to give the retinoid time to get into the skin cells before you put on moisturizer.
Make sure to use a very small amount of retinoid product--no bigger than a pea. It should be applied thinly and evenly over the area you want to treat. Retinoids are not spot treatments and could burn your skin if you glop them on over one area.
Be prepared for an increase in acne during the first couple of weeks on a retinoid. This is the “purge” you hear about--the upper layers of your skin is getting sloughed off, bringing underground acne infections to the surface. It should go away soon.
If you do get flaky, be careful with how you treat it. Mechanical exfoliation could really damage your skin in its vulnerable state. Try just gently washing your skin with your hands in the morning to try to slough off the flakes. Follow up with a moisturizer and sunscreen to protect your skin.
Be aware that retinoids do not play well with benzoyl peroxide, beta hydroxyl acids like salicylic acid, or alpha hydroxy acids like glycolic acid. Mixing the two isn’t going to light your face on fire, but neither will work correctly. If you are going to use one of these actives, you can apply it as part of your morning routine.
Above all, don’t wax hair off skin that is treated with retinoids. It can tear off part of your skin. It is terrible and gross and painful and please don’t wax retinoid-treated skin. I’ve done it. I’m trying to forget it.
Here is my nighttime skincare regime, which includes 0.1% tretinoin. I remove my makeup and wash my face with a gentle cleanser. After waiting at least 10 minutes, I apply the tretinoin cream. I follow up with the occlusive-free moisturizer after at least another 10 minutes.
If I'm in a hurry to get to bed, I skip the tretinoin. I would rather give my skin a break from the retinoid than risk irritating my skin by applying it too soon after washing my face.
But remember, your doctor's instructions trump everything that you read on the internet. He or she is best suited to advise you on your personal skin care regime.
Retinoids are considered the gold standard in anti-aging technology. There is new stuff coming out that is promising and exciting, but the big challenge for these new ingredients is, can it measure up to retinoids? The answer is usually no.
These pharmaceutical products are the antithesis of misleading luxury anti-aging creams that don’t do anything but cost a fortune. Retinoids work. And they're cheap, especially with health insurance.
Do you use a retinoid? What do you think of it?