12 November 2021
Retinoids/ retinol/ retinoic acid- While we’re spending more time at home, it’s a good time to relook at your skincare routine and perhaps, experiment with products and ingredients you’ve been thinking about. One skincare ingredient that I would recommend is: retinoids. Retinoids or vitamin A take it back to basics for your skin while combating acne, pigmentation, rough skin texture, clogged pores and fine lines.
Over and over again, you’ll hear and read that doctors recommend retinoids for anti-aging and age-proofing skin. This is because there’s a lot of data to prove that vitamin A speeds up cell turnover and increases collagen production in the skin. At the same time, retinoids are a skincare ingredient that’s feared and mysterious by many. Google “Retinoid Uglies” and you’ll understand.
When I first started on retinoids for age-proofing my skin a few years back, I also experienced redness, peeling and irritation. It took almost a year for me to finally tolerate using retinoic acid (tretinoin). My personal retinoid experience was a journey that demanded patience and taking a step back on some days. I’m now using retinoic acid (tretinoin), the most potent form of retinoid. This journey has paid off for me; especially now that I can’t get my lasers and peels at my clinic because of Circuit Breaker.
In this review on retinoids, I’ll be discussing what you need to know about this skincare superhero before you get started. If you’re confused about the differences between retinols vs retinoids and whether retinoids are safe, this guide will answer these questions as well. Plus, I’ll be sharing tips on how you can avoid the much dreaded side effects of purging and retinoid dermatitis. If you would like to know about my product recommendations, please read 5 Affordable Popular Retinoid Serums Reviewed.
Retinoids is the family of compounds derived from vitamin A. You may have heard of retinol, adapalene and retinoic acid- these are examples of retinoids. Not all retinoids are equal. Within the different retinoids are pharmacological differences that affect their behaviour and results on the skin.
Of all the retinoids, retinoic acid (tretinoin) is the only natural form of retinoid that the skin can utilise. All the other types of retinoids- retinyl, retinol, retinaldehyde- are precursors of retinoic acid. In other words, retinyl, retinol, retinaldehyde need to be converted to retinoic acid to work on the skin.
Retinoic acid (tretinoin) is the natural and most potent retinoid. It was also the first retinoid to treat skin aging, with concentration of 0.05% showing improvements1-3. Compared to retinol, retinoic acid (tretinoin) is 20 times more powerful4.
In Singapore, retinoic acid (tretinoin) needs to be prescribed by a doctor.
Retinyl, retinol and retinaldehyde are converted back to its natural form i.e. retinoic acid by enzymes in the skin in this same order. These retinoids are ‘milder’ than retinoic acid (tretinoin) but are also effective in treating aging in the skin.
The results of using retinyl, retinol and retinaldehyde may be slower, but are useful for avoiding the main side effect of retinoids: retinoid dermatitis.
More about the retinoid dermatitis and the side effects of using retinoids; and my tips on how to avoid them will be covered in later sections of this post.
A new retinoid that’s got everyone excited is Trifarotene (Aklief). Trifarotene/ Aklief is the first retinoid to receive US FDA approval for treating acne vulgaris on the face and trunk (chest, shoulders and back) in 2019.
So far, Trifarotene/ Aklief has been shown to be a safe and effective treatment for facial and truncal acne vulgaris. It is a fourth-generation retinoid that acts on the gamma RAR receptors with greater specificity than tretinoin. This means that Trifarotene/ Aklief is potentially gentler on the skin, with lesser likelihood of side effects. In turn, Trifarotene/ Aklief can be used over larger surface areas (e.g. back, neck, chest) with lower skin irritation or retinoid dermatitis.
For acne sufferers who are struggling with using tretinoin, sensitive skin and truncal acne, Trifarotene/ Aklief is a potential alternative. Currently, Trifarotene/ Aklief is available in 0.005% concentration; but it is not available in Singapore. I am very excited to tryTrifarotene/ Aklief out for myself to see how it compares against the OG, tretinoin. Afterall, many new retinoid alternatives like Bakuchiol and Ethyl lactyl retinoate have failed to live up to the hype.
Quite simply, retinoids increase cell turnover in the skin and increase collagen levels in the skin1-9. These changes translate to smoother, brighter and healthier skin1-9. The exfoliation effect also removes clogged pores, so retinoids improve acne and reduce scarring.
Retinoids also build collagen in the skin and reduce fine lines and wrinkles. Long term use also improves thickness (which thins with age)4,9. Hence, retinoids are powerful ingredients for treating a good number of conditions including acne, photoaging, rough skin and fine wrinkles. You’ll find that retinoids or vitamin A consistently appear among doctor’s recommendations for these conditions. Compared to newer buzzwords like copper peptides or DNA, the data and evidence that support the benefits of using retinoids are a lot more robus1-9.
Retinoid dermatitis, retinization and retinoid uglies
One of the most common side effects of using retinoids is retinoid dermatitis. It is also called retinoid uglies- google it to see what it looks like if my selfie above is not a clear depictioin. Retinoid dermatitis is a specific type of irritant contact dermatitis related to retinoid use. It is characterised by redness, peeling, burning sensation, itching, scaling and increased sensitivity in the skin10,11.
Retinoid dermatitis or retinization is temporary; and it occurs as your skin is getting adjusted to retinoids. The discomfort lasts 1-2 weeks11,12. Not everyone experiences the side effects of retinoid dermatitis or purging. If you start on stronger retinoids like tretinoin without getting your skin retinized, these side effects are more likely to occur.
Purging and acne flare
Purging or an acne flares can also occur initially with retinoids13,14. This usually occurs in the first two weeks of starting retinoic acid (Tretinoin).
For both retinoid dermatitis and purging, the discomfort will settle with continued use. These usually happen with retinoic acid (tretinoin). If you use the retinyl, retinol or retinaldehyde, these side effects are less likely to occur. Later in this post, I’ll share with you how you can overcome these side effects.
Oral retinoids (Isotretinoin) have been shown to cause serious birth deformities if taken during pregnancy. The manufacturers of topical retinoids recommend that topicals should be avoided during pregnancy and breastfeeding due to a lack of conclusive safety data.
If you are pregnant or breastfeeding, there are other alternatives for you. Check in with your doctor to know what’s safe.
Since we’re spending more time at home because of Circuit Breaker; and there are no lack of filters to hide any retinoid uglies, now is a good time to get started on retinoids. Retinoid dermatitis and purging/ acne flare ups typically last over 2-4 weeks, so if you’ve been thinking about starting retinoids; this period of WFH/ isolation/ quarantine should suffice and you’ll emerge with healthier, younger and radiant skin. The aim is to work your skin up to using stronger retinoids more frequently without side effects. My personal goal was to use the strongest retinoid available in Singapore on alternate nights. It took some patience and a few lessons but I finally am able to do so!
Here’s what you need to know before, during and after you start retinoids.
Tip #1: Make sure your skin is suitable for retinoids!
Retinoids are powerful exfoliants that slough off the top layer of the skin to get smoother and brighter skin. If your skin’s barrier is damaged, due to say, conditions such as eczema flare or psoriasis, wait till your skin has healed before starting retinoids. When the skin barrier is compromised, the skin is more sensitive and vulnerable to irritation. Using retinoids during this time increases the risk of retinoid dermatitis. Two alternatives to retinoids that can brighten and age proof your skin are vitamin C and Bakuchiol
Tip #2: Start gentle and plan ahead
Retinoids will pay off, so please be patient. Retinoid dermatitis can be very uncomfortable and irritating, especially you start on prescription grade retinoids (retinoic acid/ tretinon) without getting your skin acclimatised.
I recommend starting with lower potency retinoids like retinols, before moving up to retinaldehydes or prescription grade retinoic acid (tretinoin). Retinols at concentrations of 0.3-0.5% are a good starting point. Once your skin has been retinized, you can move up to a higher concentration or higher potency retinoid. You can find retinol creams and serums of this concentration over the counter. I would recommend trying them on alternate nights. Gradually increase the frequency if your skin tolerates well to finally use retinoids every night.
When it comes to trying retinoids, avoid attempting near social events. If you are recovering from retinoid dermatitis or purging, it may be hard to conceal with makeup.
Tip #3: Consider newer retinoids
Newer retinoids are an alternative to bypass the side effects of retinoids. One example is granactive retinoid for anti-aging and improving skin texture. Granactive retinoid (hydroxypinacolone retinoate) is a newer generation retinoid that seems to cause less irritation. Granactive retinoid is relatively new and there aren’t enough studies to recommend it as a first line treatment for acne for now.
If you have acne, the situation is more complex than treating anti-aging, rough texture or dull skin. Before you decide to change your medications or escalate, please check in with your doctor.
Tip #4: How do I increase the strength of my retinoid?
The key to moving up the retinoid potencies is to reap the maximum benefits while avoiding side effects. This can be achieved by making sure conditions for your skin are right and gradually increasing the potencies (i.e. retinyl → retinol → retinaldehyde → retinoic acid) , concentrations and frequencies of your retinoid use.
How do you know if you’re doing it right? My tip is to observe your skin for 2-4 weeks before escalating your retinoid potency/concentration/ frequency use. If your skin is tolerating well, and you do not experience any symptoms from retinoid dermatitis like dryness and peeling; you can safely increase your retinoid potency/concentration/ frequency. However, if your skin experiences burning, redness and peeling, your skin is not ready for escalation. Take it down a notch again and let your skin recover before adjusting your retinoid use.
Tip #5: Use retinoids at night
Most retinoids are used only at night as sunlight oxidises the active ingredient. Some retinoids are light stable which allows them to be used in the day. Check the manufacturer’s instructions before using retinoids.
Retinoid dermatitis and purging are temporary and cease in a few weeks. Here are some skincare tips to help reduce retinoid dermatitis and purging/ acne flares. The key is to start introducing retinoids gradually.
Treating retinoid dermatitis
• Stop or scale down the retinoid. Retinoid dermatitis usually occurs with tretinoin, so start with retinols or retinaldehydes first.
• Moisturise and use ingredients that protect the skin barrier to reduce skin irritation and sensitivity. Examples of these ingredients which improve retinization are hyaluronic acid, ceramides and niacinamide.
• Avoid skincare that could compromise the skin barrier e.g. physical or chemical exfoliants; these worsen the dermatitis.
• Severe cases of retinoid dermatitis may require steroids.
Treating purging/ acne flares
Acne flares/ purging are due to the pre-pimples in the skin being expelled out of the skin. This makes the acne condition worse before improving.
• Medications can help to reduce purging- check with your doctor to know if you are suitable for these.
• Acne treatments like Q-switched laser and LED light are useful. These treatments reduce inflammation and P.acne bacterial count.
Treating acne is much more complex than treating conditions like dull skin and photoaging. Before you change your medications, check in with your doctor first.
Include skincare products that moisture and improve the skin barrier. As previously mentioned, hyaluronic acid; ceramides niacinamide and cica are a good addition to also reduce skin irritation.
When you are using retinoids and especially if you are experiencing retinoid dermatitis; avoid physical scrubs and acids in your skincare products. Last but not least, sunscreen is an absolute must if you’re using retinoids.
Before you dismiss retinoids, please take note that retinoids take time to work. The results can take 2 weeks to 12 weeks after starting retinoids for anti-aging15. So do not give up if you do not see results yet.
If your pigmentation, wrinkles, dull skin and acne do not improve, it’s about time to consider alternatives or get some help from your doctor to improve your results
Some of the treatments that can help to lighten pigmentation, brighten dull skin and treat acne are a combination of Q-switch lasers and chemical peels.If you have fine lines and wrinkles, dermatological treatments that build collagen like fractional CO2 laser, Profhilo and Rejuran Healer reverse these signs of aging.
Retinoids are a useful ingredient to brighten and improve skin texture and combat aging and acne. If you are new to retinoids, start with lower potency ones such as retinol and retinaldehyde (I personally find retinyl too mild) and increase the concentration and frequency of use gradually before using prescription grade retinoic acid.
When you first start using retinoids, you may encounter retinoid dermatitis or purging as your skin gets adjusted to retinoids. This process of retinization is temporary and the key is to go slow and work your way up. This can be avoided by starting on milder retinoids like retinol first and not starting with retinoic acid when you first begin. You can also minimise these side effects by using retinoids when your skin barrier is well and pairing with skincare products that moisturiser and protect the skin barrier. My personal favourites are ceramides, hyaluronic acid and niacinamide.
I hope that this beginner’s guide to starting retinoids was helpful in understanding the basics about vitamin A. Retinoids are a tried and proven anti-aging ingredient frequently recommended by doctors; and I’m a personal fan. It’s a little tricky when you first get started so I hope that my tips and experience will help you bypass the dreaded side effects of retinoids. Do you already use retinoids? What is your journey like? Do you have a retinoid product you love?
1. Topical tretinoin for photoaged skin. Kligman et al. J Am Acad Dermatol 1986; 15: 836–859.
2. Isotretinoin improves the appearance of photodamaged skin: results of a 36-week, multicenter, double-blind, placebo-controlled trial. Maddin et al. J Am Acad Dermatol 2000; 42: 56–63.
3. The role of retinoids in the prevention and repair of aged and photoaged skin. Griffiths. Clin Exp Dermatol 2001; 26: 613–618.
4. Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments. Malwina and Budzisz. Postepy Dermatol Alergol. 2019 Aug; 36(4): 392–397.
5. Profilometric evaluation of photodamage after topical retinaldehyde and retinoic acid treatment. Creidi et al. J Am Acad Dermatol 1998; 39: 960–965.
6. Topical retinaldehyde on human skin: biological effects and tolerance. Saurat et al. J Invest Dermatol 1994; 103: 770–774.
7. Topical retinoids in the treatment of photoaging. Stefanaki et al. J Cosm Dermatol 2005; 4: 130–134.
8. The role of topical retinoids in the treatment of photoaging. Stratigos and Katsambas. Drugs 2005; 65: 1061–1072.
9. Topical Retinoids in Skin Ageing: A Focused Update with Reference to Sun-Induced Epidermal Vitamin A Deficiency. Sorg and Saurat. Dermatology 2014; 228(4): 314–325.
10. Efficacy and tolerability of once-daily tazarotene 0.1% gel versus once-daily tretinoin 0.25% gel in the treatment of facial acne vulgaris: A randomized trial. Webster et al. Cutis 2001; 67:(suppl):4–9
11. Randomized facial tolerability studies comparing gel formulations of retinoids used to treat acne vulgaris. Leyden and Grove. Cutis 2001;67(suppl):17–27.
12. Topical retinoids in the treatment of acne vulgaris. Bershad et al. Cutis 1999;64 (suppl) 8–20.
13. A review of the use of combination therapies for the treatment of acne vulgaris. Leyden. J Am Acad Dermatol. 2003;49(suppl 3):S200–S210.
14. Topical vitamin A acid in acne vulgaris. Kligman et al. Arch Dermatol. 1969;99(4): 469–476.
15. Topical tretinoin improves photoaged skin. A double-blind vehicle-controlled study. Weiss et al. JAMA. 1988 Jan 22-29;259(4):527-32.