Searching for the fountain of youth? Don't neglect retinoids.
The vitamin A derivatives have been around for about 40 years, and dermatologists still regard them as indispensable in their anti-aging arsenal.
Retinoids minimize the appearance of wrinkles, bolster the thickness and elasticity of the skin, slow the breakdown of collagen, and lighten brown spots caused by sun exposure. They are safe for long-term use, and they offer a protective benefit from damaging rays.
"For dermatologists, they're a favorite because there's so much science behind it," says New Orleans dermatologist Patricia Farris, MD.
"I recommend retinoids to everybody," says Chicago dermatologist Carolyn Jacob, MD. "If you're pregnant or breastfeeding, I like the ob-gyn to say it's OK, but everybody can benefit. It's never too early, really, to start using a retinoid product."
Retinoids first came to market in the early 1970s as an acne-fighting drug -- still among its primary uses. Since then, they have been used to treat psoriasis and warts and the wrinkles and blotchiness caused by sun exposure. They also seem to work on intrinsically, or naturally aged skin. One form of retinoic acid is even used to treat acute myeloid leukemia.
Jacob and Farris like to use retinoids as part of an overall skin-enhancing regimen that might include regular facial peels, Botox injections, and injectable fillers that erase lines around the mouth and eyes.
"Fillers and Botox don't help the appearance of the skin. You can have a facelift, but if you have discoloration, you won't have skin with clarity," Farris says. "I'm unlikely to do one thing without good topicals."
The Way Retinoids Work
Retinoids work by prompting surface skin cells to turn over and die rapidly, making way for new cell growth underneath. They inhibit the breakdown of collagen, the protein that keeps the skin firm, and thicken the deeper layer of skin where wrinkles get their start, Jacob says.
It is a common misconception, Farris says, that retinoids such as tretinoin and retinaldehyde thin the skin and thus leave it more vulnerable to sunburn. They typically cause peeling and redness in the first few weeks of use -- but the topicals actually thicken the epidermis.
"It doesn't make you more sensitive to the sun -- that's anecdotal," Farris says. "But you still have to wear sunscreens when you're on prescription retinoids. You can't be treating sun damage and then not protect yourself from the sun.''
For brown spots that give the skin an uneven tone, retinoids slough them off and inhibit the production of melanin, the darker pigment produced by melanocytes, pigment-producing skin cells, Jacob says.
Prescription v. Store-Bought Retinoids
For aging skin, dermatologists like to prescribe tretinoin and retinoic acid (Retin-A, Renova, Refissa) that is "100 times" as potent than the retinol-containing over-the-counter cosmeceuticals, Jacob says.
"Tretinoin works better because it has a stronger capability of preventing the breakdown of collagen," she says. "I prescribe it to my patients, because if they're here, it means they've tried the over-the-counter varieties."
Retinol, found in OTC topicals, converts to retinoic acid when applied to the skin.
"For a new patient, I might start with a retinol and build up slowly to prescription strength. Sometimes, retinol is a better choice for a new patient," Farris says.
Makers of the over-the-counter creams and gels are not required to tell the consumer how much retinol their products contain, and in the short term, the products might not be as effective as tretinoin. But they do smooth out the skin and minimize the effects of sun damage, Farris says. Generally, it takes about 3-6 months of daily use to notice a difference. With prescription retinoids, a patient might notice smoother, more even-toned skin in as early as 6-8 weeks.
Retinaldehyde, another form of retinoid that can be had without a prescription, is highly effective in rejuvenating older skin, says Jacob. A Swiss study found that among the cosmeceuticals, retinaldehyde is the most efficient and well-tolerated retinoid in renewing skin cells, filtering ultraviolent light, preventing cell breakdown, and improving aging skin.
Jacob and Farris serve and have served as consultants for several cosmeceutical manufacturers. Farris has consulted for Johnson and Johnson, the parent company of Neutrogena and Roc, and La Roche Posay, all of which market retinol and retinoid skin care products (excluding Renova and Refissa). Jacob has consulted for the drug companies Medicis and Abbott.
How Do You Use Retinoids?
For prescription retinoids and OTC retinol-based products, a pea-sized dollop applied to the skin daily is effective, Jacob says. More than that could irritate the skin.
Farris says she tells patients to start slowly, using a retinoid every other night until the skin can tolerate it. "Not everyone gets irritation, but most do at first. That goes away in a couple of weeks," she says.
The National Institutes of Health (NIH) recommends using the exact amount prescribed by the doctor and to avoid other topical medications while using tretinoin. It also recommends that patients using tretinoin avoid sun exposure or wear a sunscreen and protective clothing when they are outside.
It's best to use a retinoid topical on clean, dry skin, and to refrain from using it with skin care products that contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid. The combination can cause severe skin irritation.
Using tretinoin with certain medications -- diuretics, antibiotics such as tetracycline and Cipro, and sulfa drugs such as Bactrim -- may also make the skin more light-sensitive.
Are Retinoids Safe?
Topical retinoids are safe, according to Jacob and Farris, but pregnant or nursing women are advised to ask their health care provider about using it.
Severe side effects could include hives, swelling, and breathing difficulty.
Less severe side effects from using tretinoin could include burning, warmth, stinging, tingling, itching, redness, swelling, dryness, peeling, irritation, and discoloration of the skin.
In case of extreme irritation, Jacob says, "You can moisturize and back off; it'll clear up in a few days.''
As for OTC retinol-containing products, little safety research has been done. "FDA has a very loose grasp on the cosmeceutical industry," Jacob says. "But I think they try to make sure the stuff isn't dangerous.''
As far as she is concerned, the over-the-counter products and tretinoin are both safe.
"You can use tretinoin or OTC retinols forever," Jacob says.