If you ask any dermatologist about their recommendations for must-have products in any skincare routine, “retinoids” will definitely be an answer. In addition to sunscreen, retinoids are probably the only other product that we all swear by. So, what are retinoids? What’s the difference between retinoid products, and how should they be used to get the most benefit? Today we are going to talk about this anti-aging holy grail.

What Are Retinoids?

Retinoids are a class of compounds that are derivatives of beta-carotene, also known as vitamin A. Vitamin A is an essential compound needed by the body to stay healthy and functional. It also plays an important role not only in the skin, but also in the development of other organ systems such as the eyes and blood vessels. The active form of retinoids is retinoic acid. This structure is formed through metabolism by our body or skin. At the molecular level, retinoids carry out their function by turning on or off certain genes via the retinoic acid receptor inside the cells.

What Are the Different Forms of Retinoids?

There are various forms or metabolites of retinoid acid: retinol, retinaldehyde, retinyl esters, and lastly retinoic acid—which is the biologic active form. These types can be found in our body at various stages of metabolism of vitamin A as well as in different products.

Oral Retinoids

There are a few forms of oral retinoid, mostly available medically to treat various conditions. The most common one is isotretinoin, which is commonly prescribed by a dermatologist for the treatment of severe nodulocystic acne. This prescription medication works by decreasing sebaceous (oil) gland size, and exerting anti-inflammatory effects to indirectly reduce bacteria load that is involved in acne.

Although there are limited studies about the benefits of oral retinoids for antiaging, there are some preliminary data that suggest it can be beneficial. There are even drinkable retinoids on the market.

However, oral retinoids come with risks. When individuals are on isotretinoin, they are subjected to routine lab tests to evaluate for liver and lipid abnormalities. I do not recommend ingesting high doses of oral vitamin A or drinkable retinols for skin benefits.

Topical Retinoids

Topical retinoids are one of the most studied ingredients for anti-aging. They truly are the holy grail in the sense that multiple and reproducible studies show their benefits with regard to improving acne, sun damage, fine lines, wrinkles, and overall complexion when applied to the skin directly. Additionally, retinoids can be combined with other ingredients, such as lightening agents, to improve the appearance of hyperpigmentation. Topical retinoids can be found in various forms for personal use, including prescription, over-the-counter, and medical grade formulations.

How to Choose a Topical Retinoid

So, which topical retinoid should you use? That depends on your needs and your skin type.

Prescription retinoids are stronger, but also more effective for acne and antiaging. The most commonly prescribed retinoid is Tretinoin cream in various strengths. Tretinoin is the most heavily studied retinoid for its effects on antiaging. It also works for acne by unclogging pores, and decreasing inflammation and sebum production. Other prescription forms include Adapalene and Tazarotene. Although it’s been more heavily studied for its effects on acne, a few studies do suggest that Adapalene may be beneficial for photoaging. Tazarotene is a much stronger retinoid. It’s more often prescribed for medical skin conditions, but can be used like tretinoin to treat acne and most likely help with improving photoaging. 

Non-prescription forms of retinoids are available over the counter mostly in forms of retinol, retinyl esters or retinaldehydes. These work more for aging and are less effective for acne. Since these metabolites need to be converted to the active form, they seem to be less irritating than prescription forms.

What are Some of the Side Effects of Retinoids?

Skin dryness, redness, flaking, and burning are the most common side effects of topical retinoids.

Retinoids should not be used together with alpha hydroxy or beta hydroxy acids such as glycolic or salicylic acids. These will cause too much irritation. I also recommend going gentler on exfoliation when using retinoids, and limiting it to no more than once or twice weekly or even a few times monthly depending on how sensitive your skin is. Benzoyl peroxide is another ingredient commonly used to treat acne. It can cause dryness and burning of the skin. People with sensitive and dry skin may want to avoid using the two ingredients together.

How Can I Add Retinoids to My Skincare Routine?

Since dryness and irritation is the most common side effect, I recommend starting off slowly with retinoids at night. You should consider using an over-the-counter retinol product like a cream or serum. Apply a pea-sized amount to the entire face. If using a serum, you should also follow with a good moisturizer. If you have sensitive or dry skin, I suggest even starting off once or twice weekly, and then slowly increasing to nightly as tolerated. If you have a hard time spreading that pea size amount to your entire face you can even mix it with your moisturizer for ease of application. You can layer on moisturizer before and after retinoids to further limit dryness—this will not interfere with its efficacy.

Retinoids are a highly unstable molecule and can easily be degraded by ultraviolet light and oxidize. Because of this, they are only recommended for nightly use. Some of the newer generations of retinoids and retinols are more light stable, but I still suggest using these products at night as you may want to take advantage of your morning routine to apply other antioxidants or active ingredients that may interact with retinoids or make your skin too irritated if used together.

Retinoids should not be applied to your eyelids as it will likely cause horrendous eyelid dermatitis. Instead, you can look for eye creams containing retinols as these are especially formulated for the eyelid area and are less irritating. 

As you can see, retinoid is a must for youthful and healthy-looking skin. And remember it’s never too late to start using it. As always, if you have skincare questions or concerns, always talk to your board-certified dermatologist about them.