The term "retinoid" is used to refer to products, both over-the-counter, and prescription strength preparations that are a class of compounds derived from or similar to Vitamin A. They are a key ingredient in many anti-aging skin care products. Retinols must be converted into retinoic acid in order to work; whereas the prescription retinoids such as Tretinoin can work faster since this step of conversion to retinoic acid is skipped (tretinoin is retinoic acid). All of the retinoids can help improve the skin texture, by increasing skin cell turnover, decreasing the appearance of fine lines and wrinkles. Many of them also help to reduce hyperpigmentation (such as that seen with Melasma), and can help treat and prevent acne. In fact, many prescription retinoids were originally used in the treatment of acne, and were later noted to have other positive effects on skin appearance and aging. Other prescription retinoids include Differen (Adapalene), and Tazorac (tazarotene) which also bind to retinoic acid receptors in the skin, and can work in a similar fashion to increase skin cell turnover and have anti-inflammatory effects.
One thing that's essential to know about using a retinoid: they can increase your skin's sensitivity to the sun; so wearing sunscreen daily is a must. It goes without saying that daily use of sunscreen also helps to prevent skin cancers and protect against premature aging due to sun damage.
If you're thinking about introducing a retinoid into your skincare routine, the golden rule is to start low, go slow. This is because some people, especially those with sensitive skin, can experience some mild to moderate skin irritation, redness, dryness, or flaking of the skin during the initial trial of the products. You don't want to start off out of the gate applying the new product all over your face every night. Likewise, you don't want to use the highest concentration product available in the beginning. You may consider instead doing a small test patch in an inconspicuous area first (I use the back of my neck). If you tolerate the product on this small area, next try using it on a small area on your face. If you tolerate this, you may try using it all over your face, but not every night (maybe try it for 2 nights a week, and then 3 nights a week, etc.). You do not have to use it every night to get the benefits. But try working your way up very slowly to see if eventually you can use in on your face, neck and décolleté in a consistent and regular routine. Also, don't be discouraged if you don't tolerate one product. There are lots of formulas out there that you can try, and may tolerate one better than another. Sometimes it may be other ingredients in the product that are the actual culprit of skin irritation- for example artificial fragrances or other additives.
Who should not use retinoids? The main contraindication to using retinoids is if you are pregnant, or trying to conceive. You should wait until after delivery and when you are no longer trying to become pregnant, to start using a retinoid. Also, if you're planning to do a skin treatment such as microneedling, photofacial (IPL), laser skin resurfacing, or laser hair removal on the face, you should hold your retinoid for at least 7 to 14 days before the procedure based on your clinic's instructions, as well as for at least 7 days after the treatment (6 weeks if doing a skin resurfacing) per the instructions given by your clinic.
If my skin is dry, can I mix my retinoid with my moisturizer? While some docs recommend against this, I have no problems with it. By mixing it with a moisturizer, you can decrease the drying effects, and perhaps avoid the flakiness that can occur when using a potent prescription retinoid. While it's true that you are essentially diluting the active ingredient, if this helps you tolerate the product and use it consistently, you can still see beneficial effects on your skin's appearance. Be careful when applying any retinoid near the eyes, as you don't want it to get in the eye.
To summarize, retinoids can be a great addition to your skincare routine, having many positive effects on the skin texture, boosting collagen, decreasing fine lines and wrinkles as well as hyperpigmentation, and even helping to combat acne. Start low, go slow, and don't give up after trying just one product. And don't forget your SPF! :)
Cheers to your health,
Dr. B
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