By Daniel I. Wasserman, M.D.
Retinol (Vitamin A) and Retin-A (the old brand name for what is really tretinoin) are structural and functional analogues of vitamin A that exert multiple effects on cellular growth and development, the immune system, and embryonic development. Topical retinoids are used to treat a variety of conditions such as acne, photoaging, psoriasis, and several other conditions. They are often limited topically by a dose-related skin irritation.
While retinol is Vitamin A, tretinoin and other synthetic retinoids (adapalene and tazarotene) are more commonly recommended products in acne and photoaging. This therapeutic space is where nearly 99% of the topical retinoids are prescribed. While their use in acne is nearly 40 years old and therefore more accepted and understood, the public’s understanding of their value for photoaging is still limited.
Photodamaged skin is characterized by fine and coarse wrinkling, a rough texture, a sallow color, and irregular pigmentation. Several controlled studies have clearly demonstrated that topical retinoids, such as tretinoin, can improve fine wrinkling and lighten uneven pigmentation. It generally takes 3–6 months of daily applications to see significant clinical improvement. Cutaneous irritation is usually the limiting factor. Photoaging is the consequence of UV radiation-induced skin damage. Topical retinoids promote an increase in hyaluronic acid and a decrease in the enzymes that lead to breakdown in some skin components such as elastic fibers. Microscopic findings after repeated topical application of tretinoin include epidermal thickening, correction of atypical (precancerous) cells, dispersion of pigment granules, increased dermal collagen production, and increased blood supply to the skin. These findings explain the reported smoother skin, rosy glow, decrease in blotchy pigmentation, and diminished fine lines and wrinkles. Retinol can be converted by the body into tretinoin but require higher concentrations to be clinically effective. These higher concentrations will produce the similar skin irritation experienced in Retin-A, but given its over-the-counter status, consumers are much less willing to tolerate or manage the skin irritation seen with therapeutic levels of retinol in the absence of a physician’s supervision therefore, subtherapeutic doses are often seen in over-the-counter retinol products. Skinceuticals® is one of a few skincare lines that carry higher concentrations of retinol likely able to produce benefits like tretinoin and thereby do not need a prescription.
After reading this and our former articles on sunscreen and Vitamin C, it is probably easy to understand that the first three products anyone should be using for their skin starting at an early age and indefinitely are: a retinoid, topical antioxidant, and sunscreen. Stick to these three and time will move more slowly for your skin.
Daniel I. Wasserman, MD
Fellowship-trained Laser and Cosmetic Dermatologist Fellowship-trained Mohs Surgeon Board Certified Dermatologist
Dr. Wasserman is a board certified dermatologist with fellowship training at Harvard Medical School in laser and cosmetic surgery, as well as fellowship training in Mohs skin cancer surgery. He has contributed as a dermatology expert for online and print magazines. In addition, he frequently lectures to professional societies and organizations on his diverse research. For more information about skin care visit the Skin Wellness Physicians website at www.skinwellnessflorida.com