It’s all about Vitamin A! Here’s everything you need to know about retinoids and retinols

We’ve all seen skin care products being advertised as miracle cures, promising to deliver youthful looks and make fine lines and wrinkles vanish. While there is no miracle cure, there is an (almost) miracle skin care ingredient that delivers results which are Vitamin A derivatives. Dr Martin Wade, Dermatologist Consultant at London Real Skin, discusses why you should be including retinoids or retinols in your skincare regime, how they work, and how to pick the right products for you.

What are Vitamin A-derivatives?

Retinoids and retinols are Vitamin A derivatives which are complex molecules that have a direct effect on the retinoid receptors in the skin. Topical retinoids are only available on prescription and are approximately 10 times stronger than a retinol. As they are only available on prescription, topical retinoids are not promoted by the wider cosmetic market as they can’t be sold in the retail market. This is why we see and hear more about the weaker form of retinols in over-the-counter skincare products and cosmeceuticals as they are more readily available. Retinols are converted to retinoic acid in the skin which is the active molecule.

Why do Dermatologists recommend we use retinoids and retinols?

While Dermatologists recommend the use of topical retinoids and retinols as active treatment for a number of skin conditions including acne, they also provide various other skin benefits. The treatment is clinically-proven to provide anti-ageing results through repairing photo-ageing and helping to maintain the levels of collagen and elastin in the skin.

How do retinoids and retinols benefit our skin?

Retinoic acid is clinically proven to repair photodamage and increase the production of collagen and elastin in the skin whilst also improving uneven pigmentation. Retinoids can appear to have a ying and yang quality to them as some of their actions appear opposing. For example, while topical retinoids will make the skin more sensitive to the sun, they also repair photo damage. For this reason, if a person gets sunburnt whilst using topical retinoid, the amount of damage to the skin is reduced. Retinoids also slightly thin the level of the top layer of the epidermis (the stratum corneum), yet they increase the entire thickness of the epidermis.

How do retinoids and retinols actually work?

When we apply retinoids to our skin, the retinoids attach to retinoid receptors in the skin which cause the structural changes and improves skin thickness and quality.  There have now been a number of clinical trials which have clearly proven this effect. During these clinical studies, biopsies were taken of the before and after topical retinoid use, and the beneficial changes in the skin were clearly documented.

What are the different forms of Vitamin A-derivatives used in skincare and what are the benefits and downsides of each form?

Tretinoin retinoic acid is the original and gold standard retinoid for repairing photodamage. There are newer synthetic retinoids which have been developed and, whilst these have a beneficial effect on acne prone skin and reducing sebum production, their ability to repair photodamage is not as great as tretinoin. Retinols are 10 times weaker than a retinoid and are converted into retinoic acid in the skin. Retinols do not require a prescription therefore they are more readily available and can be used on a nightly basis in most patients.

The stronger tretinoin and retinoids can cause some peeling and redness of the skin, so retinols are sometimes seen as being a gentler option. However, the downside is that you are using a weaker ingredient on your skin and may not experience the same affects. Dermatologists now advise using tretinoin or retinoids a few times a week, rather than every night, in order to reduce the amount of peeling and redness experienced.

How do I know which is the best type of Vitamin A-derivative to use on my skin?

A Dermatologist can advise you on what is the best form of topical retinoid or retinol to use on your skin. There are contraindications for using topical retinols and retinoids on the skin, including certain skin conditions and women who are pregnant trying to conceive breastfeeding.

How do I compare strengths of Vitamin A-derivative products?

Generally, retinols are 10 times weaker than retinoids. Comparing percentages within a particular retinol or retinoid is an indication of strength, however, it is not a reliable means of determining which is the strongest.

Which skin types are suitable for using Vitamin A-derivatives?

Topical retinoids or retinols are suitable for all skin that is acne prone and also for people who are wanting to repair photo damage, reduce lines and wrinkles or maintain the thickness and structure of their skin.  Topical retinols and retinoids are contraindicated in pregnant women, women trying to conceive and women breastfeeding.  Certain skin conditions which present with skin sensitivity such as rosacea or lupus may find their skin cannot tolerate a topical retinol or retinoid. Patients with dry skin conditions such as eczema may also find it difficult to use topical retinoid.

When’s best to apply Vitamin A-derivatives to your skin, morning or evening, every day or less frequently?

A retinoid or retinol should only ever be applied at night time. This is because sunlight will break down the retinol or retinoid making it ineffective. If you are using a topical retinoid, the frequency of application would initially be once per week, increasing to a maximum of three times per week. As retinols are weaker they can be applied on a second nightly basis, increasing to nightly if tolerated.  Side-effects of using these products are redness, dryness and irritation and, if this is occurring, then the frequency of application should be reduced. The advantage of using a retinoid only 1-3 nights a week means that it leaves other nights of the week to apply other skin care products. Many people perceive retinols to be gentler than retinoids however they do need to be used more frequently to achieve the same response.

Is there anything to avoid if you use Vitamin A-derivatives on your skin, or any other products not to use with Vitamin A-derivatives?

Things to avoid if you are using a topical retinol or retinoid are extreme sun exposure. It should be possible to perform any daily or leisure activities however the skin does need to be protected from the sun with a high SPF broad-spectrum sunscreen. I generally recommend a broad spectrum SPF 30 and above, and ideally SPF 50+. If you are pregnant or breast feeding you should avoid using topical retinol or retinoid.

Will eating more Vitamin A help my skin?

Ingesting higher quantities of Vitamin A orally will not be as beneficial as applying a topical retinol or retinoid on the skin. The reason for this is that the same high concentrations of Vitamin A will not reach the skin when taken orally, and they are not in the same form as the Vitamin A derivatives known as the retinoids and retinols.