Retinoids: what I think you should know

(And what an excellent dermatologist thinks you should know, too)

When I thought about what to suggest next from the exciting choose-your-own-adventure skincare smorgasbord, there was just one obvious choice, if you’re over 30ish and want to see some positive change in your skin: retinoids — in other words, some form of Vitamin A, like retinol, retinaldehyde, or retinoic acid (available by prescription only, for good reason, because it’s quite strong).

Retinoids have been the gold standard in skincare for most age-related skin conditions for decades; they’ve long been proven to correct photoaging, increase elasticity, even skin tone, clear pores and breakouts, and smooth fine lines and wrinkles. I’m an enormous fan.

Since retinoids can fall under both OTC and prescription categories, I’ve brought in some perspectives from my dermatologist, Seth Matarasso, MD, who inspired me to incorporate retinoids into my own skincare routine several years ago. (I adore him. I don’t make much use of his other talents in cosmetic dermatology, which are renowned, but after he pierced my ears and saw how dramatic I was about going anywhere near a needle, I suspect he’s genuinely relieved about that.)

Key takeaways from today’s post

1. You don’t need to use a prescription product to reap retinoids’ benefits. Retinoic acid (e.g., tretinoin, available by prescription only) is the most bioavailable form, but retinaldehyde and retinol are also great options.

2. Whatever retinoid you choose, remember to take it slow and be consistent. Retinoids work at a deeper level to deliver real results, so they do take time. Find a formula you love, keep at it, and know that you’re doing something great for your skin.

You’ll find the full story, which I think is always worth it, below the photo of my own favorite retinoid.

Why so many people love retinoids

Dr. Matarasso told me that about 80% of his patients are using some type of retinoid, whether prescription or OTC. Here are the reasons why he prescribes and suggests it so frequently:

“It’s great for adult acne, and I use it often with adults who have early onset photodamage — it can mitigate and prevent brown spots and solar lentigines. It’s also a good way to prevent or reduce very fine lines. Because, while it’s addressing the superficial layers of the skin, with time, you get neocollagenesis (new collagen growth), which leads to a reduction in fine lines.

“You’ll notice some subtle improvement in discoloration after a few months; it takes a good 8-12 months to see a significant improvement in fine lines. But with any topical preparation, it’s a matter of diligence and continuity. If you just use these products sporadically, you’re not going to see real results.

“I also use Retin-A for patients who have gotten a lot of sun damage or actinic keratosis (little rough, scaly spots from UV exposure). I’ll put many of these patients on Retin-A to reduce sun damage and precancerous lesions.

“Finally, if a patient’s going to have any type of resurfacing with lasers, or a chemical peel, I like to start them with Retin-A first. I find that they heal more homogeneously and more quickly, because they’ll get a more uniform application of the peel or laser.”

Do you need to use a prescription product to get results? Thankfully, no.

Even Dr. Matarasso, who likes to eventually have his patients use Retin-A, told me, “I think it’s absolutely appropriate for a patient to start with an OTC product, like a retinol, because it’s not as irritating or abrasive…It’s a good way to see if they’re compliant, and to make sure they’re using a sunscreen.” (Sunscreen: very important!)

Here are the different types of retinoids you’ll want to know about, both prescription & OTC

Stronger
Retinoic acid, or tretinoin, is the strongest form of Vitamin A that’s used on the skin, and it’s the kind you’ll get with a prescription.

Gentler
Retinol is the precursor to retinoic acid: in order to be bioavailable for the skin, it needs to be converted to retinaldehyde (a.k.a. retinal), and then retinoic acid. This makes retinol a good ingredient to look for in a “starter” retinoid product.

Perfectly (I think) in between
Retinaldehyde, that in-between form of Vitamin A, is the most potent type of retinoid available without a prescription. Many dermatologists and brands mention that retinal (its nickname) tends to work up to 10-11x faster than retinol.

So, does that mean that retinaldehyde is more aggressive than retinol?

This is where things get complicated, because the answer is, “Not really.” There are some chemists and dermatologists I know and trust who find that retinal is actually better for sensitive skin, noting that retinol’s two-step conversion process to retinoic acid can result in more irritation than retinal’s single-step process. At the same time, others opine that retinol’s longer conversion process can allow for gentler treatment of the skin. Still others have found that retinol and retinal are equally easy on the skin. Obviously, it’s murky.

My opinion? At the end of the day, it’s all about how a given formula works for you. I personally love the efficiency of retinaldehyde, which is why I chose to use it in the Sea Retinal. (To mitigate sensitivity, you’ll also find our own hand-harvested giant kelp in the formula, along with a biomimetic peptide based on a sea anemone protein. Over the past almost-year, we’ve heard from lots of customers that it delivers the results they’re looking for without the redness they usually expect from a retinoid, and I can’t live without it myself; the longer I use it, the better my skin looks.)

Don’t forget this key point: whatever retinoid you’re using, give it time

I’d like to circle back to the fact that Dr. Matarasso said it takes a good 8-12 months to see a significant improvement in fine lines. 8-12 months may sound like crazy dog years compared to a lot of the near-instantaneous results claimed by various brands, but retinoids work at a deeper level for real impact, so they do take time. Find a formula you love, keep at it, and know that you’re doing something great for your skin.

Also: don’t go too crazy with it

Whatever retinoid you use, please follow the usage instructions and apply it to dry skin to minimize irritation. And it’s meant to be applied at night only. If you’re thinking, “Well, everyone knows that,” here’s a story from Dr. Matarasso that would indicate otherwise:

“I just saw a woman in my office who flies in from LA for her filler and Botox, and I asked her if we could use Retin-A for maintenance. She said, ‘Oh no, no. My internist told me that I’m allergic to it.’ It turns out that she was using Retin-A twice a day and inadvertently gave herself a peel. Her internist, who originally prescribed it for her, may not have been aware of its side effects. It’s just a cream, but it’s very deceptive. With Retin-A, it’s all about keeping it slow and steady.
“I’ll frequently have patients come in who have used retinol or Retin-A before and became irritated as a result. They assume they can’t use it or they’re allergic to it, when they just didn’t have the information or guidance they needed.”

So, want to give it a go? A few more tips for success:

• Start off by using your retinoid 2-3 times a week, gradually working your way up to nightly application. Keep your skin well-moisturized, avoid the eye area (especially above the eyes!), and always wear sunscreen during the day.

• Keep an eye on your skin and back off as needed. Dr. Matarasso told me, “A little bit is good; a lot is not necessarily better. I’ve been using retinoic acid for nigh upon a decade. I use my Retin-A five nights a week, and if you come into my office on a Friday, you’ll see I’m a little pink. So I take weekends off. Patients can tell that they’re over-retinized when they’re pink, when they’re scaly, when their face is too irritated. At that point, you should back off and take a ‘drug holiday.’”

• You can make any retinoid less zingy by layering it over a moisturizer. (But, fun fact that was shared by Valerie Monroe in her recent newsletter: if you want to maintain the bioactivity of your retinoid at a higher level, you won’t want to then put a layer of moisturizer on top. As you can read here in Dermatology Times, “full sandwiching” of your retinoid — applying moisturizer, then retinoid, then moisturizer again — can reduce retinoid bioactivity by three-fold. The horror, the horror.)

Finally, here are the formulas I love the most

Because I consider retinoids to be so helpful, I chose a lot of retinol and retinaldehyde products for Ayla’s shelves, just like we have a lot of hydrating/moisturizing products, sunscreens, and antioxidants on our shelves: everyone’s different, and it’s good to have options. It turns this incredible but sometimes scary-seeming ingredient into something that’s accessible to more people, as it should be. Here’s how I suggest sorting through the options.

If your skin tends to be a little sensitive

BioRecept Lyco'Vitamine A: This French pharmacy inspired, super-gentle starter formula uses retinyl palmitate, a step back from retinol — it gets converted to retinol, then retinaldehyde, then retinoic acid (not my favorite form of Vitamin A, but it’s a nice option if you’re super-sensitive)

Marie Veronique Gentle Retinol Night Serum: This longtime best-seller with retinol and Vitamin C is a classic starter formula

Luzern Creme NUIT: With bakuchiol added to retinol in a luxe, creamy base, this one's extra gentle but gives great results

de Mamiel Gravity Fix: A touch of retinal, blended in with a whole bunch of other goodies with Annee de Mamiel’s signature magic

Dara Kennedy Sea Retinal: Developed for sensitive skin (like mine!), it’s well tolerated by most complexions and leaves skin soft and glowy

If you’re thinking, “Give me the stronger stuff! But…not too strong”

Marie Veronique Multi-Retinol Night Emulsion: A super-charged retinol in a creamy base

Ursa Major Lunar Bloom Retinal Serum: A super-efficient retinal in a super-light, sinks-right-in base

Dara Kennedy Sea Retinal: I’d put this flexible formula in this section, too, because you can easily bump up its power by applying it directly to clean skin and layering some Sea Serum on top. It sits in between the other two options in terms of weight.

If you’re thinking, “Thanks, but no thanks”

Do you need to use retinoids if you have super-sensitive skin, eczema, or rosacea, or you’ve had trouble with it in the past? Absolutely not. If you still want to give your skin a collagen-boosting treat but need to steer clear of retinoids, try one of the options below.

Dara Kennedy Sea Serum: Its sea fennel has retinoid-like effects, with no irritation (and extra soothing, firming, and brightening friends in the formula)

Luzern Firming Collagen Booster: These peptides can help firm like nobody's business, too

TWELVE Plant Perfection Gel Serum: Made for the Y-zone, where many of us notice sagging first

I hope you found this helpful. Many thanks to the wonderful Dr. Seth Matarasso for sharing his expertise!

PS Any topic discussed in this post is not intended as medical advice. If you have a medical concern, please check with your doctor.