Prescription retinoids versus drug-store retinols

Question:  I’ve seen plenty of products in the drug store skincare aisle that contain retinol and say they reduce the appearance of fine lines while balancing an uneven complexion. Is this the same as the Retin-A products I can get by prescription?

Read drug store retinol cream labels looking for vitamin A!

Read drug store retinol cream labels looking for vitamin A!

Answer: While they are both derivatives of Vitamin A, called “retinoids,” and used to promote faster skin cell turnover, they are not the same.

All retinoids have been well-studied, tested and been proven effective and powerful for treating skin issues ranging from acne to many signs of aging, including sun damage.

But there is a marked difference between retinoid products you get only by prescription and the retinol products you see on drug-store shelves.

Retinoid products are prescription-only skincare products containing the most commonly-known natural vitamin A derivative, tretinoin which comes in name brands such as Atralin, Retin-A (and Micro) among others.  These proven prescription products increase the rate of cell turnover to uncover healthier skin-whether it’s reducing fine lines or evening out the texture or color of your skin.  Common side effects include dryness, redness, cracking,  irritation and skin peeling. There are two other prescription strength (lesser known) prescription retinoids-tazarotene (Tazorac) and adapalene (Differin).

If you find, during the dead of winter, that dryness, peeling, redness and cracking are more pronounced, simply reduce the usage of your prescription retinoid to just once per day, or every other day or even every two or three days until side effects are diminished. By the way, winter weather and drier indoor heat may be exacerbating your already winter-dry skin, if you need to use them less don’t worry, the powerful retinoids still do their job!

Retinol products don’t require a prescription so you can buy them over-the-counter at the drug store or grocery store, without a prescription. Retinols are simply a synthetic, weaker version of a retionid and as such, they act more slowly than a retinoid. However, these products can be useful if you find prescription retinoid products too strong for your skin. They are also a good beginning step to starting your skin on a topical retinoid.

When choosing a drug store retinol product, check the ingredients list to make sure vitamin A is listed toward the top of the ingredients list. Also, in terms of packaging, look for an air-tight bottle that keeps the light out (exposure to light makes the products less stable and effective and more susceptible to bacteria growth.)

Other skin tips:

  • Reduce your skin’s exposure to hot-hot water.
  • Add a humidifier to rooms where you spend a lot of time.
  • Use an emollient (thick) cream to counter peeling and cracking skin.
  • Always wear sunscreen.

-Jodi

Should I be using a retinoid?

Question:  As I’ve moved through my thirties and into my forties, I’ve noticed a marked change in my facial skin. I have some dark spots and discolorations and my face seems thinner overall and a little more sallow. I’ve heard about using a Retin-A cream but I thought that is for acne or wrinkles. Is it for me?

Answer:  Actually Retin A is not just for acne or wrinkles. It is a simple, inexpensive topical cure-all for all pre-mature aging and photo-aging (skin damage caused by sun exposure).

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How your skin looks and feels as you age is influenced by many factors such as genetics, environmental exposure (sun, medication, mechanical stress), hormonal changes and metabolic processes. All of these factors, some of which have to do with your lifestyle and some  you have no control over, cause a change in skin structure, function, and appearance as you age. Although, we dermatologists have studied and seen first-hand that solar UV radiation (sun exposure) is the single major factor responsible for  the unwelcome, premature  effects of skin aging on face, neck or back of  hands such as:

  • Coarser, rougher skin feel and appearance
  • Sallowness
  • Wrinkles
  • Irregular coloration and discolored spots or patches
  • Discolored brown spots called lentigines
  • Telangiectasias (little red visible blood vessels)
  • Benign neoplasms (abnormal, yet non-cancerous, masses of discolored or raised tissue)
  • Pre-cancerous lesions called actinic keratoses and lentigo maligna
  • Cancerous lesions such as basal and squamous cell carcinomas and malignant melanomas.

So, what’s a “retinoid?”

First, a little science lesson.  You may hear or read about a lot of terms that all have “retin” in them. That’s because the retinoid family comprises vitamin A (retinol) and its natural derivatives such as retinaldehyde, retinoic acid and retinyl esters, plus many other synthetic derivatives. Vitamin A cannot be synthesized by our bodies, so it needs to be supplied and is naturally present in foods as the compound beta-carotene. Retinoids are required for a vast number of biological processes inside the body such as embryo development, reproduction, vision, growth, inflammation and cell differentiation, proliferation and apoptosis (naturally occurring cell death for normal cell growth stages).

Retin-A (tretinoin) is the most popular retinoid for facial skin and is also the retinoid most studied for the treatment of chronological or photo-aging. I have tracked numerous studies which have repeatedly shown clinical improvement in photo-damage with tretinoin treatment, as well as with some other topically applied retinols such as isotretinoin and retinaldehyde (which are not my favorites because they are not as potent or stable.) Longer-term studies (6-12 months) on tretinoin were carried out once short-term studies showed that patients’ skin condition continued to improve in appearance over time. Additionally, most of these studies compared the use of the various strengths of tretinoin to arrive at the optimal concentration for the treatment of skin aging.

How do retinoids work?

Retinoids are known to speed up the cellular processes such as cellular growth and differentiation. Retinoids work on the skin surface by prompting surface skin cells to grow and die quicker and slough off faster, making way for new cell growth underneath. In this way, they cause discolorations and spots to lighten and they hamper the breakdown of collagen and thicken the deeper layer of skin where wrinkles start.

Interestingly, current studies have found that the mechanism by which collagen and elastin are lost after skin is exposed to UV radiation may be blocked when topical tretinoin is applied before sun exposure. More studies are ongoing.

What about side effects?

The most common and frequent adverse effect of topical retinoids is called the “retinoid reaction” which you may or may not experience as burning, peeling, reddened or inflamed skin at the sites of application or in skin folds such as around the nose or lips where additional product might be deposited by accident. It’s this reddening and peeling that occurs within the first two weeks of use which cause many patients to give up therapy before realizing any of the benefits which can take two to three months or longer to see and feel. What most people don’t know (or wait for) is that the skin builds up tolerance to the retinoid treatment and side effects eventually subside. Also, you can reduce application amount and days or try a lower potency formula to start if you experience these side effects. The most important factor in success with tretinoin is to follow the entire course of treatment not to give up!

The other side effect associated with tretinoin therapy is photo-sensitization (you will be more sensitive to the sun’s rays and burn easier), which normally occurs at the beginning of treatment. I always advise patients on tretinoin therapy to avoid excessive sun exposure and use a broad-spectrum sunscreen of at least SPF 30 (and a hat).  Your skin’s response to UV radiation should also return to normal after a few months of treatment.

We love combination creams

I have found that the way to counter the side effects is to use a retinoid combination cream containing a corticosteroid to reduce inflammatory response and if discoloration or brown spots is one of your problems, you might want to add 4% hydroquinone (a known skin bleaching agent). We think that this combination may be even more effective than the individual components alone.

Has tretinoin worked for you? How long did it take?

 

Winter-whipped skin! Now what?

Question:  I have been using a Retin-A (tretinoin) anti-aging  skin-care regimen but with all this extreme winter weather my skin is chapped, cracked and looks and feels terrible. What should I do?

Answer: You may need to adjust your skin-care routine and anti-aging product use during the winter when your skin is exposed to extreme cold, wind, snow as well as extreme drying from indoor heat.

  • Reduce Retin-A use. The great thing about Retin-A is that you can cut down your usage and it still continues to work. Instead of using your Retin-A twice every day (at bedtime) try applying it every other day or even two or three times a week. Experiment with the amount you can use without causing the drying effects.
  • Switch out the Alpha Hydroxy Acid lotion. Instead, use an emollient (thick) cream moisturizer to help avoid cracking, peeling and chapping. You can even apply this over your Retin-A.
  • Leave the long, hot showers.  Hot, hot water irritates skin’s top layer and also strips it of its natural oils, leaving it unprotected and open to cracking and peeling. Instead  take a quicker, lukewarm shower, less than 10 minutes tops, and pat skin dry gently (no harsh rubbing on skin or hair). While skin is still damp, apply a  super-rich cream moisturizer for hands, feet and anywhere else you are dry and cracked.
  • Don’t forget the sunscreen. Just because it’s not summer doesn’t mean the sun is not strong. Skin is always vulnerable to the sun’s damaging UV rays so I always recommend patients use a daily facial SPF of at least 30. Especially protect skin when doing winter sports such as skiing or ice-skating outdoors – some of the most severe sunburns occur while skiing since snow reflects sunlight (plus the wind-burn). Don’t forget to protect lips with a sunscreen, too.
  • Try a humidifier. If the heating air in your home is especially drying to your skin, turn on a humidifier all day and all night to help keep skin and nasal passages from drying out.

How have you changed your skin routine for the winter?