“Retinoid” vs. Retinol – What is the Difference?

What is the mechanism of action of retinoids?
All retinoids are converted by skin enzymes into retinoic acid, which is the form that our skin is able to process. Retinoic acid works by binding receptors inside cells to cause multiple effects, including:

• Increasing collagen production and collagen organization
• Reducing collagen breakdown
• Improved organization of elastic tissue
• Increasing deposition of glycosaminoglycans (a structural component of skin that helps maintain moisture)
• Decreasing melanin (reducing discoloration)
• Exfoliating the top layer of skin called the stratum corneum

What does all of this translate into? Because collagen is the most important component of skin structure, the beneficial effects on collagen quality and quantity help to smooth the skin and reduce the appearance of fine and course wrinkles. The effect on decreasing melanin helps reduce skin discoloration that results from photo aging. In addition, the anti-cancerous properties help to reduce risk for premalignant lesions and to stimulate regression of existing premalignant lesions.

What are the different types of retinoids?

• Retinol – an OTC retinoid that is extremely popular and effective. Like the other retinoids, it works by increasing collagen and helps to reduce the appearance of fine and course wrinkles, smooth the skin and reduce discoloration, and has additional anti-cancerous properties. Retinol is less irritating to the skin and causes less peeling compared to prescription retinoids.
• Retinyl palmitate– another OTC retinoid that results in even less skin irritation and peeling than retinol, but comes at the cost of being less effective.
• Retinaldehyde – more effective than retinyl palmitate but not as effective as retinol, and has particular anti-acne properties.
• Retin-A (tretinoin, also known as retinoic acid) – the most popular prescription topical retinoid. Highly effective against lines and wrinkles, acne and discoloration, but can cause significant irritation and peeling, moreso than retinol.
• Accutane (isoretinoin) – comes in oral form and is used to treat acne. Should not be taken by pregnant women. Can cause an increase in cholesterol and triglyceride levels.
• Differin (adapalene) – topical retinoid used to treat acne and prevent breakouts. Less irritating than tretinoin and now available over-the-counter.
• Tazorac (tazarotene) – topical retinoid also used to treat acne. Similar in strength and level of irritation when compared to isoretinoin.
• Beta-carotene – this is a natural source of retinoids that appears in our diet from orange and yellow plant pigments, which is prevalent in foods such as sweet potatoes, squash, carrots, pumpkins, cantaloupes, apricots, peaches and mangoes. However, topically applied beta-carotenes are not as effective and don’t penetrate as well as retinol and tretinoin. However, these foods are still great sources of antioxidants and convert to vitamin A in the body.

What are the side effects of retinoids?
The primary issue with topical retinoids is skin irritation, redness and peeling. These side effects are normal and can be avoided if the regimen is started slowly with a lower potency, and increased in frequency and strength over time. You can also adjust the strength and type of retinoid to match your skin type for an optimal result with minimal side effects. Typically, it takes a few days to see the effect of skin irritation, so it is important to wait at least four days after the first application before reapplying. In addition, your skin is more sensitive to the sun, so applying the retinoid only at night and using a sunscreen of SPF 15 or greater during the day is helpful.

What type of retinoid should I use if my skin is too sensitive to retinol?
If your skin is extremely sensitive to retinol and you are not able to tolerate the level of peeling and irritation, you can still benefit from using retinoids. You may be switched off of retinol onto one of the less irritating retinoids, like adapalene.

What is the best way to apply retinoids?

1. Always apply retinoids AT NIGHT because your skin will be more sensitive to the sun after application and there is a potential for deactivation of the product by sunlight. Retinoids should always be stored in airtight containers and you should avoid exposure of the product to sunlight and air.
2. Wash your skin with a skin cleanser, apply moisturizer, and then make sure your skin is completely dry before applying the retinoid.
3. Apply a dime-sized amount of retinoid product to clean, dry skin as the LAST step of your skin care routine at night.
4. Use a sunscreen of SPF 15 or greater during the day.
5. Wait four days before your second application to make sure your skin doesn’t react with too much irritation. It takes about four days before you may see the side effects of skin irritation, peeling and redness.
6. Perform the second application in the same manner as the first.
7. Continue the regimen at night every three nights for the next two weeks.
8. If your skin is tolerating the routine, increase the frequency to every other night for two weeks.
9. Increase frequency to applications every night.
10. Depending on the level of irritation with your current regimen, you can consider increasing the strength of the retinoid product.
11. After 6-9 months of topical retinoid therapy, you can begin reducing the application to three times a week without compromising on efficacy.

Important things to know while you are using retinoids:

1. Stop using retinoids one week prior to any facial waxing because your skin is more sensitive while using retinoids.
2. Avoid chemical peels and facial scrubs while using retinoids.
3. Retinoids can make rosacea worse, so discuss this with your physician prior to using retinoids.
4. Protect your skin from the sun during the day by using sunscreen of SPF 15 or greater

When will I start to notice the benefits of retinoid therapy?
After one month, you will start to see an improvement in skin smoothness. After 2-4 months, you will see some lightening of brown spots and reduced hyperpigmentation. After four months, you will notice improvement in fine lines and a more significant improvement in skin texture. Course wrinkles take the longest to improve.