Everything You Need to Know About Retinoids

Today, the term “retinoids” refers to a range of products that are all derived from vitamin A. These compounds are used not only for acne but also dark spots, psoriasis, sun damage, stretch marks, uneven texture, and, of course, fine lines and wrinkles.

“If you’re thinking about keeping your skin looking the best for the long term, the two most important things to do product-wise are use sunscreen and some sort of vitamin A derivative,” says Dr. Evan Rieder, a top board-certified dermatologist in New York City.

While many skin care products are largely experiential, Dr. Rieder says retinoids are almost in a category of their own. “These aren’t just cosmetic skin care products. They are active agents causing real cellular changes to your skin,” he says, “so it’s worth being patient and taking the time to find what works best for you.”

How retinoids work

Skin naturally exfoliates itself, shedding dead skin cells and replacing them with new ones. Retinoids accelerate this, preventing clogged pores and literally making your skin thicker. Retinoids also slow the breakdown of collagen, increase collagen production, and enhance how pliable your skin is.

What are the different types of retinoid products?

There are many types of vitamin A-based products. The key variable is potency: over-the-counter options typically require your body to convert them before it can use the ingredients. The closer an ingredient is to the form your skin can use, the more potent its effects will be, but this also means it’s likely to be more irritating to your skin.

• Retinyl esters: These take three steps to convert into the active form, so are the weakest form of vitamin A products.
• Retinol: The most common form of vitamin A, this requires two steps of conversion before it can affect your skin, so it is considered fairly mild. It is in many over-the-counter skin care products and can be a good starting place.
• Retinal: This needs only one conversion, so it is a step up in strength. Retinal is also included in many over-the-counter products.
• Retinoids: In addition to referring to the overall category, retinoids can refer to prescription-strength products, which are typically ready for your body to use immediately, and so more powerful. These include tretinoin, tazarotene, and more. Adapalene is a retinoid that’s available both over the counter and by prescription.

What to consider

• Oral retinoids are known to cause birth defects and are not safe during pregnancy or while breastfeeding. As a precaution, doctors also recommend pausing topical retinoids during pregnancy to avoid any risk that the product could be absorbed throughout the body.
• All retinoids can lead to dry, irritated skin, itching, burning, redness, peeling, and flaking. This doesn’t happen to everyone, and these side effects are typically temporary as your skin adjusts to the products.
• Retinoids make your skin more sensitive to the sun, so it’s crucial to use them at night and to wear SPF and cover up during the day to prevent getting sunburned.
• Oral retinoids are strong prescription medications that require careful clinical monitoring due to their wide-ranging effects on the body. They can stress the liver and significantly alter lipid metabolism, leading to elevated cholesterol and triglycerides. Some people also experience joint aches or rare changes in bone density, as well as headaches and vision changes. These medications also come with warnings about potential shifts in mood, depression, and anxiety, so it’s important to talk with your care team if you have a history of mental health conditions.

Dr. Rieder’s recommended routine

When you first start using retinoids, Dr. Rieder says it’s important to start slow. He suggests using them once or twice a week to let your skin adjust to the new treatment. After a couple of weeks, you can ramp up to every other night, and eventually aim for every night. He also notes it takes time to see meaningful changes in your skin. For acne, Dr. Rieder says it can take at least six to eight weeks to see whether a product is working, and for anti-aging, it can take several months.

• Start with a gentle, hydrating cleanser to wash your face. Never scrub your face before applying retinoids.
• Use a pea-sized amount of the retinoid product all over your face, avoiding your eyes, nose, and mouth. Dr. Rieder recommends skipping the area between the eyebrow and the bone under your eye to avoid irritating your eyes and eyelids.
• Follow this with a basic moisturizer that does not have any other active ingredients in it. (This can be simple like Vanicream or LaRoche-Posay Cicaplast Balm B5 or more high-end like SkinCeuticals Triple Lipid Restore 2:4:2.)

What to do if you have sensitive skin

Dr. Rieder says it’s important to think about your skin type and your climate, because retinoids can be not just irritating but drying. For instance, living in a warm or humid climate can make it easier to start retinoid use. However, if you live in a dry, cold place like New York City, Dr. Rieder suggests waiting until warmer weather to start.

For those with extra sensitive skin, he also offers a few additional tips:

• Mix your retinoid into your moisturizer and apply that mixture after cleansing your face.
• If that’s still too much or your face feels extra dry, try adding in a hydrating serum to sandwich the retinoid. This would mean cleansing, then using your hydrating serum, then applying the retinoid, and moisturizing afterward.
• If your skin is even more sensitive, you can try short-contact therapy to start. First cleanse, then apply the retinoid for about an hour, and wash it off. The goal is still to work up to applying the product overnight.

Dr. Rieder’s product recommendations

Dr. Rieder says that while prescription-strength retinoids are going to be more effective than over-the-counter options, there are some brands he says have strong evidence behind them: Neutrogena’s Rapid Wrinkle Repair line; SkinBetter’s AlphaRet line; SkinCeuticals retinol creams.

The bottom line

Vitamin A-based products are powerful treatments that can have a significant impact on your skin. But everyone’s skin is different, so it may take trial and error—and definitely patience—to find the right routine for you. As Dr. Rieder puts it: “Everybody’s journey is going to be different.”

— By Abigail Abrams