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  • Dr. Daniel Sugai

Why You Should Consider Using a Retinoid: Practical information on this amazing medication

This post is not going to dive into the nitty gritty details of retinoids at a molecular level and how it needs to be converted into retinoic acid and such. This is practical advice and information on a very important ingredient that I recommend nearly all adults (especially over the age of 30) to consider incorporating into their skin care regimen (unless you are pregnant).

Retinoids are Vitamin A-derived and can be found as a topical or an oral medication- most notably isotretinoin (aka "Accutane") for moderate to severe acne. Retinoids provide a broad range of benefits-there are so many pros to starting a topical retinoid that it seems too good to be true.

Here is a quick breakdown of what a topical retinoid can do for you:

  1. Increases production of collagen and thus can soften fine lines and wrinkles: If you want to invest in an eye cream- look for ones with a retinol as it will be less irritating around the eyes (very thin fragile skin) than the prescription-strength retinoids like tretinoin and it will also help soften the fine wrinkles around the eyes ("crow's feet").

  2. Treats acne and will keep your pores small and clean: I typically prescribe a topical retinoid after finishing a course of "Accutane" as this will maintain your near perfect skin. I compare a topical retinoid to retainers after having braces taken off. Retainers prevent shifting of your teeth once the braces are off. Your topical retinoid will prevent clogging of your pores and will try to keep your pores small. There are many forces at hand that will try to enlarge your pores with time: age, oxidative stress from pollution and sunlight/sun damage. Your topical retinoid will fight these tendencies and will try to keep your pores small and clean.

  3. Lightens brown spots and reduces signs of photo-aging and sun damage (redness, wrinkles, sagging skin): I once had a brown freckle (aka solar lentigo) that I developed while in Japan during a medical school rotation- I had forgot to pack sunscreen and I was having so much fun, I did not think to inquire about Japanese sunscreen during my medical rotation. I developed a large sun freckle ("solar lentigo") on my nose after a day at Universal Studios Japan in Osaka and I was pretty bothered after that- it was on my mind for the remainder of my trip. I had a large brown spot in the middle of my face! Upon coming home to Hawaii, I looked into trying a retinoid cream (tretinoin) and I was able to lighten the freckle with time and now, after more than 8 years of consistently using a retinoid, that freckle is gone and has stayed clear off of my nose for many years!

  4. Improves texture and complexion of skin: Upon finishing a course of isotretinoin, all of my patients have a youthful glow. It is beautiful to see. Small pores, smooth textured skin with restored elasticity, and an even complexion and tone...the list goes on. Even acne scarring is improved through the increased production of collagen.

I mentioned isotretinoin as an oral medication for acne. I reserve this for patients with significant acne (nodulocystic, diffuse) that is causing scarring on the face and/or body. I also use it for patients who have trouble managing their acne with other treatments like oral and topical antibiotics. In contemporary medicine, we as doctors are guilty for overusing antibiotics and I am cognizant about this issue. I tell patients that being on an oral antibiotic for too long can be way more harmful than being on a six month course of isotretinoin which can provide long-term clearance of their acne while improving acne scarring. It is truly a magical medication.

Retinoids can be broken down into over-the-counter (OTC) or prescription formulations.

OTC options available at the local retail store or online are "Retinol," "Retinyl" or "adapalene."

Retinol is probably the most popular option you see in "anti-aging" creams and my favorite brands are: RoC and Skinceuticals. I suggest looking for a retinol that is 0.25% and above.

Retinyl palmitate is the least potent retinoid but also the most tolerable (least incidence of peeling, redness/irritation). Notable products containing this include Skintensive (with Vitamin C and coconut oil) and Derma-E Anti-Wrinkle Renewal Cream (also with Vitamin E and allantoin).

Adapalene 0.1% gel is a retinoid that used to be prescription. In the last couple of years, it has become over the counter as "Differin gel." The higher strength 0.3% formulation is still a prescription medication that can be combined with benzoyl peroxide to provide a bigger punch at attacking acne (branded as Epiduo Forte). This can serve as a good start to treating mild teenage acne but if your acne is out of control and worsening quickly, see your dermatologist quickly!

Prescription-strength retinoids are great and work better than their OTC counterparts for acne and for anti-aging purposes but they can be more irritating, especially when you first start using them. I think there is a role for using both a less irritating OTC retinoid (retinol or retinyl) and alternating with a prescription strength retinoid. Here are the possible prescriptions your doctor may prescribe for you:

  1. Tretinoin: brand names Retin-A, Renova, Retin-A micro. I like this a lot but it can cause dry, peeling skin when used at higher doses (ie 0.05% and above).

  2. Tazarotene: brand names include Tazorac and Fabior (foam which is nice for truncal acne/scarring).

  3. Trifarotene: brand name is Aklief cream. It is fairly new and I have less experience with this given that it was launched in 2019.

  4. AlphaRet: SkinBetter Science has done a great job with making this prescription-strength retinoid that has become my favorite. It comes in a beautiful twist-top canister that looks shiny and luxurious. It provides adequate potency while being very tolerable- the best of both worlds! We sell this in my office for $121 and it is our best seller (also winner of Allure Magazine's awards). This canister can last for 4-6 months and thus your monthly cost is not bad at all: 20-30 bucks a month!

I hope that this was a helpful introduction to the world of retinoids. More posts to come on this topic as it truly is a magical medication! See your dermatologist for more information on this and to possibly get a prescription-strength retinoid if you are up for it!

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