Retin-A: Friend or Foe?

There are few skin care ingredients which provoke such strong feelings as tretinoin, commonly known by one of it's brand names, Retin-A. The entire family of these skin care ingredients, all derived from vitamin A, are even more familiar, including retinol and retinaldehyde. You see them in products targeting everything from acne to sun damage to aging and wrinkles. Can one chemical treat all these things? And if so, what's the catch? Those who care for others' skin realize that few ingredients can have a positive impact on so many skin issues as retinols (the common name for this entire class of drugs). They increase cell turnover, resulting in younger, fresher skin cells at the surface. They also thin the skin which can decrease plugging and breakouts in acne and rosacea patients and give a smoother look to those with aging skin.

The downside is that our skin isn't just a cosmetic attribute. It protects us from the world around us, and that includes the sun. Thinner skin is more prone to burn and those who use retinols need to take extra precautions against its rays.

Even more important, retinols are chemically changed when exposed to sunlight, becoming pro-oxidants which can promote not only burns, but also DNA damage. For that reason retinols should ONLY be used at night. It is a disturbing fact that there are actually "anti-aging" sunscreens which try to gain market share by promoting that they have both spf and also retinol - one stop shopping for those who don't know better. Unfortunately such products places the unsuspecting at risk of greater skin damage than benefit.

The other issue is that retinols offer a double-edged sword in skin improvement. In a way, they're like a workout for your skin as they stimulate skin turnover. If you've never been to the gym and then spend 8 hours working out at high intensity, you're going to get pretty darn sore. If you've never used a retinol product and jump in too fast and at too high of a concentration, your skin will end up red, flaky and irritated. Many patients receive a tube of tretinoin from their physician and never get, or fully understand, how to gradually build up their use to get their best result. Many of those tubes end up in the trash when the patients find they look worse, rather than better.

If you haven't used a retinol before, you want to do so under supervision of someone who has looked at every skin care product you are using. Retinol derivatives now exist in so many products that it is easy to find yourself applying three or four a day with damaging results. Most do best if they start slowly - no more than once or twice a week at a low concentration and then gradually increasing their use only as tolerated. Sensitive areas near the nostrils and corners of the mouth are best avoided. Those who are on a retinol product need to discontinue its use for at least 5 days and often longer before waxing  and many laser treatments to prevent injury.

If you use tretinoin or other retinols thoughtfully, they can offer significant anti-aging benefits and help many sufferers of acne, rosacea and sun damage. The key is understanding how to use them safely to get your best results.