By Dr Davin Lim
Retinol & retinoids are widely prescribed by dermatologists. These are powerful molecules used to treat conditions such as acne, blackheads, oily skin, psoriasis, & is a common ingredient in anti aging formulations.
I suggest starting off with a good retinol formulation before trying prescription retinoids. Why? Because most patients will have side effects with prescription formulations. When you master retinol, graduate to prescribed retinoids.
What is the skin science behind retinoids?
Retinoids increase cell turnover, proliferate blood vessels, reduce tyrosinase activity, decrease inflammation, stimulate collagen, reduce sebum & many more. Hence their use in the treatment of inflammatory disorders & anti-aging concerns.
How to start?
Here’s how to incorporate retinol into your skin care regime. The best time to use retinol is in the evening as this molecule is sun sensitive. Start every second night for the first fortnight, & increase as tolerated.
Formulations matter, especially for ‘leave on’ products such as retinol, niacinamide, & ascorbic acids. My recommended brands include Skinceuticals, Obagi 360 Retinol, Medik 8 & Aspect Dr.
Step 1. Face wash
Wash your face with a bland formulation. Do not initially use skin care acids such as glycolic, lactic or salicylic acids prior to using retinol, as interactions can occur. One you have mastered the use of retinol, you can ADD skin care acid to your routine.
Step 2. Prep skin
Wait a few minutes until your skin is completely dry. This is important, because if your skin is still damp, the retinol will be able to absorb more deeply into your skin and might cause irritation.
Step 3. Titration
Take a pea-size amount of your retinol and apply with your fingertips in upward and outward motions. If you are unsure how your skin will react, conduct a test patch. This means to try application of a small amount of retinol to the front or the back of your ear.
You can mix this with your moisturizer to titrate the dose. For example if you have a 1.0% retinol formulation, you can dilute this product with a bland emollient. Half a pea size of each gives you approximately 0.5% concentration. Start slowly, increase the concentration over 2 weeks.
Step 4. Moisturise to seal
Finish with your moisturizer 30 minutes after application of your ‘actives.’ This reduces potential retinoid side effects such as flaky skin, redness & overall skin irritation. Obagi Hydrate is a good formulation.
Step 5. The morning after
Remember to rise & clean your face in the morning. You should apply a broad-spectrum sunscreen the morning after, as retinol makes skin more sensitive to the sun.
There are literally thousands of retinol products on the market, ranging from very low end formulations such as The Ordinary through to higher end products such as SkinCeuticals.
My take is that for leave on products, formulations do matter. Mid ground formulations include Obagi 0.5 to 1.0 360 retinol, Medik8 & Aspect Dr.
Pregnancy & lactation, retinol & retinoids
There is a blanket cover for the use of retinol & retinoids in pregnancy & breast feeding. Consider ‘Category A’ topicals such as azelaic acid, niacinamide, alpha hydroxy acids & ascorbic acids in pregnancy .
Davin’s Viewpoint on retinol
This ingredient is the number one skin care line prescribed by dermatologists after sunscreen. Retinol is so flexible as it can be used by beginners or even expert users. For the later retinoic acid peels consisting of 2-5% pure retinoic acid is one of my favourite superficial peels.
The only relative contraindication to retinol, is sensitive skin, especially inflammatory rosacea. For this subgroup of patients, consider anti-inflammatories before vitamin A preparations. Once controlled, retinol can be very carefully titrated over a period of time.