Retinol, for beginners
Perhaps the most ubiquitous ingredient in medical grade skin care is retinol. And for good reason, as it the most researched and respected compound when it comes to treating multiple skin concerns (ageing, acne, pigmentation, congestion… I could go on). So it helps to understand how to choose a retinol compound that is going to do the work you want it. Skin care should be personalised, and we need to be clear of the impacts of marketing when it comes to making a science-backed decision about what to use for our skin health.
Why is retinol so ‘in’ right now? It’s been ‘in’ for a long time. Retinol refers to topical (on the skin) vitamin A. We have used topical vitamin A creams to manage acne and ageing for many years. We also use an ingested form of vitamin A (isotretinoin aka Roaccutane) to manage severe acne. I’d have to give it my vote for the most results-giving compound in skin care. However, I’d also propose it Is the most widely misused product due to its abundance in proprietary skin products. One retinol does not equal the other retinol.
The most widely available forms of retinol are 1. Retinol itself 2. Tretinoin. Basically tretinoin is a bit more punchy – better for treating to a clinical endpoint. When tretinoin hits the skin, it is directly active in enhancing skin cell turnover. However when retinol hits the skin, it needs to be converted to a lower concentration of tretinoin to become active in a less potent manner. This punchiness of tretinoin does not make it better. The leading factor inchoosing which retinol to use should be your TOLERANCE. It is common to have redness, flaking around the mouth and nose corners, dryness and sun sensitivity with improperly used retinols. It is best to start retinols according to a conservative Starter Program – commencing with a lower strength (over the counter) formula and then aiming for a prescription strength cream. The Starter Program can take you six weeks or six months, and if aiming for a prescription vitamin A, then it should be medically supervised. Please note,that pregnancy and breastfeeding are contraindications to the use of vitamin A, both topical and oral forms.
What’s the Starter Program?
Level 1. Commence low strength retinol with a single overnight application. Apply to skin (this is your skin medicine so must be in contact with your bare skin to do it’s magic), and moisturise on top. Make sure you have a sunscreen to apply when you wake up – this is your new daily routine! All going well – you can apply at night on Monday, Wednesday and Friday. If any redness occurs, inform your cosmetic doctor and apply only moisturiser to the affected areas. You can continue the retinol application to unaffected skin if your doctor agrees.
Level 2. This should take around 8-12 weeks, but everyone is different. Now is the time you should be finishing up the first bottle of retinol and it is time to go up to a moderate strength. Once again – perform a single overnight application and if all went smoothly, you can progress to applying Monday, Wednesday and Friday at night time.
Level 3. There are two options – you can increase your application of the moderate strength retinol to Monday through Friday. Or you can seek out a clinical strength formula. My personal practice is to use a custom option for the patient which is on prescription. I will select the appropriate retinoid and strength based on your skin and it’s reactivity and needs.
Once using higher strength compounds, managing the skin barrier is important. After all, we say first do no harm in medicine. Same goes for the skin. Applying medical grade creams, then subjecting yourself to an array of lasers, peels, microderms, Nancy’s neighbours creams etc can disrupt your skin’s beautiful invisible layer of immunity and glow. The caution I provide to my patients is to apply their medical grade skin care Monday to Friday (like it’s your full time job) and to give the skin a rest on the weekend. I also utilise ceramide or peptide compounds where necessary to further protect and reinforce the skin barrier. A lovely option for this is the SkinCeuticals Triple Lipid Restore cream. Also, snail mucin serums can be considered from the K-Beauty world. Skin barrier issues may present as breakouts, sensitivity, dermatitis or even histamine response. More on this in another blog.