Retinoids for Anti-Aging Skin

Searching for the fountain of youth? Don't neglect retinoids.

Retinoids minimize the appearance of wrinkles, bolster skin's thickness and elasticity, slow the breakdown of collagen (which helps keep skin firm), and lighten brown spots caused by sun exposure.

"For dermatologists," New Orleans dermatologist Patricia Farris, MD, says, "they're a favorite because there's so much science behind them."

"I recommend retinoids to everybody," Chicago dermatologist Carolyn Jacob, MD, says. " It's never too early to start using a retinoid product."

Retinoids first came to market in the early 1970s as an acne-fighting drug. Since then, they have also been used to treat psoriasis, warts, wrinkles and blotchiness caused by sun exposure, and aged skin.

The Way Retinoids Work

Retinoids work by prompting surface skin cells to turn over and die rapidly, making way for new cell growth underneath. They hamper the breakdown of collagen and thicken the deeper layer of skin where wrinkles get their start, Jacob says.

It's not true, Farris says, that retinoids thin the skin. They typically cause peeling and redness in the first few weeks of use -- but they actually thicken the skin.

For brown spots that give the skin an uneven tone, retinoids slough them off and curb the production of melanin, a darker pigment.

Prescription and Non-Prescription Retinoids

For aging skin, dermatologists like to prescribe tretinoin and retinoic acid (Retin-A, Renova, Refissa) that is "100 times" as potent as the retinol- containing products sold without prescription, Jacob says. "Tretinoin works better because it has a stronger capability of preventing the breakdown of collagen," she says. "I prescribe it to my patients because, if they're here, they've already tried the over-the-counter varieties."

Retinol, found in over-the-counter products, changes to retinoic acid when you put it on your skin.

"For a new patient, I might start with a retinol and build up slowly to prescription strength," Farris says. "Sometimes, retinol is a better choice for a new patient."

Makers of the over-the-counter creams and gels don't have to say how much retinol their products contain, and in the short term, the products might not be as effective as tretinoin. But they do smooth out the skin and minimize the effects of sun damage, Farris says. Generally, it takes about 3 to 6 months of daily use to notice a difference. With prescription retinoids, a patient might notice smoother, more even-toned skin in as early as 6 to 8 weeks.

Retinaldehyde, another form of retinoid that you can get without a prescription, is highly effective in rejuvenating older skin, Jacob says.

Farris has consulted for several companies that market retinol and retinoid skin care products. Jacob has consulted for the drug companies Medicis and Abbott.

How Do You Use Retinoids?

You only need a pea-sized amount each day of prescription retinoids or non- prescription retinol-based products, Jacob says. More than that could irritate the skin.

Farris recommends starting slowly by using a retinoid every other night until the skin can tolerate it. "Not everyone gets irritation, but most do at first," she says. "That goes away in a couple of weeks."

If you're using prescription tretinoin, use it exactly as your doctor prescribed. Ask your doctor if you should avoid using other medications on your skin at the same time.

Avoid sun exposure, especially between the hours of 10 a.m. and 2 p.m., when the sun’s rays are most intense. Wear sunscreen with an SPF of 30 or higher, and cover exposed skin with protective clothing, such as a long-sleeved shirt, pants, and a wide-brimmed hat, when you're outside. "You still have to wear sunscreens when you're on prescription retinoids," Farris says. "You can't be treating sun damage and then not protect yourself from the sun.''

Clean and dry your skin before applying the retinoid. Don't use it with other skin care products made with benzoyl peroxide, sulfur, resorcinol, or salicylic acid. The combination can cause severe skin irritation.

Using tretinoin with certain medications -- diuretics, antibiotics such as tetracycline and ciprofloxacin, and sulfa drugs -- may also make your skin more light-sensitive.

Are Retinoids Safe?

Yes, say Jacob and Farris.

But pregnant or nursing women should check with their doctor about using these products. "If you're pregnant or breastfeeding, I like the ob-gyn to say it's OK," Jacobs says.

The most common side effects from using tretinoin include burning, warmth, stinging, tingling, itching, redness, swelling, dryness, peeling, irritation, and discoloration of the skin. Rarer side effects include hives, swelling, and breathing difficulty.

"If your skin becomes very irritated, you can moisturize and back off using the retinoids. It'll clear up in a few days,'' Jacobs says. "You can use tretinoin or [over-the-counter] retinols forever."

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