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Editors: Small, Rebecca

Title: Practical Guide to Chemical Peels, Microdermabrasion, & Topical Products, A, 1st Edition
Copyright ©2013 Lippincott Williams & Wilkins

> Table of Contents > Section 5 - Topical Skin Care Products > Introduction > Treat > Retinoids

Retinoids
Retinoids are vitamin A derivatives and analogs which range from potent prescription products such as tretinoin and
synthetic tretinoin derivatives such as tazarotene, to less active cosmeceutical products such as retinol and
retinaldehyde (Fig. 1). Retinoids promote healthy epidermal turn over and proper skin function through reducing
corneocyte cohesion and enhancing desquamation, inhibiting melanogenesis, antioxidant functions, stimulating
collagen production, and reducing keratinization within hair follicles (i.e., clogged pores). They are effective for
treatment of photoaged skin as well as hyperpigmentation and acne. Due to their stimulating effects, it is advisable
to use caution with retinoids in patients with rosacea or sensitive skin, as erythema can be exacerbated.

Prescription retinoids have the most profound and rapid rejuvenating effects on photoaged skin. Benefits are
usually apparent by 1 month with improved texture due to compaction of the stratum corneum, and by 3 months
reduction of hyperpigmentation and fine lines are visible. Prescription-strength retinoids can be used alone or in
combination with other products, such as the Obagi Nu-Derm group of products which includes a prescription
retinoid, alpha hydroxy acids, hydroquinone, and sunscreen. A significant disadvantage to prescription retinoids is
“retinoid dermatitis” associated with their use consisting of erythema, sensitivity, and skin flaking. While this
irritative response spontaneously resolves for most patients after 4–6 weeks of use, it can persist for longer. In
addition, combining prescription retinoids with other in-office aesthetic procedures such as lasers and chemical
peels can be challenging. Prescription retinoids are discontinued 1–2 weeks prior to procedures to allow for an
intact epidermis at the time of treatment, and are restarted 1–2 weeks after procedures. This repeated stopping and
starting cyclically can induce retinoid dermatitis. Therefore, prescription retinoids are often used as a stand-alone
intervention for photoaged skin, as opposed to integrating them into treatment plans with other minimally invasive
procedures.

Cosmeceutical retinoids are less effective than prescription retinoids in reducing the signs of photoaging; however,
they rarely cause retinoid dermatitis when used in recommended doses and are well tolerated by patients. Retinol is
one of the most commonly used cosmeceutical retinoids for photoaging and is an important component of the
Topical Product Regimen for Photoaged Skin. Cosmeceutical retinoids are converted to the active form of retinoic
acid after application to the skin as follows:

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Cosmeceutical Retinoids
Retinaldehyde is an immediate precursor to retinoic acid. It requires stabilization to remain in an active form in
skin care products.

P.133
Retinol is the most commonly used cosmeceutical form of vitamin A. New stabilizing technologies such as
polymers and antioxidant additives have made it possible to have more active and effective retinol topical
products.

Retinol esters have weaker biologic activity.

Retinyl palmitate is the ester of retinol and palmitic acid, and is the primary storage form of vitamin A. It is
typically used for its antioxidant properties in sunscreen and moisturizer products.

Retinyl acetate is the ester of retinol with acetic acid.

Retinyl propionate is the ester of retinol and propionic acid.

Retinoid Application (e.g., Retinol 1% by SkinCeuticals)

1. Apply a small pea-sized amount every third evening for 2 weeks.
2. Increase application frequency to every other evening for 2 weeks.
3. Increase application frequency to every evening as tolerated.

Flaking is normal and expected as is a mild pink color to the skin.

4. Apply in the evening.

If prescribing tretinoin (e.g., Retin-A), the above general guidelines can also be followed with a starting dose of 0.5
g of retinoic acid 0.025–0.05%. One gram of a cream is roughly equivalent to 1 inch of most products squeezed from
an average sized tube, and 0.5 g is ½ inch. Skin redness, flaking, and sensitivity are anticipated when using
prescription-strength retinoids. Tolerability can be increased by mixing tretinoin in equal parts with the evening
moisturizer; however, this may reduce efficacy.

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