Retinols Explained
The Retinol Hierarchy: The Ultimate Guide To Understanding Retinoids
Dr. Michelle Hwang
5/1/20248 min read
Retinoids are a group of compounds derived from Vitamin A that have gained significant popularity in the skincare industry for their remarkable ability to improve skin texture, reduce wrinkles, and combat acne.
Most professionals in the aesthetics industry will recommend starting these vitamin A derivatives as early as your mid-twenties, as they address a wide range of skin concerns and can be beneficial for most people. Whether you’re fighting adult acne or looking to delay tell-tale signs of aging such as dark spots, fine lines, crepey skin and more, retinoids are an integral part of any skincare regimen. However, understanding the hierarchy of retinoids, and choosing the most suitable one for your skin can be quite complex.
In this guide, I discuss the main categories of retinoids, what's available over the counter and through prescription only, alternatives to retinols and how to choose what works for you. Sit tight as this is a long one! TLDR at the bottom of the page for a quick summary.
Main Categories of Retinoids
When it comes to retinoids, it's important to understand that no matter what category of retinoid you use, your skin can only use its biologically active form, which is retinoic acid. Retinoids can be broken down into five main categories: retinyl esters, retinol, retinaldehyde, retinoic acid esters and retinoic acid. The first three are available as over-the-counter skin care products from pharmacies and beauty retailers such as Guardian, Watsons and Sephora. Retinoic acid is only available by prescription or from medical clinics. The relatively new category of retinoids called Retinoic Acid Esters fall somewhere between retinol and retinoic acid. All retinoids work by binding to and activating retinoic acid receptors in the skin.
Retinyl esters, retinol, and retinaldehyde all need to converted to retinoic acid in the skin to reap the benefits. Retinoic acids are the most potent as they directly act on their receptors in the skin. Retinoic acid esters are unlike other forms of retinoids, as they directly act on retinoic acid receptors and convert into retinol in the skin. This allows retinoic acid esters to offer both instant and delayed benefits as the retinol itself is converted to retinoic acid.
Over-The-Counter Retinoids
Most people struggle with retinoids because of the inverse relationship between their effectiveness and skin irritability. Gentler retinoids may not deliver the desired results. However, the more potent the retinoid, the higher the risk of skin sensitivity. Of the over-the-counter preparations, retinyl esters are the least potent but most well tolerated, retinol is in-between, and retinaldehyde (retinal) is the most potent but most likely to cause sensitivity issues. Retinoic acid esters are an increasingly popular group of retinoids for as they can deliver retinoid-acid level of results with minimal skin sensitivity.
Retinyl Esters
The least potent form of retinoids as it takes three steps to convert into retinoic acid on the skin. Examples include retinyl palmitate, retinyl linoleate, retinyl acetate, and retinyl propionate.
Tips:
Suitable for first-time [retinoid] users or people with very sensitive skin
With consistent use, can still address skin concerns like lines and wrinkles, uneven texture and tone, and milder forms of acne.
Examples:
Paula's Choice - Triple Active Total Repair Serum - 0.3% retinyl propionate
Retinol
The most popular form of retinoids is retinol, known for its many acne control, anti-aging and skin-renewing abilities. Retinol takes two steps to convert into retinoic acid. Retinol comes in a range of strengths from 0.1% to 1.0%. Higher concentrations are usually found in clinics as it can be irritating, drying, or cause the skin to peel, which may be less suitable those with sensitive skin.
Tips:
Build up your tolerance slowly, starting with small quantities and once- to twice-weekly applications
Pair with a suitable non-comedogenic moisturiser to reduce side effects
Sensitivity varies with concentration as well as product formulation - e.g. Brand A's 0.5% retinol may be more irritating than Brand B's 1.0% retinol
Examples:
LA ROCHE-POSAY - Redermic Retinol B3 Serum 30ml - 0.3% Retinol
DRUNK ELEPHANT - A-Passioni™ Retinol Cream - 1.0% Retinol
Retinaldehyde/ Retinal
The strongest of the over-the-counter retinoids, it takes one step to convert to retinoic acid, making it more potent than the aforementioned retinyl esters and retinol. Clinically, results and tolerance profiles are similar to retinol.
Tips:
Same as with Retinol!
Examples:
Retinoic Acid Esters
Relatively new compounds, promising for being more active than retinol, without the irritation. Examples include retinyl retinoate and hydroxypinacolone retinoate (HPR), which is more widely known as "granactive retinoid".
Retinoic acid esters are unlike other forms of retinoids, as they directly act on retinoic acid receptors and convert into retinol in the skin. This allows retinoic acid esters to offer both instant and delayed benefits as the retinol itself is converted to retinoic acid.
Tips:
Build up your tolerance slowly, starting with small quantities and once- to twice-weekly applications
Pair with a suitable non-comedogenic moisturiser to reduce side effects
Sensitivity varies with concentration as well as product formulation - e.g. Brand A's 0.5% retinol may be more irritating than Brand B's 1.0% retinol
Examples:
Sunday Riley - A+ High-Dose Retinoid Serum - 5% HPR (granactive retinoid) + 1.0% Retinol + 0.5% Botanical Retinoid Alternative
Et. Al - Lumiere - 1.0% Retinol + 0.1% HPR (granactive retinoid)
Prescription Retinoids
Adapalene
Adapalene is known by the brand name Differin and is available to purchase from a medical clinic or a licensed pharmacist in a pharmacy. It is a synthetic retinoid that does not need to be converted to retinoic acid before it becomes active.
Tretinoin
Tretinoin, also known as Retin-A, is a topical form of pure retinoic acid, meaning that it is already active and does not need to be converted on the skin. It has been widely researched and proven to have positive effects on photo-aging and acne. It is used in aesthetics and dermatology to treat severe comedonal acne, even out skin pigmentation, and is used as prevention and treatment of fine lines and wrinkles.”
Because it is more active and potent, it has a stronger side-effect profile and can cause skin reactions such as mild flaking, dry patches, mild redness, and a purge of acne legions when you first start using it.
Isotretinoin
Isotretinoin, known as Roaccutane, is the oral form of retinoic acid and the most potent of all retinoids — thus, it is often reserved for severe or resistant acne. When taken orally, it reduces oil gland size and oil gland production. It is also effective for body acne that can happen on the chest and back. As it is taken orally, it has stronger, systemic side effects that include dry skin, eyes, nose, and lips. It also requires a blood test prior to initiation, and shortly after to ensure the patient is tolerating the medication.
Isotretinoin is usually prescribed for a minimum duration of 12 months. It is the only acne treatment that has long-term beneficial effects on the skin and can have permanent effects. Research has shown that 70% of people treated with Roaccutane will not have acne recurrence. Those who recur tend to recur after a few years and would usually be less severe than before.
Trifarotene
Trifarotene, available as Aklief, is a newcomer into the prescription topical retinoid scene used for acne treatment. Trifarotene is unique as it selectively targets the gamma retinoic acid receptor, which is the most common retinoic acid receptor found in the skin. It is more potent than adapalene but less potent than topical tretinoin. It is better tolerated than topical tretinoin. It is also the only retinoid that is FDA approved for body acne such as the chest, shoulders, and back.
Retinoid Alternatives
There are a number of plant-based alternatives can treat acne, improve skin texture, and provide anti-aging benefits. These include bakuchiol, resveratrol, carrot oil and carotenoids such as astaxanthin. Retinoid alternatives offer similar benefits to retinoids whilst being gentler, though not as effective. It is an option for those who cannot tolerate over-the-counter retinoids or want a natural alternative.
Of the retinoid alternatives, Bakuchiol and Reservatrol are the most popular in Korean and European skincare.
Non-retinoids that you can consider for anti-ageing are Hyaluronic acid and Vitamin C. Hyaluronic acid is a naturally occurring substance in the skin that helps retain moisture. Skincare products containing hyaluronic acid can hydrate and plump your skin, reducing the appearance of fine lines and wrinkles.
Vitamin C is a powerful antioxidant that can protect the skin from free radicals and promote collagen synthesis. By incorporating vitamin C into your skincare routine, you can brighten your complexion, treat pigmentation, improve skin texture and reduce the signs of aging.
Choosing a Retinoid
There is no one-size-fits-all! Factors such as skin type, sensitivity, age, skin concern and climate would influence your decision. Start with a product within your budget that aligns with your skin concerns. For example, if you are young and using retinol for anti-ageing and wrinkle prevention, you can afford to go for a gentler and milder retinoid. If you have significant pigmentation and existing lines, you may opt for something stronger like Retinol 0.5-1.0%, a Retinal or Retinoic Acid Ester. The thought process is similar for the severity of acne.
When it comes to pricing, the strength of a retinol does not directly correlate with a higher price tag. This varies because the preparation is as important as the active ingredient when it comes to sensitivity and effectiveness. A product’s formulation can greatly affect how it interacts with your skin.
That being said, there are brands such as The Ordinary who focus on simple ingredients at an affordable price. The Ordinary itself has a wide range of retinoid products (Retinol 0.5-1.0%, Retinal 0.2%) to choose from for those on a budget. Drugstore OTCs are also available at a cheaper price point than premium brands such as Allies of Skin, Sunday Riley and Kiehl's.
Again, in order from weakest to strongest, we have Retinyl Esters, Retinol, Retinal, Retinoic Acid Esters and Retinoic Acid (in both Topical and Oral forms).
How to start using Retinoids
In general, I recommend a 'start low, go slow' approach to retinoids, especially for those with sensitive skin. It is crucial to start slowly and gradually increase the frequency and concentration of use. If you have mild skin irritation, you can apply if after moisturiser or combine it with a small amount of non-comedogenic moisturiser before applying over the whole face.
If you face persistent skin irritation such as flaking, redness and itching despite the above, then this class of products may not be suitable for you. I would advise going down the potency ladder or considering a Retinoid Alternative.
Regardless of the type of retinoid you choose to incorporate into your skincare routine, it is important to use them properly and follow the recommended guidelines. Retinoids can increase sun sensitivity, so it is crucial to use a broad-spectrum sunscreen during the day and to start with a low concentration and gradually increase as your skin adjusts.
It is important to note that retinoids can take time to show results, so patience is key when incorporating them into your skincare routine. Results usually take a minimum of 4 to 8 weeks to be seen with daily application. If you have been applying the product regularly for 8 to 12 weeks and are not satisfied with the results, I would recommend going for something stronger if your skin can take it.
In conclusion, understanding the hierarchy of retinoids is essential for anyone looking to reap the benefits of these powerful compounds. By knowing the different categories of retinoids, their availability, and the potential side effects, you can make an informed decision about which retinoid is best suited for your skin type and concerns. Whether you choose an over-the-counter option or a prescription retinoid, proper usage and precautions are key to achieving the desired results while minimizing potential irritation or sensitivity.
TLDR: Too Long, Didn't Read
Retinoids are a group of compounds derived from Vitamin A in my Top 3 list of MVP skincare products.
They offer remarkable skincare benefits, with the ability to improve skin texture, lighten pigmentation, reduce wrinkles, and combat acne.
Whether you’re fighting adult acne or looking to delay tell-tale signs of aging such as dark spots, fine lines, crepey skin and more, retinoids are an integral part of any skincare regimen.
Find the right balance between effectiveness and sensitivity! Stronger retinoids, whilst being more effective, have a higher tendency to cause skin irritation, dryness, and flakiness, especially during the initial stages of use.
When in doubt, it's always best to consult with an aesthetic physician or dermatologist who can assess your specific needs and recommend the most suitable options for you.
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The Hierarchy of Retinoids:
A Comprehensive Guide
