Five Retinoid Myths Debunked
While there are a variety of skincare myths that often circulate, retinoids draw particular attention. With this in mind, we asked board-certified dermatologist, Ranella Hirsch, to bust the most common myths around the gold-standard ingredient.
Myth 1: Retinoids exfoliate the skin
Since the common early side effects of starting a retinoid (peeling, irritation and redness) closely mirror those of starting a skin exfoliant, this is a common misconception. In fact, the mechanisms for each differ. Dermatologists often describe the epidermis (top layer of the skin) as a brick wall, with bricks (the individual cells) and mortar (the glue, aka lipids) holding the wall together. With exfoliants, bonds between cells are broken, which causes the shedding of cells at the top layers. By contrast, retinoids rev up the production of more new healthy cells.
Myth 2: Retinoids work for a while until the skin “gets used to them” and then stop being effective
Often, as one becomes acclimated to an active ingredient, they stop seeing side effects like peeling and flaking skin and assume it is no longer working. But this is not an indication that the skin isn’t responding, just that the early period of irritation is over.
The Ranella-ism I use to explain this to patients is of an aeroplane. At first, the plane takes off and is elevating to gain speed and momentum until the point at which you hit cruising altitude. What is so often described as "the skin getting used to" is just "cruising altitude." True, it's no longer bumpy, but you are still en route to your destination. Your skin continues to improve, even if you are no longer seeing those signs.
It is the difference in how individuals tolerate this adaptation process that determines whether it’s helpful to change your approach. For many, retinoid success can be defined as the consistent use of a single product or potency. For others, it may include a gradual increase in the potency or frequency of the product being used. This is especially true with sensitive or more melanated skin types where irritation and/or hyperpigmentation are a concern.
Myth 3: Retinoids thin the skin
There is a kernel of truth here. The misunderstanding stems from the initial reaction of a specific skin layer. The epidermis, or the upper main layer of the skin, is comprised of five layers, with the stratum corneum at the top. This layer of dead skin cells is compressed when you start a retinoid, which does seem as though the skin is thinning.
Myth 4: Retinoids are all the same
Retinoids are a blanket term for a category of vitamin A derivatives used in skincare. They are beloved for their ability to impact many skin concerns, including acne, psoriasis, hyperpigmentation, and the appearance of sun-damaged skin. They range widely in formula and potency, encompassing a spectrum of products available both with or without a prescription. Generally speaking, they are classified by potency based on the number of steps necessary for their conversion to tretinoin, the form that is immediately bioavailable (has specific receptors for) to the skin. Each conversion step decreases the strength of the ingredient. For example, retinal is stronger than retinol.
Myth 5: Retinoids during pregnancy
Retinoic acid is normally found in human blood and has extensive applications in medical practice. Oral retinoids produce a characteristic set of birth defects and are absolutely contraindicated in pregnancy.
To explore the risk of topical retinoids, a collaborative study looked at the rate of genetic malformations following first-trimester exposure. 235 exposed pregnant women were compared with 444 non-exposed pregnant women, and no significant differences were observed with regard to spontaneous abortion, birth defects, or evident retinoid-induced abnormalities.
The fact that topical tretinoin application seems to show minimal skin absorption and does not seem to show a higher risk for major birth defects in newborns is highly reassuring. However, because potential fetal abnormality-causing exposure levels in humans are unknown, the risk/benefit ratio is lacking, to justify regular use. In clinical practice, our advice is to have a conversation with those caring for your pregnancy, as the two of you know your pregnancy and situation best.
I have recommended this for years because it’s just a winner. Great price, widely accessible, and a fantastic starter retinoid. It’s lasted this long because it works.
A pricier option for certain, but a lovely product that is really pleasant to use. Nice texture, no funky smell, does what it is supposed to. Also helped by the stepwise approach they take to increase potency for those who need/want it.
They have several retinoid offerings but this one by far is the standout formula. Elegant and light on the skin, beautiful hydration not often seen with an effective retinoid treatment, can actually serve as a moisturiser for many in the evenings.
Skin Rocks also sell a Retinoid 2. Newer products and admittedly more pricey for a retinoid, but if they are an option for you, they are lovely. Silky base that is rich enough to potentially forgo moisturiser while gentle enough for weekly exfoliation. Dreamy texture, zero smell. Two strengths, one starter, one maintenance. Well worth significant allocation of skincare actives budget.
This is great for acneic skin. Initially a prescription drug, this does a nice job on both white and blackheads for a great price and is available over the counter. Widely accessible and works.
Words by Ranella Hirsch, MD FAAD
Past President, American Society of Cosmetic Dermatology and Aesthetic Surgery