Retinoids: A Case Study

I love talking dermatology more than almost any other subject. It combines my passion for Evidence Based Medicine with my...er...passion for beauty? There is no way to phrase that sentence without sounding like a geeky ditz. Anyway in my ongoing quest to learn about the products I put on my skin and in my body I've been turning a lot to resources like UpToDate and PubMed to get a feel for the safest and most effective options to make my skin look prettier without unwanted side effects (unnecessary expenditures count as a side effect, too). Up to now I've mostly played it safe with my skincare routine, sticking to gentle cleansers and moisturizers that don't irritate my skin but also don't make any promises. Now that I'm in my mid-twenties (*gasp*) I've seen the light! It's 2014, I should be using products that actually have active, hardworking ingredients. I love buying foundations and BB creams and playing with makeup, but I want my skin to be so amazing that I never ever hear the dreaded phrase "you look tired" ever again. I want to glow, like a cute little baby or something.

Gratuitous photo of a famous baby with great skin. I want skin like his but maybe more hair and teeth. 

Now, to abruptly change the topic. Last summer in Atlanta I worked with a large group of extremely attractive female doctors all in their late 20s to early 30s. Every single one of them was brilliant, compassionate, and excellent at their jobs obviously but at the end of my rotation my burning question was, "how do you all have such amazing skin?" The Georgia humidity was wreaking havoc on my face, I was in a constant battle of new blemishes and random dry patches that wouldn't resolve no matter what. The very sweet attending who was clearly wearing no makeup at all apart from mascara and lipgloss, informed that her dermatology colleagues prescribe everyone Retin-A long before any wrinkles appear.

The Science Bit

"Retinoids" is a generic term for any product derived from Vitamin A. It encompasses Retin-A (available by prescription only, also called tretinoin), retinol, retinoic acid, and retinyl palmitate. Those of you who suffered from severe acne as teenagers may remember taking Accutane (isotretinoin), an oral formulation also derived from Vitamin A. All Vitamin A-derived products work in a similar way to exfoliate skin (keratolysis) and stimulate collagen production (collagenesis). This means the skin will feel softer, hyperpigmentation will be reduced, and wrinkles will disappear. Retinoids have been used for decades in dermatology for conditions like severe acne, psoriasis, and keratosis pilaris. In fact, their use as antiaging products was only investigated in last 20 or so years when dermatologists noticed that their acne patients had very youthful skin.

When choosing a retinoid product everything boils down to potency. Tretinoin is available by prescription from your doctor and is about 10 times more potent than retinol, the over the counter equivalent that is present in many anti-aging serums. Tretinoin's potency means that its effects will be evident more quickly but this is associated with an increased risk of side effects. Some patients note that their skin becomes sensitive, dry, and flaky when they start using tretinoin. Depending on your tolerance for pain and the "severity" of your skin's "condition" (sarcastic quotes because normal aging isn't a pathological process in my mind) it may be worthwhile to discuss a prescription with your doctor.

Retinol is a lower potency because after application it has to be converted to retinoic acid by the body, so it's a less efficient delivery system of active ingredients. It's present in a lot of over the counter formulations up to a maximum concentration of 2%.

It is also important to note that high dose Vitamin A is a known teratogen. Please discuss it with your doctor first if you are planning to get pregnant. Also retinoids are delicate little molecules so are packaged in foil containers and if exposed to sunlight will be deactivated. Apply them at night time before your moisturizer. It's a common misconception that retinoids cause an increased risk of sunburn but they definitely don't. Every single woman (and man, but I guarantee there are no men reading here) should wear SPF on the daily. There's no point fighting the first signs of aging all night with your hard working retinoid and then causing more photo damage during the day.

Fun fact: high dose Vitamin A is also used as a treatment for certain lymphomas and is being investigated as a potential treatment for malignant melanoma as well. Is there anything this humble vitamin can't do?

Picking A Retinoid

I'm going to focus on the over the counter retinoids at this stage, since Retin A/tretinoin is only available by prescription. I personally opted to start with an over the counter retinoid since I'm young and my "problem areas" don't bother me too much. I'm saving the tretinoin/big guns for when I'm a bit older and need something more aggressive.

The number of anti-aging products on the market are truly mind-boggling and it can be difficult to sift through the marketing mumbo-jumbo to arrive at something resembling the truth. Lots of products use vaguely science-y words ("Nanotechnology! Proteoglycans!") accompanied by photographs of attractive people in lab coats. I'm sure in a few years one of these companies will emerge the triumphant winner but in the meantime I'm sticking with retinols because the data is there to back it. Plus I feel a little better knowing that the FDA has approved tretinoin as a pharmaceutical, rather than a cosmetic. My feelings about cosmetic labeling is a completely different rant though so I will spare you the details.
When hunting for an anti-aging product in my opinion simple is better. As products start offering more and more benefits such as moisturizing, antioxidants, and sunscreen the whole thing becomes a little more dicey. Complex serums that claim to multitask are more likely to contain irritating fragrances or frustratingly low concentrations of their active ingredients. Right now the maximum that any non-prescription retinoid can contain is 2% retinol, so I set out to find a product that was exactly that and nothing more.

Perhaps unsurprisingly, retinoids are expensive! I presume this is a conspiracy to keep us all either youthful and poor or haggard and wealthy. My feeling is that if your skin looks flawless you save money on foundations and concealers, so justification of the price is easily had.

The Contestants

My first Glossybox arrived, containing a sample of Vichy's newest anti-aging product called "LiftActiv Advanced Filler." The website doesn't list the concentration of retinol and mentions some proprietary product called "LR2412" which is also present in Lancome's Visionnaire serum but must be an industry secret because I can't find any information about what it is. At 37 EU for 30 mL, this Vichy serum is a little more expensive than I'd like. Also I don't like the idea of investing in a product that I don't know enough about, so when my sample runs out I might hold off on repurchasing. I've used it for a few nights now and I'm happy to report no side effects at all. I also had a few nasty little stress-induced blemishes on my chin and this cleared them right up within a few days.

Pros: available at your local Boots, contains retinol, non-irritating, cleared up blemishes
Cons: $$ what am I, an heiress?

In two weeks my darling little brother is coming to visit all the way from New Orleans! Obviously this means I'll be using him as a mule and demanding that he bring me some Sephora products because this trip isn't about family, it's about skincare. I'm having him bring me Dr Brandt Overnight Resurfacing Serum and Philosophy Help Me. Both contain 2% retinol and very little else. I'm also glad to see they are formulated without parabens and phthalates, though I haven't done enough research about those ingredients to really make my mind up about them. Still, safe rather than sorry, etc etc. I chose these 2 from Sephora because I was happy with the cost:benefit ratio and I've used products from each brand before with no problems.

Two Retinols enter...

...this metaphor doesn't work

Since retinoids can take several weeks, if not months, to have a visible effect I won't likely be able to do any kind of review of their efficacy for awhile. The scientist in me is tempted to do one side of my face with the Dr Brandt product and the other side with the Philosophy product, sort of a cosmoceutical Hunger Games where the arena is my face. I probably won't, though. As much as I love a controlled trial I'm kind of worried that the difference will be dramatic and the phrase "this is my good side" is going to take on a scary and literal new meaning.

The Before

So what's my starting point? I'm tempted to upload a photo wearing zero makeup in the name of science but that is quite frankly kind of scary and you never know what handsome millionaire might stumble across it and decide not to marry me. I took a "before" photo for posterity with my cell phone though, so stay tuned in a few months and we can track progress together. By then I'll have convinced the millionaire to marry me and I can expose my scary face to the Internet. At the moment I'm dealing with some hyperpigmentation around my mouth, some post-inflammatory hyperpigmentation (fancy talk for acne-related dark spots) on my chin, and a bit of redness on my nostrils and cheeks. I don't have any wrinkles and my skin is in pretty good condition. I've been breaking out quite a bit, likely because of stress, and I'm glad the retinols will take care of that too. Ain't nobody got time for the ravages of time and the problems of puberty, right?

Stay tuned for updates on my retinol experience! Share your grown-up skincare secrets too, I'm all ears.

xo Caitlin