Retinoids for anti-ageing: the evidence

Key takeaways

• Among skincare ingredients, retinoids have some of the most solid evidence for photoageing.
• Tretinoin is prescription only; retinol and retinaldehyde are milder cosmetic forms.
• Irritation in the first weeks (redness, peeling, dryness) is common and usually manageable.
• Results take months. Benefits in trials appeared from about a month and continued for up to two years.
• Not for use in pregnancy. Some retinoids are known to harm the developing baby.

What are retinoids, and why do they work on ageing skin?

Retinoids are a family of compounds related to vitamin A. DermNet lists the main ones: - Cosmetic: retinol and retinaldehyde - Prescription: tretinoin, adapalene, tazarotene and trifarotene

See, what happens is, retinoids act on receptors in skin cells and change how those cells behave. They speed up the turnover of the surface layer, and over time they influence the deeper layer too, where collagen is made. Sun damage over years causes fine lines, rough texture, blotchy pigment and spots. Retinoids partly reverse some of those changes.

What does the evidence actually show?

Two recent systematic reviews summarise the trials.

DermNet adds that long-term tretinoin use, beyond six months, may reduce fine wrinkles, freckling, sun spots and some precancerous rough spots.

For retinol, the evidence is lighter. Mayo Clinic describes it as a milder retinoid that may smooth wrinkles and reduce discoloration, with some irritation at first. Basically, retinol is a gentler entry point, and tretinoin has the stronger trial record.

Retinol or tretinoin: which should I use?

DermNet notes that among prescription retinoids, adapalene is the least irritating and tretinoin the most, and that creams irritate less than gels. In Mumbai's humidity some people prefer a lighter texture, and in an air-conditioned office or winter the skin often needs a richer cream. Normally I choose the form after looking at your skin.

How do I start a retinoid without wrecking my skin?

This is where most people go wrong. They buy a strong product, use it every night, their face peels and burns, and they stop. That is retinoid dermatitis, which DermNet describes as redness, peeling and dryness.

What I tell my patients: 1. Start low and slow. A pea-sized amount for the whole face, two or three nights a week at first. 2. Apply to dry skin, at night, after cleansing. Wait a little after washing. 3. Moisturise. Before or after the retinoid, whichever your skin tolerates. 4. Avoid the corners of the nose, the lips and close to the eyes in the beginning. 5. Increase gradually over weeks, as your skin settles. 6. Sunscreen every morning. Retinoids can increase sun sensitivity, as Mayo Clinic and DermNet both note. In Indian sun this is not optional.

Do not combine a new retinoid with other strong actives like exfoliating acids in the first weeks. One change at a time.

Is there a risk of pigmentation in Indian skin?

Retinoids themselves often help uneven pigment over time. The risk in brown skin comes from irritation. If the skin becomes red and inflamed and you keep pushing, some people develop darker patches afterwards. That is very important to understand. Gentle and consistent beats strong and irregular.

If you have melasma, sensitive skin or eczema, speak to a doctor first. DermNet notes retinoids can make eczema worse.

Who should not use retinoids?

• Pregnant women, or women trying to conceive. DermNet notes some topical retinoids are known to harm the developing baby. Absorption through the skin is limited, but the advice is to avoid them. Mayo Clinic also lists retinoids as not for use during pregnancy.
• People with active eczema or very irritated skin, until the skin settles.
• Before some procedures. I may ask you to pause a retinoid a few days before a peel, laser or waxing.

If you become pregnant while using one, stop and tell your doctor. Do not panic, but do inform them.

How long before I see a difference?

In the trials, early changes appeared from around a month, and continued improvement was seen over months to two years. In practice I tell people to give it three to six months of steady use before judging. Take a photo in the same light every month. Mayo Clinic also points out that when you stop most skincare, the skin gradually returns to where it was. So this is a long-term habit, not a course.

Retinoids fit naturally into an evidence-based anti-ageing routine, and they work alongside, not instead of, in-clinic treatments such as laser for fine lines and texture.

How we approach this at Dr Tvacha

At a face assessment within the Long Game Anti-ageing Plan, I look at your skin type, pigment, sensitivity and what you already use, and then suggest whether a retinoid suits you, which one and at what strength. Prescription retinoids are a doctor's decision made after examining your skin. We start small and review, because the skin you want in five years depends on what you can keep doing every week.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.