Updated: Nov 8, 2018
Perhaps the most ubiquitous ingredient in medical grade skin care is retinol.
And for good reason, as it the most researched and respected compound when
it comes to treating multiple skin concerns (ageing, acne, pigmentation,
congestion… I could go on). So it helps to understand how to choose a retinol
compound that is going to do the work you want it. Skin care should be
personalised, and it isn’t enough to bang on that $130 lotion because Nancy’s
cousins next door neighbour looks great on it.
Why is retinol so ‘in’ right now?
It’s been ‘in’ for a long time. Retinol refers to topical (on the skin) vitamin A.
We have used topical vitamin A creams to manage acne and ageing for many
years. We also use an ingested form of vitamin A (isotretinoin aka Roaccutane)
to manage severe acne. I’d have to give it my vote for the most results-giving
compound in skin care. However, I’d also propose it Is the most widely misused
product due to its abundance in proprietary skin products. One retinol does
not equal the other retinol.
So how do I choose one for me?
The most widely available forms of retinol are 1. Retinol itself 2. Tretinoin
Basically tretinoin is a bit more punchy – better for treating to a clinical
endpoint. When tretinoin hits the skin, it is directly active in enhancing skin cell
turnover. However when retinol hits the skin, it needs to be converted to a
lower concentration of tretinoin to become active in a less potent manner.
This punchiness of tretinoin does not make it better. The leading factor in
choosing which retinol to use should be your TOLERANCE. It is common to
have redness, flaking around the mouth and nose corners, dryness and sun
sensitivity with improperly used retinols. It is best to start retinols according to
a conservative Starter Program – commencing with a lower strength (over the
counter) formula and then aiming for a prescription strength cream. The
Started Program can take you six weeks or six months, and if aiming for a
prescription vitamin A, then it should be medically supervised. Please note,
that pregnancy and breastfeeding are contraindications to the use of vitamin
A, both topical and oral forms.
What’s the Starter Program?
Level 1. Commence low strength retinol with a single overnight application.
Apply to skin (this is your skin medicine so must be in contact with your bare
skin to do it’s magic), and moisturise on top. Make sure you have a sunscreen
to apply when you wake up – this is your new daily routine! All going well –
you can apply at night on Monday, Wednesday and Friday. If any redness
occurs, inform your cosmetic doctor and apply only moisturiser to the affected
areas. You can continue the retinol application to unaffected skin if your
This should take around 8-12 weeks, but everyone is different. Now is the time
you should be finishing up the first bottle of retinol and it is time to go up to a
moderate strength. Once again – perform a single overnight application and if
all went smoothly, you can progress to applying Monday, Wednesday and
Friday at night time.
There are two options – you can increase your application of the moderate
strength retinol to Monday through Friday. Or you can seek out a clinical
strength formula. My personal practice is to use a custom option for the
patient which is on prescription. The end points I commonly use are 1.
Tretinoin cream ongoing 2. Retinol 3% 3. Retinol 5%.
Once using higher strength compounds, managing the skin barrier is
important. After all, we say first do no harm in medicine. Same goes for the
skin. Applying medical grade creams, then subjecting yourself willy nilly to an
array of lasers, peels, microderms, Nancy’s neighbours creams etc can disrupt
your skin’s beautiful invisible layer of immunity and glow. The caution I provide
to my patients is to apply their medical grade skin care Monday to Friday
(heck, it’s your full time job) and to give the skin a rest on the weekend. I also
utilise ceramide or peptide compounds where necessary to further protect and
reinforce the skin barrier. Skin barrier issues may present as breakouts,
sensitivity, dermatitis or even histamine response. More on this in another