Rethinking Retinoids: A Modern Review

by Sarah Villafranco, MD /

Here we are, asking the retinoid question - again! Let me give you the straight answer: there is no straight answer. So let’s focus on the other questions instead, and then you can see what feels right for you.

What is Vitamin A?

Natural sources of dietary Vitamin A, also called retinoids, come from animals and plants. Animal-derived retinoids (retinol, retinal, and retinyl esters) come from liver, some fish, egg yolks, heavy cream, and butter. Plant-derived Vitamin A comes in the form of carotenoid provitamins like beta-carotene (carrots, sweet potatoes, cantaloupe, kale, broccoli) and must be converted by the body into a usable form. Vitamin A is then used for reproductive development, vision, immunity, and cell function and division. The first symptom of deficiency is often night-blindness. (Cool fact - Vitamin A deficiency is rare these days, but the ancient Egyptians, apparently clever about more than just pyramids, ate liver to treat night blindness.)


In skin care, Vitamin A also has many names. Retin-A (tretinoin) is the name most people know, and was the first, patented version of a cream containing retinoic acid. It was initially used to treat acne, with moderate success for many people, but had the unexpected side-effect of much younger-looking skin with long-term use. (Can I get a cha-ching?)

Why would I use Vitamin A on my skin?


It turns out that retinoids do a lot of good stuff for your skin! Proven benefits by randomized, controlled, double-blind studies) include the following:
  • Increased cell turnover (fewer breakouts, better skin tone, glowing complexion)
  • Increased production and decreased breakdown of collagen (firmer skin, fewer wrinkles)
  • Increased glycosaminoglycans (GAGS) in the skin (greater hydration, stronger skin)

Who wouldn’t want all that goodness??

Why would I NOT use it?

Sigh. There are a number of factors worth considering:

  • Retinoid toxicity may be an issue. The jury is still out on whether retinoids, when used in small amounts on the skin, are truly carcinogenic or teratogenic. Most people say there is no proof of toxicity in this setting, but when I see that something is not recommended during pregnancy, it gives me pause.
  • Side effects are a big problem. Dry, flaky, tight red skin when using retinoids can be very uncomfortable. There are workarounds - lower concentration, decreased frequency - but some people still struggle to make their skin accept the plan.
  • Other ingredients alongside the retinoic acid can be more toxic than the retinoid itself. Most prescription products have parabens, ethoxylated ingredients, and butylated hydroxytoluene (BHT). Commercial, non-prescription retinol products may also have fragrance, artificial colors, and petrochemicals.
  • Sun sensitivity is substantial - when your skin is deeply exfoliated, it is much more sensitive to sun. Retinyl palmitate, an over-the-counter Vitamin A option and an ingredient in many sunscreens, may accelerate certain skin cancers. (The evidence is inconclusive at present, but the Environmental Working Group and the National Toxicology Program are not fans.)

Can everyone use Vitamin A?

Definitely not. Some people won’t tolerate the side-effects, even when they employ all the tricks. People with dermatitis, rosacea, or thin facial skin may have a very difficult time with retinoids. And pregnant (or soon-to-be-pregnant) women need to know that most retinoids are Category C, which means they cause birth defects in animal studies but there is no human data.  Hmmmm.

How can I use it on my skin?

There are three options:.

  • Prescription retinoids work most quickly (4-12 weeks) with the most side effects. There are newer, receptor-specific retinoids (tazarotene, adapalene) that are gentler, but come with parabens and PEGs and other undesirables. Read your labels.
  • Over-the-counter retinol products have a wide spectrum of efficacy and ingredient quality. Retinol itself is unstable, must be packaged properly, and is often combined with BHT. It’s also 20 times less potent than tretinoin, so adjust your expectations - you’ll wait longer for results. Retinyl palmitate is another OTC alternative, but raises concern for photocarcinogenicity (accelerating skin cancer when exposed to UV light).
  • Natural oils that are high in carotenoids, vitamin A, or similar active ingredients are becoming increasingly popular. Oils from rosehip seed, sea buckthorn berry, argan, black currant, and broccoli seed can provide retinoid-esque benefits, albeit much more slowly.

Should I use it?

Only you can decide what’s right for you. What’s your priority? If you’re out to decrease wrinkles and sun damage (and not considering pregnancy) then retinoid therapy is worth a try. If being totally non-toxic and natural is higher on your list, then most retinoid formulations are out, and you’ll probably want to consider a botanical oil high in Vitamin A and carotenoids.

If I decide not to use it on my skin, can I get benefits through my diet?

Yes, but not to the same extent when it comes to skin appearance. That said, a diet high in carotenoids has been shown to decrease the risk of multiple cancers (breast, ovarian, colorectal, and cervical), and the incidence of certain eye diseases. So why not incorporate the dietary Vitamin A no matter what you do with your skin? (Don’t go for the supplements, though - they carry a higher risk of toxicity and overdose.)

What are the best Osmia products for vitamin A?

Our Luz Enzyme Facial Soap is gently exfoliating, with pumpkin and tomatoes to increase cell turnover. Our Brighten Facial Serum has similar exfoliative effects, without irritation or redness. Our Restore Facial Serum and Nectar Vital Rose Drops are rich in vitamin A and carotenoids, and healing to sun-damaged skin.

 

 

 

 

This post was originally published on MindBodyGreen - see it here

 

 

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