Frequently asked questions about retinoids

Want to use the same products that a dermatologist uses on their skin? Consider a retinoid.

“Most dermatologists don’t use dozens of products but rather a small handful, one of which is usually a retinoid,” says UNC Health dermatologist William Huang, MD, MPH. 

We asked Huang about the benefits of retinoids and what to keep in mind when shopping the skin care aisle.

Retinoid is an umbrella term that refers to products that use vitamin A derivatives to improve skin. Under that umbrella is retinol, over-the-counter topical formulations that you apply to your skin, and prescription retinoids, which include oral medications and topical creams, lotions or gels.

You might have heard prescription retinoids referred to by their medical or brand names. Isotretinoin, which used to be sold under the brand name Accutane, is the most common oral prescription retinoid and is used to treat severe acne. Tretinoin (Retin-A), tazarotene (Tazorac), trifarotene (Aklief) and adapalene (Differin) are other prescription retinoids. A lower-strength version of adapalene is available without a prescription.

While retinoids are available by prescription, you can buy over-the-counter creams and serums with retinol as the active ingredient. The difference is in potency and how quickly they work.

When you apply a prescription retinoid to your face, it’s immediately converted to retinoic acid, its active form, which means it can start working on your skin right away.

“With over-the-counter retinol, your skin has to do one or two steps of conversion for it to be retinoic acid,” Huang says. “That means retinol is often gentler and more well-tolerated, but it takes more time to work.”

Both prescription and over-the-counter products have a number on them, usually under 1 percent, which indicates the concentration of the retinoid. While a higher number indicates higher strength, you can’t necessarily compare two over-the-counter products with the same percentage, or an over-the-counter product and a prescription product with the same percentage. Different companies use different formulas and it’s not an apples-to-apples comparison, Huang says.

Retinoids convert into retinoic acid, which creates new cells.

“It binds to receptors in your skin cells and causes more cellular turnover, which means you get new cells much more quickly than you normally would,” Huang says.

That quick turnover of cells helps with acne because the older cells can’t clog pores, which diminishes the number of whiteheads and blackheads. Retinoic acid also reduces oil production, which can make pores look smaller. Over time, it can reduce redness and appearance of old acne scars.

Retinoids were first approved for use by the Food and Drug Administration in 1971 for treatment of acne, but since then, other benefits have been identified.

“Now, people request it for anti-aging, because it diminishes fine lines and wrinkles and can clear up brown spots from too much sun,” Huang says. But “it can’t erase years of not using sunscreen, and it’s not going to make you look 30 years younger.”

Your dermatologist can help you understand if a retinoid is likely to help with your skin care goals or if another product or treatment would be a better fit.

“If you want brighter skin and to minimize fine lines, a retinoid will help, as will taking care of your health overall,” Huang says. “Your skin can reflect what’s going on inside you, if you’re not getting enough sleep, not eating properly, not mitigating stress. You don’t want to be missing the boat on these other things that will help your skin and overall health.”

Retinoids are known for making your skin feel irritated and look red and flaky in the first few weeks.

“Irritation is the biggest thing I talk about with people,” Huang says. “It doesn’t happen right away, but after a week or two, you might feel like you have a light sunburn. That might mean that product is too strong for how frequently you’re using it.”

Eventually, your skin will get used to the product, but you’ll be at greater risk for sunburn because of the new skin cells that result from the treatment.

If you’re pregnant, retinoids are not safe to use because of a risk of birth defects. The risks are especially high with the use of oral isotretinoin. Even with topical retinoids, it’s important to be very cautious.

“It’s not worth the risk to use a retinoid if you’re pregnant or thinking about becoming pregnant,” Huang says.

When you’re using a product with a retinoid, start slow and light.

“Start by using the product every other night, or two nights per week, and then increase the number of times you use it gradually,” Huang says. People with sensitive skin or eczema-prone skin may need to go even slower.

Even as you increase the number of times per week that you use the product, don’t increase the amount of the product that you use.

“You only need a very small amount—the size of a frozen green pea—for your entire face,” Huang says. “People think, ‘If a little is good, more must be better,’ but that little bit goes a long way. If your prescription is a 45-gram tube (about 1.6 ounces), that should last four to six months.”

Retinoids can break down in sunlight, so apply the product at night. Make sure your face is clean and dry before putting it on, and avoid sensitive parts of your face such as your eyelids and lips.

After applying the retinoid, you can use a gentle, hydrating moisturizer. Then, be patient.

“For acne, it takes about six to eight weeks of using a topical product to notice a day-to-day difference in breakouts,” Huang says. “For post-acne skin changes, like pigmentation or superficial scarring, it might take three to six months.”

Be extra careful about sun exposure, and use sunscreen every day.