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Retinoids 101

The basic fundamentals of anti-aging By Jaime Crocker

Retinoids 101

As a nurse practitioner working in the world of aesthetics, I often get asked, "What is the best thing I can do for my skin?" My answer to my clients is almost always retinol and sunscreen. Most of us are familiar with the benefits of sunscreen and the important role it has on anti-aging and protecting our skin from free radicals. However, very few are familiar with the benefits and actions of retinoids.

Retinoids are a class of synthetic and naturally occurring vitamin A compounds and derivatives that include retinol and retinoic acid. Some retinoids, such as retinoic acid (Retin-A or tretinoin), are available by prescription only. Other retinoids, such as retinol, are cosmetic and can be found in various OTC products, however, it does not work as quickly nor as deeply as prescription retinoids (tretinoin).

The primary mechanism of action for both tretinoin and retinol is to stimulate epidermal turnover, causing skin to rapidly exfoliate and make new, brighter skin while stimulating collagen and elastin. The result can be smoother, thicker skin with fewer imperfections such as sunspots, acne, fine lines and scarring.

Retinoic acid (Retin-A or tretinoin) can be found in both topical and oral forms. Retinol is a topical retinoid. Both formulations require patience and commitment. For best results it takes three to six months of regular use before improvements in skin and reduction in wrinkles are apparent.

The most common adverse effect of topical retinoids is skin irritation, notably erythema and peeling. The most severe adverse effect of systemic retinoids is teratogenicity (birth defects). Do not use these products while pregnant or considering pregnancy.

Retinoids are recommended for daily use, yet due to the common side effect of redness, itching and flaking, most patients cannot tolerate the once daily application initially. If patients have sensitive skin or are new to a medical-grade skin regimen, I recommended to start off using tretinoin every other night or three times a week, working up to nightly use for best results. Retinoids should be applied at night due to increased sensitivity to sun exposure. Due to the increased cell turnover of the epithelium, it is recommended that anyone using tretinoin use a daily sunscreen SPF 30 or greater containing an increased level of titanium or zinc oxide. Even if you are not using a vitamin A product, daily sunblock is essential.

Tretinoin and retinol are safe to use in conjunction with alpha hydroxy acids (AHAs) and salicylic acid (SA); just stagger applications—acids in the morning and retinoid in the evening for additional benefits. I recommend avoiding use of glycolic acid and benzoyl peroxide at the same time due to increased exfoliation and epithelial turnover. Benzoyl peroxide is also known to oxidize retinoids, making them less effective.

When is it not appropriate to use retinoids? Aside from pregnancy, caution should be applied when waxing or preparing for laser treatments of our upper body (areas where you apply retinoids). Your esthetician, PCP, dermatologist or aesthetic RN can educate you on pre-treatment instructions for the associated procedures; usually it is avoidance for five to seven days prior to treatment. I also caution my patients when planning a trip to a sunny destination. As you are more sun sensitive when using these products, this makes you at greater risk for sunburn. If we are working toward healthy skin, a sunburn is definitely not in the skin-care regimen. Protect your investment.

Jaime Crocker is a nurse practitioner in Spokane, Washington, who is also the owner of Odara Medical Spa. Jaime has practiced in emergency medicine for the past 17 years and most recently entered into the practice of aesthetics. To connect with her, please follow her Instagram page at OdaraMedSpa or directly via

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