We have made great headway when it comes to treating acne. Our understanding of the role played by the bacterium Propionibacterium acnes (P. acnes) has grown, and we know more about how certain vitamin deficiencies can contribute to acne vulgaris. We know that prevention is the key to fighting acne of all types—that means going below the surface to where acne starts. We’ll talk about all these advances and what they mean in later posts, but first I’d like to discuss the most effective weapon in the acne battle—vitamin A derivatives. Since vitamin A derivatives (retinoids) have also proved to repair photodamage, they're the go-to ingredients if you have aging issues. Clearly, their multiple benefits make them the ideal choice for adults with acne.
While almost everyone can benefit from topical vitamin A, confusion reigns over what works best over what doesn’t work at all. Unfortunately the facts tend to get drowned out in resounding marketing clamor, and some people may even get scared off from using them at all. Here’s the straight scoop, starting with retinoids.
Retinoids is the term used for the group of vitamin A derivatives that study after study have proven to unclog pores, stimulate collagen production and improve collagen density. Your skin can only use retinoids that are retinoic acid (or like retinol, can be converted to it), because retinoic acid works by binding to retinoic acid receptors found on the outer membrane of cells. On the acne-fighting front it penetrates to sebaceous glands and reduces sebum production by binding to sebocyte receptors. Its anti-inflammatory effects keep P. acnes in check. Currently three prescription-strength retinoids are available: Tretinoin (includes Retin-A, Retin-A micro and Renova), Tazarotene and Adapalene. Tazarotene is regarded as the strongest and Adapalene the gentlest to the skin. There is no argument that prescription formulas deliver the best results, but there are drawbacks.
They can be irritating, and some people experience peeling and redness.
Most, if not all, prescription products contain ingredients like propylene glycol and parabens that the natural community has long ago rejected. My suspicion is that some of the irritation might be a result of the non-active ingredients in the formulation rather than the retinoic acid. The irritation problem could possibly be mediated by using formulations that do not contain other known irritants.
They require a prescription, which may be inconvenient.
Retinol (vitamin A)
Here the confusion begins. The most popular version of vitamin A found in over-the-counter products is called retinol, but besides retinol there are the various types of esters, also derivatives of vitamin A, that are often described as retinol: Retinyl Acetate, Retinyl Linoleate, Retinyl Palmitate and Retinyl Proprionate. It's important to remember that all vitamin A derivatives must convert to retinoic acid. Their effectiveness depends on several factors:
- Number of conversion steps
Vitamin A esters like retinyl palmitate have a three–step process (Retinyl palmitateretinol), while retinol takes two steps to convert to retinoic acid (retinolretinaldehyderetinoic acid).
The drawn-out conversion process of retinyl palmitate militates against its efficacy.
All vitamin A derivatives degrade very quickly when exposed to air and sunlight. In fact, dermatologists favored prescription retinoic acid over retinol for decades because the latter was simply too unstable in solution to be effective. Fortunately advances in nanotechnology have given us encapsulated versions of retinol that do not degrade as quickly. It's still important to keep your retinol product away from light and use the product at night only.
The efficacy of retinol depends on concentration—higher concentrations result in higher conversion rates to retinoic acid. However, higher concentrations of retinol can sometimes lead to increased irritation, the same problem encountered with, for example, prescription-strength Retin-A. The upside here is that if you experience irritation when using a high-concentration retinol product without known irritating preservatives (parabens or sodium benzoate), you are very likely reaping the benefits of retinoic acid being absorbed into the skin’s cell receptors.
Choosing the right retinoid
Retinoic acid: The key to success is choosing your retinoid carefully. Always bear in mind that the active ingredient that repairs photoaging and alleviates acne is retinoic acid. Your skin can only use retinoids that are retinoic acid or, like retinol, can be converted to it. Adults with both acne and aging issues will want to get the full benefit of retinoic acid if they can tolerate it. Some people experience irritation at first, which generally improves over time. If not, your dermatologist may decide to try a different prescription. If irritation persists it may be other ingredients like preservatives and so on in the cream that are causing problems.
Retinol: Remember the mantra—retinol is not retinoic acid. Many people, however, prefer using over-the-counter retinol products for a variety of reasons, including uncomfortable skin reactivity. But watch out—retinol products can be less irritating because the retinol concentration is so low nothing is happening. Effective products do exist, and if you prefer retinol look for a product with the following profile:
- Contains an encapsulated version of retinol (protects against degradation)
- Contains an effective concentration of retinol
- Does not contain retinyl palmitate or other vitamin A ester (too far removed in the conversion chain)
- Does not contain preservatives like parabens, phenoxyethanol or sodium benzoate that may irritate skin
Prescription retinoids are regulated because they are teratogenic. Pregnant and nursing women should also avoid retinol products.
Use at night only, and always wear a broad-spectrum SPF 30 sunscreen during the day.
Keep all retinoid products away from light.
Never use benzoyl peroxide products, especially if you are an adult with acne. Prolonged use of BP can make skin photosensitive, and it impedes new skin cell formation, both of which accelerate skin aging.