Part Three of our Skin Care Primer Series: Tretinoin

We’ve already talked a bunch about the effects of aging on the skin and both the internal and external factors that impact that process. Last week we learned how to prevent the most important external factor on aging, the sun, with the proper use of sunscreen. But how can you slow the internal aging process of the skin and reverse the existing photodamage already caused by the sun? Enter Tretinoin.

Tretinoin (all-trans retinoic-acid), brand name Retin-A, is the single best skin care product available to slow, and even reverse, the skin’s internal aging process and pre-existing damage done by the sun. Together with the protective effects of sunscreen, these two products should form the foundation of any skin care regimen.

Tretinoin is a Vitamin A derivative. Since Vitamin A is fat soluble (dissolves easily in fat), Tretinoin can be absorbed readily by the skin. This makes it perfect for topical use. Its positive effects occur in both the upper layer of the skin (the epidermis) and the lower layer of the skin (dermis).

In the epidermis, Tretinoin produces changes that promote healthy, glowing skin. To understand the effects of Tretinoin a little bit of science is necessary. The epidermis grows from the bottom up by the replication of special cells. As these cells progress upward, they go through some changes which produce four distinct layers. This is important because the top layer (the stratum corneum) is essentially dead skin cells. This layer gets much thicker with age and contributes to the dry, flaky, uneven appearance of the skin.

Tretinoin increases the turnover of the skin, translating to less build-up of dead skin cells at the skin’s surface. This reduction of dead skin cells creates the appearance of smoother, glowing skin. Additionally, since Tretinoin speeds skin turnover, skin pigment becomes more evenly distributed. This improves the regularity of the skin tone and reduces age spots.

In the dermis, the main effect of Tretinoin is increasing collagen production. Collagen is the primary structural protein of the skin. Collagen content reduces with age (about 1% less production per year after age 20!!) and the skin becomes more fragile, less resistant to sagging, and prone to wrinkling. Tretinoin use actively promotes the production of collagen in the dermis; strengthening skin and reducing fine lines and wrinkles. Bonus; it also prevents the breakdown of existing collagen caused by exposure to UV radiation. The collagen promoting effects of Tretinoin has been shown to increase collagen content of the dermis by up to 80% in one year!

Tretinoin also increases hyaluronic acid content in the skin. Anyone familiar with fillers like Juvéderm® and Restylane® knows that hyaluronic acid can add volume (in all the right places). But less known is the fact that hyaluronic acid is a substance naturally occurring in our skin.  Its primary job is to retain water in the skin, and it’s this that gives the skin its full, youthful appearance.

To get all these benefits you need make sure you are using true Tretinoin. Countless cosmeceuticals and beauty products sold over the counter advertise the same effects but contain retinol, retinal, or retinyl. Although all three of these agents are also Vitamin A derivatives, they are much weaker than Tretinoin and cannot match the anti-aging effects of the real deal. Tretinoin is a prescription medication and needs to be acquired through a physician, beware of over-the-counter alternatives.

The most important thing about treatment with Tretinoin is proper use. If too much is used, too quickly, the skin can become quite irritated. We’ve seen too many patients who started Retin-A and thought “if some is good, more is better”. They ended up with redness, cracking, and discomfort, eventually tossing the product. They never gave themselves the chance to see the benefits.

We recommend starting off by using Tretinoin twice a week for the first two weeks. If that is well tolerated, increase the dosing to every other day. The eventual goal for most patients is daily use, but some with sensitive skin may only ever get to every other day dosing. You are in the perfect zone if you are having light flaking of the skin (don’t worry, this is only temporary and will eventually stop), without significant redness or discomfort. If at any point these arise, scale back the frequency of application. Tretinoin also comes in multiple concentrations and the proper strength needs to be carefully selected to fit your skin and meet your goals.

Another critical part of Tretinoin therapy is patience. The effects of Tretinoin take a significant amount of time to manifest. It takes time for the skin to turn over and shed the dead cells. It takes time for the collagen to increase. It can be a few months before you start to notice a difference, but the results are well worth the wait.

Adding Tretinoin to your skin care regimen is crucial if you want to slow the aging process, reverse pre-existing damage, and give yourself the best possible skin. Good skin care is unique for each person, and any regimen needs to be tailored to fit your skin and maximize your results. Call for an individualized skin care consultation to help meet your skin care goals, 860-676-2473.