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Retin-what? Breaking down the differences between retinol, retinaldehyde, and tretinoin.

Retin-what? Breaking down the differences between retinol, retinaldehyde, and tretinoin for skin aging.    Retinol (vitamin A), retinaldehyde (also called retinal), and tretinoin (also called retinoic acid) are all considered “retinoids” or vitamin A derivatives. This class of compounds is among the most well-studied in topical skin care, but their similar names and great marketing efforts can make choosing the right formulation confusing.    Retinol (vitamin A) is a fat-soluble vitamin found in some foods like green leafy vegetables and dairy sources, and is also made from beta-carotene found in foods like carrots and cantaloupe. Vitamin A is absorbed by the small intestine and either stored in the liver or converted to an active molecule that can be used by cells, called tretinoin. There is a two-step conversion process to make tretinoin from retinol, and one of the compounds that is formed during this process is called retinaldehyde. Thus, retinol and retinaldehyde are precursors to the more active form of vitamin A –> tretinoin. When these compounds are applied topically to skin (as opposed to ingested through foods in our diet) they have been shown to increase collagen production leading to firmer skin with less sagging and laxity, and to decrease fine lines and wrinkles (Hubbard et al., Plast. Reconstr. Surg. 133: 481e, 2014).   
  • Retinol is the most widely available option and is found in many over the counter products and cosmetics.  It causes less skin irritation, redness and flaking than the other vitamin A derivatives, but it also doesn’t work as well. Retinol is not as available for cells to use because it must be converted into tretinoin, and it is easily degraded by the environment making it far less potent by the time it hits your skin (Hubbard et al).  Any clinical results from these products will be more subtle and may require longer use to become apparent. One randomized controlled study suggested no difference between OTC retinol use and placebo (Van Wicklin, Plastic Surgical Nursing, Vol 41, No 4, 2021), but other studies have suggested mild improvements in skin appearance.  
  • Retinaldehyde is another retinoid available without prescription. Like retinol, retinaldehyde must be converted to tretinoin to be available for cells to use, but unlike retinol, the research has shown comparable results to that of tretinoin in terms of improvements in skin. It may also cause less irritation than tretinoin, making it a good alternative for people who don’t tolerate tretinoin well or who have very sensitive skin. SUZANOBAGIMD Retivance® is one of our favorite retinaldehyde products, which is available to purchase at our office.   
  • Prescription only tretinoin is the gold standard for topical agents in terms of reversing photodamage and stimulating collagen production.  Tretinoin works faster than the other products because it is readily available for cells to use, which also means it causes more redness, flaking, dryness, and skin irritation (Hubbard et al).  These symptoms can usually be managed by choosing the correct dose of medication and by reducing the frequency of application when first starting.  Improvements in skin include: 
 
3 months of use  Reduction in fine wrinkles 
6 months of use  Evening out of skin tone  Decreased roughness  Reduction in coarse wrinkles  Decreased laxity 
12 months of use  New collagen formation  Reduced breakdown of collagen (Hubbard et al.) 
*Some studies have shown faster onset of action than those listed above    All retinoids can increase sensitivity to the sun, and it is recommended to avoid sun exposure or use sunscreen regularly when using these products. Improvements observed with retinoid use are only present while using the product, so once desired results are obtained, a lower dose maintenance plan is recommended for continued benefit.     The Bottom Line: Choosing the right topical retinoid involves more than just ordering an expensive product claiming to improve your skin. Determining the best type of product, dose, and treatment protocol is unique to each individual, which is why CFP offers many different options. Your skin care plan should be developed with a knowledgeable provider who will consider your preferred timeline for change, sensitivity to the product, and who can help you change course if the desired results aren’t achieved or if the regimen isn’t tolerated well. Consider meeting with our experienced nurse practitioner to learn more about your personal skin health and to develop a skin care plan that is right for you. Schedule a consultation today! 

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