What to know about retinoids

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The term retinoid refers to a group of compounds that derive from vitamin A. This means that they possess structural or functional similarities to vitamin A. Retinoids can be natural or synthetic and include many types and forms, such as retinol, retinal, and retinyl esters.

Retinoids are a common active ingredient in many dermatological medications and cosmeceuticals due to their positive effect on the skin and its appearance.

People can buy weaker forms of retinoids OTC to help treat mild acne or reduce signs of aging. Stronger forms are only available through a doctor’s prescription and typically treat more severe skin conditions, such as psoriasis.

Retinoids are available in two forms: topical and oral. Topical retinoids refer to creams, gels, and liquids that people can directly apply to the skin, while oral retinoids include tablets and capsules that a person can take by mouth.

The medications have complex mechanisms of action responsible for the benefits. These include:

• reducing inflammation
• increasing production of procollagen, the precursor to collagen
• unclogging blocked pores
• regulating the growth and cells on the body’s surface
• slowing skin aging due to ultraviolet light exposure

Retinoids have wide use in cosmetics and dermatology treatments. The most common use is to treat mild to moderate acne. By unclogging pores, retinoids allow topical antibiotics to get inside the pores. These two actions can help eliminate acne-causing bacteria.

Other possible uses include:

• Skin aging: The benefits of increasing procollagen production and reducing inflammation can help reduce wrinkles and other signs of aging.
• Psoriasis: Reducing inflammation and limiting high rates of skin cell proliferation help alleviate psoriasis symptoms.
• Pigment conditions: Retinoids can act on cells that produce pigments. This may help relieve conditions, such as melasma, which is patches of discoloration, and actinic lentigines, where small spots appear on the backs of forearms and hands.
• Certain types of cancer: The American Cancer Society notes that retinoids show promise in decreasing the likelihood of certain skin cancers. These include Kaposi’s sarcoma and cutaneous T-cell lymphoma. However, the oral retinoids prescribed for cancer can cause congenital disabilities, so doctors currently only prescribe them for people at high risk.
• Pseudofolliculitis barbae: This is an inflammatory condition that involves skin irritation after a hair removal method. Retinoids are one of the treatment options that can provide relief.

While retinoids can help treat some conditions, people should still take care when using them, as they can irritate the skin, particularly in people with skin allergies, dry skin, or sensitive skin.

It is advisable to speak with a dermatologist before using any retinoid products.

Skin irritation from topical retinoids mainly occurs with prolonged use of high doses.

Such irritation may result in the following:

• skin redness
• excessive skin dryness
• skin scaling
• itching

The following rare side effects occur in less than 10% of people:

• initial acne flare-up
• extreme skin sensitivity after exposure to sunlight
• skin discoloration
• eczema flare
• skin swelling
• stinging and blistering

One of the most concerning side effects of retinoids involves the potential risk of congenital disabilities. People who are pregnant or intend to become pregnant should not take oral retinoids.

To prevent the risk, people should wait between 2 months and 3 years after taking oral retinoids before becoming pregnant. The length of time will depend on the type of retinoid used.

A person will also be unable to donate blood when taking oral retinoids.

Additional adverse effects of oral retinoids may include:

• potential risk of developing a mental health condition
• muscle, joint, and bone pain
• headaches
• loss of night vision
• abdominal pain, nausea, and diarrhea

For those taking acitretin (Soriatane) to treat psoriasis, side effects may include an initial worsening of the condition. It may also cause unhealthy cholesterol levels, bumps around fingernails and toenails, and a burning sensation on the skin.

Always follow the instructions on the packaging for an OTC retinoid and the doctor’s suggestions when using a prescription retinoid.

Many prescription-strength retinoids involve applying a thin layer of cream or lotion to the affected skin once per day. It may be preferable to do this in the evening to reduce exposure to the sun. A person should:

• rub it into the skin completely
• use the exact amount prescribed
• use it only as long as prescribed

A 2017 article provides the below instructions for applying a topical retinoid for acne:

• apply a pea-sized dose in a thin layer
• use it every other day for the first 2–4 weeks
• for the first 2–4 weeks of use, wash off the medication after 30–60 minutes
• follow with a gentle moisturizer that will not clog pores

For oral retinoids, people should again follow their doctor’s recommendation for how and when to take them. When taking acitretin, for example, it is advisable to take it once a day with milk after eating the main meal of the day. Drinking milk is important because the body requires fat to absorb the drug optimally.

Retinoids are a class of compounds that derive from vitamin A. They have many uses in cosmetics to help reduce wrinkles and signs of aging on the face.

Doctors also prescribe them to treat several skin conditions, such as psoriasis.

While retinoids offer benefits, they also have side effects, such as skin irritation. However, these are more likely to occur with frequent use of high doses.

Always follow the directions for use and avoid taking the medications more frequently or in larger amounts than doctors recommend. Anyone experiencing any side effects should report them to their doctor.