Saturday, December 5, 2015

Retinoids: The must-have anti-ager

Dr. Jessica Krant who practices dermatology at the Laser & Skin Surgery Center of New York points to an additional benefit of using retinoids – their potential cancer-fighting properties: “They also help to normalize and regulate cell development, reducing the chance that cells can become abnormal enough to turn into skin cancer.”
By Delia von Neuschatz

In my quest for smoother, younger-looking skin,
I began using retinoid creams earlier this year on the advice of my dermatologist. Often touted as the “gold standard” in anti-aging skin care, retinoids – derivatives of Vitamin A, one of the body’s key nutrients – have a long track record of actually turning back the skin’s clock. This is true regardless of age, skin type or complexion. “Retinoids are proven wrinkle reducers,” says dermatologist Jessica Krant, M.D. “They are known to increase cell turnover, which helps the skin to exfoliate itself and get rid of dried out dull surface cells, while bringing younger, fresh cells to the surface faster,” she explains.

Not only do retinoids, which come in both prescription-grade formulations and weaker over-the-counter versions, even out discoloration and improve irregularities, but they also increase the thickness of the underlying layers of skin. That’s because Vitamin A has a small molecular structure capable of penetrating all the way to the dermis where collagen and elastin are produced. “Retinoids slow the degradation of collagen and elastic tissue. In short, they do everything to make our skin younger,” concurs dermatologist Karen Burke, M.D., Ph.D.
“Retinoids work at every layer of skin,” says dermatologist Karen Burke who also has a Ph. D. in biophysics. “They make the outer layer thinner and lower layer thicker. They are truly anti-aging.” And it’s never too early to start. An early proponent of Vitamin A creams, Dr. Burke has been benefitting from them since her 20s.
Despite the medical industry’s enthusiasm, however, I stopped using the retinoids I was prescribed after only a few weeks. That’s because of the cons. I expected that my skin would initially become dry, flaky and irritated – common side effects – but I did not anticipate what actually happened. At various times, scaly welts formed across both cheeks. Itchy, dry patches appeared underneath my eyes even though I was steering clear of applying them in the orbital area. And then, a red, grape-sized edema – or fluid-filled swelling – formed underneath one of my eyes. These symptoms all took a week or more to go away. Worse, several small intracutaneous cysts formed around my chin.

Initially mistaking them for pimples, I realized these irritations were growing within the skin instead of outward. They eventually went away but not before leaving a faint discoloration that is still visible many months later. That happened even though I was cutting the retinoid cream with moisturizer in order to dilute the potency and only applying it every two or three days.
Prescription-strength retinoids fall into three groups generically known as: Tretinoin, which includes Atralin, Retin-A, and Renova, Tazarotene, branded as Tazorac and Adapalene, sold as Differin. The wrinkle-reducing history of retinoids is lengthy. It wasn’t long after Retin-A received FDA approval as a prescription-strength treatment for acne in 1971 when dermatologists and their patients noticed that fine lines and hyperpigmentation were disappearing along with breakouts. Interest in the anti-aging potential of Vitamin A exploded. Today, Retin-A is the only cream officially FDA-approved as a prescription wrinkle reducer.
Somewhat alarmed, I retreated to gentle oils and emollient creams. Still, I kept thinking about two friends – one in her 40s and one in her 50s – who have smooth springy skin which they attribute to their long-term use of prescription retinoids - Renova for the former and the more aggressive Tazorac for the latter. Plus, it’s difficult to ignore the evidently unalloyed enthusiasm among dermatologists for these medications. “If you want to keep things simple and are looking for one silver bullet, retinoids are clearly the best option because they handle everything,” asserts Dr. Krant.
“Contrary to popular belief, you don’t burn more readily with retinoids,” says Dr. Mitchell Kline.
Was I doing something wrong? It turns out that despite my precautions, I was. I had started out with Tazorac, the strongest of the retinoids and then switched to the gentler, more moisturizing Renova.

But still, the adverse reactions persisted. “The key is to go very slowly. If you have sensitive skin, you have to start out with the lowest concentrations,” says dermatologist Mitchell Kline, M.D. In my case, that meant beginning with a retinol.

A molecular relative of retinoids, less-concentrated retinols do not require a prescription. “Retinols may be over-the-counter, but their effects are real. They produce the same fundamental results. It just takes a bit longer,” reveals Dr. Kline who advocates what he calls a “2/3/5/7” approach: limit the initial use to two days a week then three, five, and finally seven as tolerated. Let irritation subside before continuing treatment. After a month or two, you should be able to move up in potency. Also, the longer you wait to apply retinoids after washing your face (with a mild cleanser only!) the better as this allows the skin’s natural oils to replenish themselves forming a protective barrier. Twenty minutes is the usual recommended amount of wait time.
SkinCeuticals’ retinol 0.5%. As with prescription retinoids, apply a pea-sized drop to cleansed skin and wait for it to be fully absorbed before following with moisturizer. The product should be packaged in metal tubes as air and light can degrade the formula, reducing effectiveness. For the same reason, it should only be applied at night.
So, I recently began using one of the mildest retinols on the market – a 0.5% concentration from SkinCeuticals, and plan on progressing to a 1.0% formulation soon. (The drugstore brand RoC also makes well regarded retinols, but with lower concentrations.) The only side effect I’ve experience so far is a little bit of peeling.

If all continues to go well in the next few months on the 2/3/5/7 regimen, I will graduate to Renova and then perhaps Tazorac as the milder products should help the skin acclimate to their prescription cousins.
Two vitamin C serums – CE Ferulic and Phloretin CF from SkinCeuticals – recommended by Dr. Kline.
As wide-ranging as the benefits of retinoids are however, it is important to note that they form just one component of a comprehensive skin care regimen. “Always use an antioxidant Vitamin C serum in the morning, followed by sunscreen and a Vitamin A at night.” advises Dr. Kline.
Expert tip: Apply retinoids to the entire face, neck, back of hands and even forearms, says Dr. Burke. They can also be applied to the under-eye area according to Dr. Kline.