Retinoids are compounds related to vitamin A that act on how skin cells mature and behave. Applied to the skin they influence the turnover of the epidermis and the lining of follicles, which is why they appear in dermatology. Some are prescribed, some are sold in cosmetics, and the distinction matters.
What is a retinoid?
Retinoids are a family of compounds chemically related to vitamin A. That relationship is the starting point rather than the whole story: the retinoid family includes vitamin A itself, substances the body converts into active forms, and compounds synthesised specifically for medical use.
What unites every retinoid is how they act. Retinoids bind to receptors inside cells that influence which genes are switched on, and among the processes affected is how skin cells mature and how quickly they are replaced. They act on cell behaviour rather than sitting on the surface, which distinguishes them from most of what gets applied to skin.
Two effects explain most of their use in dermatology. They influence turnover of the epidermis, and they influence the behaviour of the lining of follicles, the channel whose blockage begins acne. Effects on the dermis, where the structural proteins sit, account for their use in other contexts.
Why does the prescribed and cosmetic distinction matter?
Because the two categories are regulated on different terms and contain different compounds.
Preparations available in cosmetics generally contain compounds that the skin must convert before they become active, which affects how much reaches the receptors. Prescribed preparations may contain compounds that are active as supplied. The compounds are relatives rather than equivalents, and treating them as interchangeable because they share a family name is a mistake people make constantly.
Regulatory frameworks differ accordingly. What may be sold without prescription, at what concentration, and with what on the label, is a regulatory question that depends on the country and is revised. Prescribed retinoids sit within frameworks reflecting recognised risks, and some of those frameworks are demanding, particularly regarding pregnancy.
That last point is the one this page will not elaborate. The requirements attaching to a specific compound are matters for a prescriber and a pharmacist, they are precise, and a general summary of them would be worse than useless.
What do people find difficult about them?
Irritation, chiefly, and early on. Dryness, redness, flaking and sensitivity are commonly described as skin adjusts, which is a recognised phase rather than a sign that something has gone wrong. Clinicians normally raise it before it happens, because forewarned patients persevere and surprised ones stop.
Sun sensitivity comes up alongside. Skin using retinoids is commonly more reactive to ultraviolet radiation, and sun protection is discussed at the same consultation for that reason.
Timescale is the third difficulty with retinoids and possibly the most consequential. Changes in how skin cells mature take time to become visible, and the interval is long enough that many people conclude nothing is happening well before anything could have. Asking at the outset how long before an assessment is meaningful is the single most useful thing to establish.
What is worth asking a prescriber?
Ask what this preparation is expected to do and over what period. That converts a vague hope into something you can judge, and it prevents the early abandonment described above.
Ask what irritation is expected and what would be more than expected. The boundary between an adjustment phase and a genuine problem is not obvious from inside it.
Enquire about sun protection specifically, since it is routinely part of the same conversation and is easily lost among everything else.
Where anything about your circumstances might bear on the choice, raise it directly, including plans that feel private. Some considerations attaching to these compounds are significant, and a prescriber can only account for what they know.
What this page does not do
It names no compound, states no concentration, and gives no frequency, quantity or duration. It does not tell you whether a retinoid is appropriate for you, does not compare products, and does not recommend any preparation, prescribed or cosmetic.
Common questions
Are cosmetic retinoids the same as prescribed ones?
They are related compounds and they are not equivalent. Preparations available in cosmetics differ from prescribed ones in the compound used and in what has to be demonstrated before sale. Whether a cosmetic preparation is appropriate for a given situation is a clinical question.
Why do retinoids often irritate skin at first?
Because they act on how quickly cells in the epidermis mature and turn over, and that adjustment period commonly involves dryness, redness and flaking. Clinicians expect it and discuss it in advance, which is why raising irritation with a prescriber is more useful than stopping quietly.
Why are prescribed retinoids regulated so carefully?
Some retinoid compounds carry serious recognised risks, particularly in pregnancy, and regulatory frameworks exist accordingly. What those frameworks require depends on the specific compound and the country, and it is the prescriber's territory rather than a general page's.
Why is sun exposure mentioned alongside retinoids?
Because skin using them is commonly more sensitive to ultraviolet radiation, and sun protection is routinely discussed at the same time. What that means in practice is part of the conversation with whoever is prescribing or recommending the preparation.
How long before anything changes?
Longer than most people expect, which is the most common reason a preparation is abandoned before it has been given a fair trial. A prescriber can tell you the timescale for your situation, and asking at the outset avoids judging too early.
Sources
- Acne — conditions — NHS (United Kingdom) · accessed
- Patient information on skin conditions and treatments — British Association of Dermatologists (United Kingdom) · accessed
Last updated . How this page was written.