It seems like every day I come in and hear another story or read another Reddit post about retinol and the havoc and/or miracle it’s wreaking on someone’s face. But because I have sensitive skin thanks largely to rosacea, I know I can’t go near the stuff. And, therefore, I’m feeling a bit left out of the inevitable bonding that comes from being in the Retinoid Club.
However, it turns out that not all types of retinoids are equally irritating. And, with some simple strategies, those of us with sensitive skin may yet earn our membership.
What do retinoids actually do?
All retinoids are forms of vitamin A, which your body typically gets from food and metabolizes into a few different “active” forms that can be used. Vitamin A plays a role in maintaining your vision and other bodily processes. And, when used topically, these compounds are thought to stimulate a variety of processes that cause skin cells to proliferate and shed more quickly and evenly, John G. Zampella, M.D., assistant professor in the Ronald O. Perelman department of dermatology at NYU Langone Health, tells SELF. That leads to well-studied medical and cosmetic benefits, such as smoother skin, less acne, and fewer wrinkles. “Retinoids are the only thing clinically proven to reverse the signs of aging, full stop,” Dr. Zampella says.
But topical retinoids are also known to cause some irritation, especially at first. That includes dryness, redness, itching, peeling, and flaking that may be worse for some people than others. And if you’re going into the process with sensitive skin, you may be hit especially hard. “People with more oily skin tend to tolerate them, while those with dry, sensitive skin tend to suffer skin irritation from retinoids,” Emily Newsom, M.D., a board-certified dermatologist at Ronald Reagan UCLA Medical Center, tells SELF. So, is there any way for people prone to irritation to still get the known benefits of using topical retinoids?
Some retinoids may actually cause less irritation than others.
There are two major categories of retinoids: those found naturally in your body and those created synthetically. Natural retinoids include retinol, which is converted into retinal (retinaldehyde), which is later converted into retinoic acid.
Well-known products like tretinoin (Retin-A) and isotretinoin (formerly Accutane) are forms of retinoic acid. But these dermatological big guns are also likely to cause the most irritation—especially if you’re already prone to those sorts of reactions.
That said, tretinoin does come in different concentrations (all the way from .025 percent to .1 percent) depending on the brand or if it’s generic, Dr. Newsom points out, and your derm will likely have you start at the low end. If you find that you can only tolerate that level, you certainly don’t need to bump it up.
“Also, certain formulations are better tolerated,” she says. For example, some people have better luck with micronized tretinoin (Retin-A Micro or micronized generic tretinoin) because it’s formulated in a way that allows for smaller doses of medication to be delivered to the skin at a time. However, she says, micronized tretinoin tends to be more expensive. The brand Renova also has a reputation for being better tolerated due its formula, she says.
Additionally, Dr. Newsom explains, some people may also find that they’re better able to tolerate the synthetic retinoids (including tazarotene and adapalene, now over-the-counter). That’s because these medications are formulated to bind to only some receptors for retinoic acid. (Actual retinoic acid binds to these receptors and many more.)
For patients with sensitive skin, Dr. Zampella recommends they start with retinal, which comes in a few over-the-counter products such as Avène RetrinAL .05 Cream, $70, and MyChelle Remarkable Retinal Serum, $48. Some research does suggest that retinal is basically as effective as those heavy duty retinoids and less likely to cause adverse reactions. For instance, in a study published in the Journal of the American Academy of Dermatology in 1998, researchers randomly assigned 125 participants with sun damage to get either .05 percent retinaldehyde cream, .05 percent retinoic acid cream, or a control cream with no active ingredient. Within 18 weeks, the participants receiving retinaldehyde and retinoic acid showed a significant reduction in wrinkles and roughness while the control group did not show any significant changes.
So, they both work. But what about irritation? Interestingly, 77 percent of those in the retinaldehyde group showed no irritation reaction (13 percent had a mild reaction and 9 percent had a moderate reaction). But only 28 percent of those in the retinoic acid group didn’t have irritation, and two participants had severe reactions. So, these results suggest that retinal can be effective at reducing the signs of aging with less unpleasant irritation than retinoic acid.
Another study, this one published in 1999 in Dermatology, compared how well participants could tolerate retinol, retinal, and retinoic acid over 44 weeks. They found that retinol and retinaldehyde were both significantly better tolerated than retinoic acid.
What to know if you want to start using a retinoid:
Trying a retinoid when you have sensitive skin is a bit intimidating. So, as with all new products, this is something that should be introduced slowly and carefully (and, likely, with the help of a dermatologist). Here are some general things to keep in mind if you want to start using one.
Don’t use them too frequently. If you’re using a prescription retinoid, your dermatologist probably gave you some very specific instructions about how and when to use it, so stick with those. But in general, our experts recommend starting with a retinoid just three times a week. If, after a few weeks of that, you’re able to handle it without too much irritation, you can bump up your frequency to every other night or even nightly, Dr. Newsom says.
If you’re using an over-the-counter product that contains a retinoid, the advice is generally the same: Start just a few times a week for a few weeks before increasing your dose gradually. If you’re able to handle nightly application with an over-the counter product and you’re looking for something a little stronger, Dr. Zampella says you may want to check in with your dermatologist about a prescription retinoid that you can start using a day or two a week instead of the OTC product. The key is to gradually build up your tolerance to these products without doing too much damage in the process.
What’s the overall formula? The retinoid isn’t the only thing in the product. So you may have a better or worse reaction to a product for reasons entirely unrelated to the active ingredient. For instance, some people find that hydrating cream-based retinoids are easier to handle than gels, Dr. Newsom says. And we know that people with sensitive skin are especially likely to have reactions to fragrances, preservatives, and other ingredients that may be in over-the-counter products.
For the love of god, moisturize. Retinoids are irritating because they speed up a natural process that results in dry, flaky skin. The best way to counteract that is, of course, to moisturize. You may also find it helpful to mix the retinoid with your moisturizer when applying it, Dr. Newsom says, or to apply it right before or after the moisturizer to help dilute it a little bit.
Plan your bedtime routine. “Some dermatologists recommend using retinoids at bedtime on oily, unwashed skin,” Dr. Newsom says, so that you’re not applying the product on skin that’s lost any natural oily buffer. But, she says, if you do wash your face before applying, other derms (and the packaging on many prescription treatments) may recommend waiting until your skin is totally dry because any dampness could cause the skin to absorb more of the product. Plus, after washing your face, your pores will be clear (a good thing) and vulnerable to irritation (a not so good thing), SELF explained previously.
Avoid other products that might make you more sensitive. “Avoid harsh soaps or alcohol-based toners prior to application that strip the natural oils from the skin,” Dr. Newsom advises. Those oils can act as a protective buffer and help keep your skin hydrated—two very important things to preserve while using a retinoid. “Also avoid harsh scrubs or brushes that may cause microabrasions to the skin that set you up for more irritation,” she says. And, of course, avoid using more than one retinoid product at a time.
You may need to adjust your routine for your environment. Remember that there are many other things that can affect your skin, including the weather. “Some people with sensitive skin don’t tolerate retinoids during dry winter months, but find they can them use during more humid summer months,” Dr. Newsom says, which is why Dr. Zampella says that summer is actually a good time to start using one for the first time. Similarly, if you recently moved somewhere with a drastically different climate, you may want to check in with a dermatologist about changing up your regimen to better suit your skin’s new needs.
Remember, though, that everyone’s skin is different. So if one retinoid doesn’t work for you, that doesn’t mean they’re all off limits. And although these strategies might help some people, others might find that even after weeks of using a gentler retinoid it still causes irritation. If that’s the case, retinoids may simply not be for you. Luckily, there are plenty of other products out there that can do similar things. The catch is that their potential benefits may not have as much science behind them, Dr. Zampella says.
So, if you have sensitive skin and are curious about using a retinoid or finding another product that can do the trick without the irritation, talk to your derm about your options.