How Effective Are Retinoids? A Complete Guide

No matter how much anyone wants to look their skin young and radiant forever, ageing is an inevitable process that will surely leave its marks. Wrinkles, fine lines, dryness, and skin thinning are normal parts of ageing. Due to their desirability, hundreds of products are available in the market, claiming to prevent the signs of ageing. However, not all these products can provide the results they claim to.

Fortunately, there are a few options that are proven to work in the eyes of research. These treatments include medications and cosmetic procedures like Botox and facelift. Retinoids can be your best bet if you are looking for an option that you can easily use at home.

In this article, you will learn briefly about different retinoids, how they can improve wrinkles, and what research says about their efficacy.

What are Retinoids?

Retinoids are the derivatives of vitamin A and have been known to carry many benefits for skin conditions like acne and wrinkles. These are one of the most common ingredients found in cosmetic products. They are available in both oral and topical formulations. You can easily buy retinoids as an over-the-counter drug, but only milder strengths are available as OTC. If you are looking for a stronger retinoid, you will need a doctor’s prescription to buy it.

Tretinoin, tazarotene, and adapalene are three of the most common retinoids that are used for treating different skin conditions.

Tretinoin

Tretinoin was the first retinoid used to treat acne in the 1970s. However, it was discovered later that tretinoin carries many more benefits for the skin, like treating uneven pigmentation, removing dark spots, and speeding up new skin cell regeneration. It is a topical medication and is sold under the brand name Retin-A. It is only available as a prescription medication and can have the following formulations and strengths:

• Cream (0.02%, 0.025%, 0.05%, and 0.1%)
• Gel (0.01% and 0.025%)
• Gel microspheres (0.04%, 0.06%, 0.08%, and 0.1%)
• Lotion (0.05%)

Many researchers have proven the efficacy of tretinoin in treating ageing skin. According to one study, using 0.05% of tretinoin from 3-12 months can be effective in treating photoaged skin (Kingman, 1986).

Using tretinoin for an extended period shows marked improvements in skin appearance as well as cause positive structural changes. According to one study conducted on Caucasians, using 0.05% tretinoin cream for 12 months showed marked improvements in the dermal layer of the skin (Bhawan, 1995).

According to a randomized control trial, that included 180 studies, tretinoin was efficacious for treating ageing skin by reducing wrinkles, removing hyperpigmented mottling, and improving sagginess. Results can take 1-24 months. These results were studied in women with photoaged skin (Sitohang, 2022).

Different tretinoin formulations are available with different brand names approved for different skin conditions. It is advised that you consult with your dermatologist before starting to use any of these formulations.

Adapalene

Adapalene is an FDA-approved retinoid for acne treatment. It can be used in children of age 12 years and older. It is also believed to be effective in preventing and treating the signs of photoaging. It is also used for off-label treatment of conditions like alopecia areata and skin discoloration caused by acne.

Like tretinoin, adapalene is also available in different formulations and strengths. The 0.3% adapalene is only available as a prescription drug, while the 0.1% strength can be bought as an over-the-counter drug. You can find adapalene in the following formulations:

• Cream
• Gel
• Lotion
• Liquid solution swab

Adapalene 0.3% gel is safe and effective in treating photoaged skin. A 24-month usage of 0.3% adapalene showed improvement in the forehead and periorbital wrinkles by 40% and 52% respectively. It also improved wrinkles around the mouth by 29% (Herane, 2011).

As both strengths of adapalene have different efficacy, you should consult a dermatologist to choose the best suitable option for your skin condition.

Tazarotene

Tazarotene, commonly available with the brand name Tazorac, is another FDA-approved retinoid for treating different forms of acne and psoriasis. It is available in the following formulations:

• Lotion
• Cream
• Gel/jelly
• Foam

Different formulations of tazarotene are available in 0.01%, 0.025%, 0.05%, and 0.1% strengths.

0.1% tazarotene gel has shown to be effective in reducing fine wrinkles, pigmented mottling, and skin roughness after using it for 12 weeks (Sefton, 2000).

A randomized controlled trial concluded that daily application of tazarotene along with sunscreen can improve wrinkles and other signs of photodamaged skin. Most trials suggest that tazarotene can provide optimal results when used for a year (Ogden, 2008).

Retinoids for Ageing Skin

To understand the mechanism of retinoids behind preventing, stopping, and reversing the signs of ageing, let us first briefly see the normal structure of our skin and how ageing affects this structure.

The Anatomy of Skin

Skin is the largest organ of the human body that protects the internal organs from the harmful external environment. It is made up of 3 layers, epidermis, dermis, and subcutaneous tissue. The epidermis is the outermost layer that consists of keratinocytes, melanocytes (responsible for pigment production), and Langerhans cells. The dermis lies below the epidermis and contains the blood supply of skin and extracellular proteins. The subcutaneous layer consists of fat that is present below the connective tissue (Rittié, 2002).

Functions of Skin

Apart from playing the primary role of protection, the skin is also responsible for the following functions (Ramos-E-Silva, 2001):

• Temperature regulation
• Electrolyte balance
• Immune response
• Production of some beneficial chemicals
• Sensory function
• Water regulation

The Process of Ageing

Like all cells of the human body, skin cells are also inevitable to degrade and die with ageing. Skin cells are genetically programmed to degenerate after they have performed their function for a certain amount of time.

Skin starts to become thinner, less elastic, and saggy with ageing. Apart from these intrinsic factors, skin cells also bear damage as a result of environmental insults. Ultraviolet (UV) rays smoke from cigarettes and automobiles, and professional exposure can also damage the DNA (Yaar, 2001).

Factors that are primarily responsible for changing skin structure and appearance include the following (Rittié, 2001):

• UV radiations
• Xenobiotics
• Mechanical stress
• Hormonal changes
• Metabolic processes

With ageing, not only the functions of the skin are compromised, but the structural changes also leave visible marks. Skin starts to lose its thickness, thermoregulation is compromised, new cell production is declined, wounds healing is delayed, and mechanical protection is lost. The blood supply of the skin is also compromised with ageing (Gilchrest, 1996).

All these factors can leave the following signs on the skin:

• Wrinkles and fine lines
• Dryness
• Itchiness
• Sagging
• Translucent skin
• Age spots
• Decreased elasticity

How can Retinoids Help?

Retinoids have long been used to treat several skin conditions. As retinoids are the derivative of vitamin A that cannot be produced by the body, we need to take this nutrient through external means. Along with their other functions, retinoids also are an essential part of keratinocytes. They can stimulate collagen production and enhance blood supply to the skin. Retinoids are also known to help remove hyperpigmented mottling and make skin smoother.

Tretinoin vs. Adapalene vs. Tazarotene: What Does the Research Say?

Although they all belong to the same group of drugs, different retinoids vary in their mechanism of action and the result they produce. Several studies have been conducted over the past few decades to compare the efficacy of these retinoids for skin ageing.

A 2001 study compared the efficacy of four different strengths (0.01%, 0.025%, 0.05%, and 0.1%) of tazarotene through a vehicle and tretinoin 0.05% emollient cream. The group treated with tazarotene and tretinoin showed significantly superior improvements when compared to the vehicle-treated group. Participants treated with tazarotene showed rapid improvements compared to the ones treated with tretinoin by the 20th week. Nevertheless, at the end of the trial, the results were similar after using these agents for 24 weeks. Tazarotene 0.1% and tretinoin 0.05% were equally effective in treating fine wrinkles, improving elasticity, and removing hyperpigmented spots. Side effects were mild to moderate and were mainly associated with higher concentrations of tazarotene (Kang, 2001).

A 2008 study compared the effectiveness of adapalene 0.3% gel and tretinoin 0.05% cream for the treatment of photoaged skin. This study included 100 participants and lasted for 24 months. Both products were comparable in terms of improving wrinkles and safety (Bagatin, 2018).

Skin irritation is a common side-effect of using topical retinoids. A 2001 Chinese study showed that adapalene 0.1% gel is more tolerable and less irritating than tretinoin 0.025% gel (Tu. 2001). Another study compared the irritation caused adapalene (0.1% gel and Differin solution), tazarotene (0.05% and 0.1% gel), and tretinoin (0.1% gel and 0,025% cream). The results showed adapalene gel and solution to be less irritating than tretinoin and tazarotene (Greenspan, 2003).

A 2004 study compared the effectiveness and safety of tretinoin 0.05% emollient cream and tazarotene 0.1 %cream. The results indicated that the tazarotene 0.1% cream was more effective for treating photodamaged skin compared to the tretinoin 0.05% cream. Tazarotene 0.1% cream also produced more rapid improvements compared to tretinoin 0.05% emollient cream (Lowe, 2004).

Side Effects of Retinoids

Tretinoin, adapalene, and tazarotene are FDA-approved retinoids that are popular for treating various skin conditions. They also carry a few side effects as follows (Philips, 2005):

• Peeling
• Redness
• Dryness
• Burning
• Itching

These side effects are local and primarily depend on the concentration of the product. To combat these effects, it is advised to avoid direct sunlight, use sunscreen and moisturizers, and avoid extreme temperatures (Philips, 2005).

Conclusion

Tretinoin, tazarotene, and adapalene are all have shown to be effective in treating diverse skin conditions. They all are available in different strengths and formulations, and each of these variants differs in efficacy and tolerability.

You can find these retinoids as over-the-counter medication or prescript drugs, depending on the strength you are looking for. They all carry risks of a few side effects, which are again dependent on the concentration of the product.

Although, retinoids have a strong reputation for treating ageing skin, especially photoaged skin, finding the right kind of retinoid for your condition is not an easy task. To make a wise choice to get the best results with minimal side effects, it is recommended to visit your healthcare provider. A dermatologist can make a prescription according to the severity of your condition after a complete assessment.