RETINOIDS & RETINOL & BAKUCHIOL - what you need to know.

What Is Retinol?

Retinol falls into a category of vitamin A derivatives known as retinoids. “Retinol is probably one of the best over-the-counter ingredients to counteract aging skin,” Dr. Jerome Potozkin, a dermatologist and author of Botox and Beyond: Your Guide to Safe, Nonsurgical, Cosmetic Procedures, told me. Other retinoids may show up on ingredients lists as retinoic acid, retinyl palmitate, retinyl acetate, and retinyl linoleate. These have varying level of potency. You may find retinol in sunscreens, anti-aging creams, and topical acne treatments. Since retinol and other retinoids can potentially heighten sun sensitivity, it is safest to only use them at night and to avoid them in products you would use during the day, like sunscreen. More on that below.

How It Works

As mentioned, retinol and other retinoids come from vitamin A, which is a nutrient that helps drive cell turnover. Studies show that when applied topically, retinoids can increase collagen production and decrease collagen breakdown. By accelerating skin renewal, it can reduce the appearance of wrinkles and age spots and even out skin tone. It can also make your skin resistant to new wrinkles. It dissolves oil and makes pores tighter and smoother, helping to keep them unclogged. Dr. Potozkin believes that retinol is great to incorporate into a daily skincare regimen. “I usually recommend it as an anti-aging ingredient and for some patients with mild acne,” he explained.

The Potential Health Risks

Carla Burns, a research analyst for EWG, says that in general, EWG recommends avoiding skincare products containing vitamin A, often labeled as retinol or retinyl palmitate, retinyl acetate, retinyl linoleate, and retinoic acid. “Vitamin A is an essential nutrient and found in many foods we eat; however, at EWG we looked more closely at its use in sunscreens and cosmetics and found it is not necessarily safe for use on skin,” she told me. Here are some of the risks EWG is concerned about.

Skin cancer: Research has linked retinoids to an increased risk of skin cancer when used on sun-exposed skin. Unfortunately, cosmetic companies have added the ingredient to plenty of products meant for daytime use — including sunscreen.

A government study from 2012 found that mice who were exposed to creams containing retinyl palmitate or retinoic acid had more tumours and an earlier onset of tumours than mice who were exposed to a cream that did not have these ingredients.

The Pros and Cons

The Pros:

There have been numerous studies (see references below end of article) that have demonstrated the beneficial effects of retinol on the skin including:

Improvement of pigmentation marks

Stimulation of collagen and elastin production

Stimulation of GAGS: molecules important for skin hydration

Improvement of fine lines and wrinkles

A more healthy and youthful glow to one’s skin

An improvement of skin laxity

Smoother skin texture and an improvement of breakouts, blemishes and bumps

Reduction of excess oil production

Improved appearance of pores: reduction in size and number

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How did researches find this all out? Well it was actually by accident. Vitamin A has been used for the treatment of acne for a long time and when it was used topically people noticed that their skins not only improved from an acne perspective but they also noticed beneficial ‘side effects’: they started looking younger.

“Further studies looking specifically at the cosmetic benefits of retinol revealed that there is an increased cell turnover in the skin and that collagen and elastin stimulation took place in the dermis. Pigmentation marks from acne blemishes improved and further investigations demonstrated the ability to reduce pigmentation marks from sun damage.”

The Cons:

One of the biggest downsides of retinol from a consumer perspective is that it is a targeted treatment product and needs to be added in addition to ones cleanser, moisturiser, serum, etc. This all adds up and may become an expensive option for some people.

Unfortunately retinol can produce skin reactions including:

Increased sun sensitivity: so wearing a good SPF is vital when using retinol as part of your skin care regime

A burning feeling or s stinging or tingling sensation of the skin: this is usually mild and lasts for a short time after the first application

A slight peeling of skin (mild)

Inflammation or Redness of the skin (mild)

Unusual dryness of skin (mild)

And an unusually warm feel to the skin (mild)

The good news is that the side effects disappear when we stop using the retinol and if you follow my advice in how to introduce it into your skin regime the above side effects will be reduced to a minimum with maximum skin and anti-ageing benefits.

OK enough with the academic stuff and let’s rather look at how we should add retinol to our skin care regimes.

Adding Retinol Into Your Skin Care Regime

The best way to start introducing retinol to our skin care regimes is slowly and intermittently first with low strength retinol (0.3%), then moving onto medium strength retinol (0.5%) and finally moving onto to higher strength retinols (1%).

Step 1:

Start with a low strength retinol applying it to the skin at night after cleansing and before your moisturiser. Start off with application every 3rd night for 2 weeks then every 2nd night for 2 weeks and then finally move onto every night. If no reactions take place with the every night application it is time to move onto step 2. If a reaction occurs stop using the retinol and wait for the skin to settle and begin again with every 2nd night application. Some people have to stay with this application and if you are one of them no worries the skin benefits will still be visible. It just may take a little longer

Step 2:

It is time to get the medium strength retinol (0.5%) and follow the same approach as in step 1. If a reaction occurs stop using the retinol 0.5% and wait for the skin to settle and begin again with every 2nd night application. Some people have to stay with this application and if you are one of them no worries the skin benefits will still be visible. If no reaction occurs it is time to move onto step 3.

Step 3:

Yes you guessed it: it’s time for the high strength retinol 1% and yes we follow the same approach as in step 1 and 2.

RETINOIDS & RETINOL -  what you need to know

For starters, we often interchangeably hear the words “retinol” and “retinoids” to describe this skin saviour, but it’s important to know that both terms aren’t one in the same. Think of the words more like cousins instead of clones—they’re related but different.

To learn a bit more about what sets these terms apart, we connected with Melissa Levin, MD, of Downtown Dermatology in Manhattan. Below she breaks down each, how to use them, when to use them, and which other products in our routine might actually make them less effective.

Their Similarities

“Both retinol and retinoids are vitamin A derivatives that ultimately get converted into retinoic acid,” explains Levin. “‘Retinoids' is essentially a basic umbrella term for both over-the-counter retinols and prescription retinoids.”

Their Differences

“Retinols, which are readily available over the counter, contain a lower concentration of the active retinoic acid ingredient,” says Levin. “Prescription retinoids have a much higher concentration of the active ingredient, so they are readily available for the skin to use.” In other words, retinol is what you’re used to using in your regular serums and creams, whereas retinoids can only be prescribed by a doctor (except for Differin, the first OTC retinoid).

“The major difference between retinol and retinoids,” Levin continues, “is that retinol works more gradually compared to retinoids due to their difference in molecular structure and how they are processed in the skin. Over-the-counter retinols are in ester forms such as retinyl palmitate, retinyl linoleate, retinaldehyde, propionic acid, or retinyl acetate. It takes more steps for these ester forms to be converted to the active retinoic acid. The more conversions, the ‘weaker’ the product.” Levin explains that while retinoids and retinol do exactly the same thing, it typically takes longer to see results from retinols compared to retinoids.

Additionally, OTC retinols are often combined with other ingredients, such as moisturizing ingredients, to minimize dryness/irritation, add antioxidants, or brighten the skin. This makes them more palatabe to the skin, but it also means that some products may have trace amounts of retinol in the bottle.

When Should You Use Each?

For both retinol and prescription retinoids, Levin recommends that you only use them in your night-time routine, as sunlight deactivates retinoic acid. They should be applied to clean, dry skin after toner (if you use toner, that is).

Who Can't Use These Ingredients?

“Most skin types can tolerate a retinol or retinoid,” says Levin, “but you have to make sure to choose the right retinol/retinoid product and that you are using a nonirritating gentle skincare regimen with a moisturizer and a gentle cleanser in addition to your retinoid/retinol.” Working with a dermatologist will determine whether you’re a candidate for retinol or if your skin requires the strength of a retinoid. They can also help recommend a safe routine (we love these moisturizers and these cleansers.)

Levin adds, “Retinoids and retinols can initially cause a process called ‘retinization,’ which leads to redness, dryness, and flaking, especially when you first start. It’s important to realize you should slowly ease into using a retinoid.” To avoid this, she recommends starting off by applying a retinoid every third night. “If your skin isn’t irritated after two weeks, increase to every other night for another two weeks. If your skin is still tolerating the retinoid, go for every night!” Another tip to ensure tolerability is to apply with a moisturizer. Apply a pea-size amount of the retinoid first, wait a few minutes, and then apply a moisturizer to combat any dryness or flaking. If you are pregnant or breastfeeding, you should avoid using retinols and retinoids altogether. A small percentage of patients are super sensitive and sometimes have a very difficult time tolerating a retinoid.

“If you have more sensitive or dry skin, I recommend starting with an over-the-counter retinol or Differin gel, which is more tolerable than other prescription retinoids. If you have more oily skin or have tried retinoids in the past, then prescription strength retinoids such as tretinoin, atralin, retin-A, retin-A micro, tazarotene, fabior, or tazorac can be tolerated but still need to be slowly up-titrated.”

Which Products Can't Be Used in Conjunction With Retinol and Retinoids?

Did you know that some products can actually have reverse effects on retinoids? “Benzoyl peroxide and alpha hydroxy acids can deactivate certain retinoids such as tretinoin, so be careful with layering product and make sure to discuss your routine with your dermatologist,” says Levin.

“Retinoids are the umbrella term for retinol products, which are all proven to improve skin tone, texture, and pigmentation over time,” explains Jennifer Chwalek, MD, a board-certified dermatologist at Union Square Laser Dermatology in New York City. “Within these categories, there are different concentrations and formulations which consequently affect the strength of the product. For instance, a 0.025 percent cream is not as strong as a .5 percent cream, and a .025 percent cream isn’t as strong as a .025 percent gel.” So yeah… it’s complicated.

To make choosing a retinoid even more difficult, they come in different textures. You can find them in creams, gels, and oils. “In general, gels are usually best for people with oily skin, while creams are better for people with dryer skin—especially forms of retinoids with emollient bases,” says Dr. Chwalek. The good news is that, whichever you choose, your skin will eventually grow to tolerate it better—despite a chance for redness and flakiness in the beginning. To help you decipher the retinol world, keep scrolling for dermatologists’ explanation of vitamin A ingredients, from the most gentle to the most potent.

Retinol ingredients from gentlest to most potent

Retinyl palmitate: 

The lightest form of retinol is retinyl palmitate, which has to be converted three times within skin, making it the most gentle form of vitamin A. “Retinyl palmitate is an earlier form of retinol, so it must be broken down into retinol, then retinaldehyde, and finally retinoic acid,” explains Dr. Chwalek.

Retinol: 

The over-the-counter standard, which is a vitamin A derivative gets converted to retinoic acid after it’s absorbed into the skin, according to Rachel Nazarian, MD, a board-certified dermatologist with Schweiger Dermatology Group. “It’s a gentler form that takes longer to see results than some other forms, but effective.” She adds that it’s great for sensitive skin types and those who are new to the retinoid game.

Retinaldehyde: 

This is the next step after retinol, which only needs to be converted once in the skin to go to work. “The skin can change retinol to retinaldehyde, which is then ultimately turned into retinoid acid,” says Dr. Nazarian. “It’s one step closer to the active molecule, and is better for those who aren’t quite ready for the prescription version, but maybe want a step up from retinol.”

Retinol Esters: 

These are essentially a storage form of retinol in your body, according to Dr. Nazarian, who notes that either applied topically or taken orally, retinol esters can be changed to forms of retinol when needed. “If it’s not used, the body gets rid of it. This form can be stored in the tissues of the eyes, lungs, skin, and spleen, among others.”

Tretinoin: 

Tretinoins are typically the mildest form of prescription retinoids. Though some tretinoins are available without visiting a derm, most commonly, you’ll find them in in Rx form. “Tretinoin is also known as all-trans-retinoic acid,” explains Dr. Nazarian. “It’s the active molecule. It can come from retinol esters which were in storage, or it can be applied directly on the skin.” According to Dr. Nazarian, it’s best suited for oily-skinned people or those without super sensitive skin, for whom it can cause mild irritation.

Adapalene: 

If you’re struggling with acne, this retinoid is a good choice. “This is a newer generation of synthetic retinoid that was developed to improve skin and acne,” says Dr. Nazarian. “It’s more chemically stable and has a greater affinity for the receptors that tretinoin targets.” Also, it’s fat-soluble, which, she notes, means it has better absorption, but due to its molecular structure it’s less irritating than tretinoin. “It’s good for people with acne or those who want something strong and have been doing retinol already, but want to take it to the next level,” says Dr. Nazarian.

Tazarotene: 

This retinoid’s in the same weight-class as adapalene. “It has a different receptor though, and has shown similar effects on the skin but with higher irritation,” explains Dr. Nazarian. “Some studies have shown it to be better for specific acne types than plain tretinoin, and it’s great for oily skin—not for those who are new to retinoids.”

Trifarotene: 

Trifarotene’s the new retinoid on the skin-care block. “This one binds to less receptors than older options, making it more tolerable and less irritating to the skin,” says Dr. Nazarian. “It had similar results of efficacy for acne—which it was developed for—and likely anti-aging as well.” She notes that it’s ideally a great option for people who have sensitive skin that want prescription-type improvement.

AND FINALLY..... BAKUCHIOL

Bakuchiol is an antioxidant and anti-inflammatory natural skin care ingredient derived from bakuchiol seeds that targets wrinkles and aging skin (pronounced “buh-KOO-chee-all”).

First off, it’s not actually retinol.

The marketing behind products containing bakuchiol strongly implies that it’s basically identical to retinol. It’s not. “Bakuchiol is actually not a [form of] retinol,” Mary Sheu, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, tells SELF. “It’s structurally and chemically completely different.” Sure, the two molecules behave similarly in cosmetic applications, but that doesn’t mean they’re the same.

Their differences mostly stem from the origins of each molecule. Bakuchiol is derived from the seeds and leaves of the Psoralea corylifolia plant, or babchi, an herb traditionally used in Ayurvedic and Chinese medicine to treat a variety of diseases. In contrast, retinol is one of the major forms of vitamin A—specifically, the form of the vitamin that your body absorbs from animal products.

This means that bakuchiol products have the potential to be vegan and/or cruelty-free, which isn’t always the case for OTC retinol products.

The research is limited but promising.

Even though it was first isolated in 1966, bakuchiol has only very recently started showing up in cosmetics—and since it’s so new, there’s not much clinical research on its efficacy and side effects. However, two recent studies have found promising data on bakuchiol’s supposed anti-aging effects, both on its own and compared to retinol.

In the first study, published in the International Journal of Cosmetic Science in 2014, researchers used synthetic skin and collagen cell cultures to test the anti-aging effects of bakuchiol. Their results showed that bakuchiol had very similar gene expression and collagen regulation properties to retinol—at least in fake skin and disembodied cells.

To get an idea of how bakuchiol performed in real life, they also had 16 participants apply a 0.5% bakuchiol product twice a day for 12 weeks. They saw improvements in every category (compared to their baseline, not a placebo treatment): fine lines and wrinkles, roughness, dryness, and elasticity, among others. And they didn’t see the usual side effects of starting retinol, like irritation and dry, flaking skin.

Then a 2018 study published in the British Academy of Dermatology took things one step further, pitting bakuchiol and retinol against each other in a 12-week, double-blind clinical trial on human subjects. For the study, 44 participants received either a twice-daily 0.5% bakuchiol product or a once-daily 0.5% retinol product, and their progress was evaluated by a dermatologist who didn’t know which group was which.

Both groups saw improvements in hyperpigmentation, wrinkles, and redness, and there was no statistically significant difference between their results, which suggests that using bakuchiol twice a day is as effective as using retinol once a day. Plus, the bakuchiol group reported less skin scaling and flaking than the retinol group.

That’s pretty much it for clinical research. At least one study has looked at bakuchiol in combination with other anti-aging ingredients like antioxidants. But as a stand-alone ingredient, our best and only data come from the two above studies. Taken together, those studies suggest that bakuchiol may be functionally comparable to retinol—and possibly a bit gentler.

Of course, there’s a catch.

“Extra-gentle vegan retinol” sure sounds like a slam-dunk, but there’s a catch: For now, we only know how bakuchiol stacks up to retinol, not any other retinoids. “They’re not comparing it to tretinoin,” Olga Bunimovich, M.D., a dermatologist and assistant professor at UPMC in Pittsburgh, tells SELF.

It’s super important to keep that in mind when shopping for a serum, especially if you have more severe acne that may require a more effective type of treatment.

Since the data we have suggest that bakuchiol’s potency is close to retinol’s, a bakuchiol serum might work as well as an OTC retinol with fewer side effects—but it won’t replace your need (and possibly a prescription) for tretinoin, isotretinoin, tazorac, or adapalene.

There’s one more potential drawback to consider: allergies. The Journal of Contact Dermatitis has published two different case reports of allergic reactions to bakuchiol cosmetics since June 2019. “It’s possible to develop allergic reactions to plant substances,” Dr. Sheu reminds us. “Poison ivy is a plant.” Allergic reactions are rare, but always test new products carefully—and if they cause a reaction, wash ’em off right away.

The bottom line: Bakuchiol might be a good starter retinoid.

So should you try bakuchiol or not? The answer, according to the three following dermatologists is an overwhelming maybe.

Bakuchiol is “a nice place to start” with retinoids, Shilpi Khetarpal, M.D., a dermatologist at Cleveland Clinic, tells SELF, acknowledging that its vegan status is a big plus for many people.

Dr. Bunimovich took a more skeptical position: “I’m not sure what you’re winning with this [as compared to retinol], to be honest,” she says. And Dr. Sheu is somewhere in between: “Sometimes the naturally derived ingredients [like bakuchiol] are nice to consider,” she says. “But sometimes synthetics are a better way to go. It has to be on a case-by-case basis.”

Just like retinol, bakuchiol could be a great place to start or a waste of time. It all depends on what you’re looking for. If you’re in a committed relationship with your Retin-A prescription, bakuchiol probably isn’t for you—but if you’re in the market for a gentle, plant-derived introduction to the world of retinoids, it might be just the ticket

Safe to use twice a day: Since bakuchiol isn't as drying or irritating as retinol, you can use it both during your morning and night-time skincare routines.

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