Retinoids: The Hidden Dangers and Side Effects

Reasons why I don't Use Retinoids

Why don't you use Retinoids? The mere fact that I, very often, have to answer this question, implies that I should be using it and that I am stepping outside the norm, veering away from mainstream habits. Mainstream, these days, as it relates to skin health is being determined by the pharmaceutical industry, Dermatologists, and beauty companies. As far as I am concerned, non of the three should have any say in my skin health, even a Dermatologist. Derms are trained in treating skin diseases via prescription drugs, not preventative healthy lifestyle habits. I have yet to meet a dermatologist that would recommend consuming a balanced diet, getting enough sleep, and consuming high-quality proteins, instead of using Retinoids. That would be abnormal. It would also put them out of business. That isn't what they went to med school for after all.

I have to clarify here that I have nothing against Dermatologists. I am very thankful they exist. I am simply against the over-prescribing of prescription drugs with serious side effects. My goal in creating The Beauty Doctrine, and writing this blog is to educate consumers on the fact that skin care is simple. Skin is an organ just like all the others, needing water, good fats, antioxidants, and protection, in order to optimally function. It doesn't need constant medical intervention, prescription drugs & loads of chemicals applied to it daily, just to merely exist.

I was thrilled when I recently came across a Business Insider article citing Dr. Mervyn Patterson, a cosmetic doctor at Woodford Medical, highlighting how irresponsible Dermatologists and the Beauty Industry are, freely recommending Retinoids for everyone. Finally, an MD that agrees with me! :)

It's been quite difficult trying to open everyone's eyes to the other side of Retinoids. Before moving along with this article, I want to preface that I am not disputing their efficacy. The evidence is clear that Retinoids work effectively to reduce wrinkles and acne. What many Dermatologists and beauty companies fail to share is that, just because something is effective, it isn't suitable for everyone. We all know that Ibuprofen is effective in treating headaches. That in no way means that we should all wake up and pop a few pills every morning. If we did so, we might not get headaches, but we'd probably get liver damage. That's how I feel about Retinoids. I don't think they are for everyone. Retinoids can be beneficial for those suffering from serious cystic acne. That's really about it!

This is all contradictory what we see on viral TikTok videos showcasing Dermatologists, in their scrubs, busting dance moves while promoting Retinoids' use to the vast population. A daily dose of Retinol is now guarded as normal as brushing your teeth.

I urge you to look beyond the scrubs and the dance moves. Western-trained doctors' job is to offer medical solutions to everything, which is helpful in some scenarios, but not everything. It is important to view skin for what it is; a delicate protective organ that needs to be nourished, not a sick one that needs constant treatment with chemicals & harsh ingredients. There is a broader view than what a western doctor can offer (even one with killer dance moves). Caring for your skin should include a nutritional approach, healthy lifestyle habits, and naturopathic modalities that do not involve inducing chronic micro-inflammation.

I believe that the side effects aren't worth the benefits, for the everyday person. Retinoids can be beneficial to those with serious and persistent acne problems, or possibly those attempting to correct deep wrinkles. Retinoids must absolutely be avoided if you have any skin sensitivities or conditions such as Rosacea or Dermatitis.

What are Retinoids?

Retinol (and other types of Retinoids) is a Vitamin A derivative touted as the gold standard for wrinkle reduction and acne treatment. It's currently the highest-trending skincare ingredient. As someone that spent 2 decades working in beauty companies' corporate offices, I can attest that most brands are always trying to catch up to the trend, no matter what it is or whether it's healthy or not. It's all about sales. The trending product is made, then the marketing story is crafted.

With the growing surge in its popularity, there has been an increase in misinformation on Retinol use with dozens of influencers promoting the hottest and newest products, supporting their partner brands. I don't see this going anywhere. Unfortunately, Retinol will continue to rise in popularity. So I wanted to bring some perspective and play the devil's advocate, hopefully I can help a few people in the process.

How do Retinoids Work?

Retinoids increase cellular turnover in the skin inducing new cell growth, revealing new skin, reducing pigmentation and increasing collagen production. During this process, the skin experiences flaking, dryness, increased sensitivity and susceptibility to sunburn.

Retinoids also help treat acne by inhibiting sebaceous gland function. The Food and Drug Administration (FDA) has approved Isotretinoin (the most commonly prescribed Retinoid) for the treatment of cystic and nodular acne that is not responsive to other forms of treatment. The side effect profile of Isotretinoin led it originally to be approved strictly for severe nodular or cystic acne, however dermatologists in the US are often prescribing it for less severe acne.

'Hypervitaminosis A Syndrome' is a name of a paper published in 1987 listing a few side effects of Retinoid Acid being: lethargy, depression, cyclothymia, insomnia and hypersomnolence, skin changes, hair loss, headache, bone and joint pain, and liver enlargement. It was also noted that it could cause irritability and frank psychosis.

What are the types of Retinoids?

There are a few different types of Retinoids that fall into two groups; natural and synthetic. Also active and inactive forms. The inactive forms (precursors to Retinoid Acid) are more gentle and convert into Retinoic Acid with a few enzymatic interactions.

Natural Retinoids:

Retinol Esters [Retinyl Acetate, Retinyl Propionate, Retinyl Palmitate], the most gentle form that needs 3 conversion steps to retinoic acid.
Retinol is a higher strength than esters and needs 2 conversion steps to retinoic acid.
Retinaldehyde or Retinal (most effective OTC) is more potent than Retinol needing only one step to convert to retinoic acid.
Tretinoin or Retin-A (brand name) an active form of Retinoid.

Synthetic Retinoids:

Isotretinoin or Accutane is an oral RA.
Tazarotene
Adapalene [Defferin]

Retinoids Strength chart:

RETINOID	STRENGTH	AVAILABILITY	IRRITATION LEVEL
Retinol Esters	Lowest	OTC	Gentle
Retinol	Low	OTC	Slight
Retinaldehyde or Retinal	High	OTC	Moderate
Tretinoin or Retin-A	Very High	Prescription	High
Adaplene	High	Prescription	High
Tazarotene	Very High	Prescription	High
Isotretnoin	Very High	Prescription	High

It might be obvious from the chart, but it's important to note that the higher the strength, the higher the efficacy, and also irritation.

Retinoids also come in various percentages, ranging from 0.01 to 1.5% which indicates strength. Higher percentages work faster in peeling the skin and can be more sensitizing.

Another variable that affects irritation levels is the formulation itself. Gels (alcohol-based) are more concentrated and can be more irritating than creams, which have moisture that acts as a buffer, lessening irritation levels.

According to this study, using a higher concentration of Tretinoin produced similar positive results in collagen production, but 0.1% caused a significantly more irritation that the 0.025% concentration. So more in this case, is definitely not better.

The most popular of all Retinoids is Retinol, a low-moderate precursor to Retinoic Acid and the most the commonly used ingredient in OTC cosmetic formulations.

What are some best practices when using Retinol?

I personally do not use Retinoids as I believe in a more gentle approach to skin CARE. However, most people are convinced they need it or just don't want to miss out on the trend. If you're in that group, here are some best practices that can help you minimize side effects:

Start slow. Introduce it into your routine once a week and gradually build to 3 or 4 times a week, always scaling back when you see irritation.
Use a small amount on top of a moisturizer.
Dot it evenly over the entire face, then blend.
Use PM only & read your moisturizer and serum labels. Some day-products include Retinol.
Always use generous amount of sunscreen when on a Retinol regimen.
Be generous with your moisturizer when using Retinol.
Retinol is practically an exfoliant. So skip AHA's and BHA's while using it.

What are some side effects of Retinoids?

Most studies are done on mice, and not enough are done on humans to measure side effects. According to a study, Excessive RA-induced inflammation might prevent collagen accumulation in aged skin despite the positive effect of RA on collagen production. High concentrations & long term use are not necessarily effective. There is a return to baseline.

This study showed that the maximum improvement was reached at 11 months of use and no further improvement was noted at 22 months of use.

A review was done that linked oral Retinoids to 104 negative side effects, including fertility and reproductive performance and on perinatal and postnatal developmen t and congenital malformations. Another study showed that 10 cohorts that were evaluated to have organic brain damage.

A study has shown that the use of Retinoic Acid for 14 days, interfered with normal Thyroid function.

And my favorite; this study showed that a skincare regimen comprised of Niacinamide, Peptides & Retinyl Propionate rendered similar results to 0.02% Tretinoin regimen without the irritation.

A peer-reviewed study revealed neurological effects correlated to the use of Isotretinoin, highlighting warnings of depression, suicide, psychosis, death and disability. That is why pregnant women are warned against the use of retinoids and excessive Vitamin-A supplementation, due to effects on brain development in utero and risk of neurological disorders in the baby.

Most of the side effects listed above are related to Isotretinoin and prescription topicals. Not enough studies have been done on humans to measure side effects from OTC topicals. What's been determined, however, is various levels of irritation, inflammation & sun-sensitivity. There is still very little that we know. As Dr Mervyn Patterson stated; 'we are lead into a massive experiment by the beauty industry'!

So the simple answer to my opening question is that I do not wish to be part of a real life experiment when I have the knowledge and know-how of how to care for my skin the healthy and safe way. I don't see a reason for topical use of Retinol. There are a multitude of better ways I can boost my collagen and firm my skin. Check out my blog here on how I was able to reverse signs of aging.

What should we use instead of Retinol?

Retinol is promoted for two major skin concerns: Acne and wrinkles. Here are great alternatives for both:

Some Retinol alternatives for wrinkles

Retinol works to repair wrinkles by speeding up cell renewal and boosting more collagen production. In order to effectively perform the two functions in the skin, you could combine Red Light Therapy (I find it more effective without the side effects), and an effective exfoliation routine using AHA's and/or fruit enzymes. In addition to that, using skincare that's naturally rich in pro-vitamin A ( a precursor to vitamin-A) would aid in repairing cell DNA damage. This will promote a healthier cellular function and prevent collagen breakdown. Examples of such ingredients are Rosehip, Carrot Root, and Apricot Kernel oils. They are all rich in beta carotene, making them an outstanding safe alternative to Retinol, that also reinforces the skin's natural barrier and helps protect it from free radicals and sun damage.

Another great collagen boosting ingredient is green tea extract, which contains catchins - compounds that inhibit MMP's, the enzymes that breakdown collagen.

Retinol alternatives for acne

All the ingredients listed above that work for wrinkles, will work for acne-prone skin. The only modification here is using Blue Light Therapy, instead of red. LED blue light helps eliminate surface bacteria without drying out the skin. More here.

Other alternative skincare ingredients that work similarly to Retinol in promoting collagen production, and reducing fine lines and pigmentation, are listed below.

Alternative Ingredients to Retinol

Bakuchiol

A big buzz word these days, but for a good reason! Bakuchiol is extracted from the Indian plant Psoralea Corylifolia, which has been found to activate skin cells, boosting collagen production and increasing elasticity, while reducing pigmentation and even acne. Bakuchiol also contains antioxidant and anti-inflammatory properties. Perfect!

The first one that come to mind is Black Tulip Overnight Retinoid Serum I have used it for several weeks now, and have had great success with it. I have very sensitive and reactive skin, and this hasn't caused any irritation at all. I also love the fact that it contains Niacinamide, Hemp Seed Oil Complex, Lingonberry, and Saponaria Pumila Stem Cells are powerful active ingredients that reduce the appearance of spots, wrinkles, and uneven skin tone.

Another phenomenal clean product, is the advanced multi-tasking Versine Gentle Actives Clarity Serum + Azelaic Acid. This doctors-vetted serum was created to calm breakouts and improve the appearance of post-inflammation dark spots and melasma. Vitamin C, Niacinamide, Squalane, Hyaluronic Acid, Kakadu Plum Extract, Ceramide, plus Azelaic Acid. All in one pH-balanced, effective formula.

Niacinamide

Brightens, hydrates and stimulates collagen; all while being well tolerated by the skin, having minimal side effects. Versine Gentle Actives Clarity Serum is a multi-tasking serum designed to minimize the appearance of hyper-pigmentation, fine lines, and dry and fatigued skin. Vitamin C, Niacinamide, Squalane, Hyaluronic Acid, Kakadu Plum Extract, Ceramide, and so much more in a gentle, effective formula. Ideal for sensitive skin and pregnancy safe.

Rosehip oil

Rosehip oil is a super star ingredient that's rich in Polyphenols, Vitamin-A (Retinol), Vitamin-C, Carotinoids and minerals. It helps address most skin issues such as acne, pigmentation, wrinkles, scarring, stretch marks and sensitivity. The Beauty Doctrine Barrier Repair Serum is suitable for all skin types and doubles up as an excellent scalp and hair treatment.

Kahai Seed Oil

Extracted from the nuts of a Colombian Amazonian tree named Cacay, Kahai oil contains some of the highest content of Linoleic Acid, Vitamin E and Retinol. It has 50% more Vitamin E, twice as much Linoleic Acid as Argan Oil and 3 times more Retinol than Rosehip Oil.

One of many firming and skin loving ingredients is, my favorite, Blübiome Plant Stem Cell Cream.

Resveratrol

Resveratrol is a powerful antioxidant and anti-inflammatory molecule, which increases skin suppleness. Ere Perez White Tea Phyto-Retinol Elixir also contains niacinamide and bakuchiol, making it an amazing formulation for acne-prone skin!

Amino acids

Also known as peptides. They are referred to as the building blocks of collagen. They work to reduce the signs of aging and protect against free-radical damage. I don't think that any skincare product is complete without peptides / amino acids. Versine Azelaic Acid Serum is an award winning product combining more than just amino acids, but also Moth Bean ( another powerful Retinol alternative)

How to get Vitamin A naturally through diet?

Vitamin A from food sources is considered safe when consumed in moderation. There are two types:

Retinoids- from animal sources such as:

Beef and chicken liver
Eggs
Fish liver oils
Dairy products

Carotenoids - from plant sources, which are converted by the body into Vitamin A. They are found in:

Dark-green leafy vegetables
Deep yellow/orange vegetables and fruits, sweet potatoes, carrots, pumpkin and other winter squashes, cantaloupe, apricots, peaches, and mangoes.

Unlike Vitamin A, Carotenoids don't build up in the body.

Most people get their recommended daily value of Vitamin A (900 mcg for men & 700 for women) through diet. Some supplements offer a daily dose that can support those with limited diets or have diseases that require supplementation. Keep in mind that supplements do not offer the antioxidant and fiber found in foods.

You can get Vitamin A from eggs, liver, dairy products; or its precursor beta-carotene from leafy greens, & orange produce. Your body converts beta-carotene into vitamin A, which supports cell division, reproduction, immunity, vision, and skin health.

Diet remains the best source of vitamin-A and also the best way to avoid adverse effects or toxicity related to supplementation. Just a single overdose of 200,000 mcg can cause cellular toxicity, vertigo, Nausea, vomiting, and blurry vision.

Long-term daily supplementation with more than 10,000 mcg of oral vitamin A can cause liver damage, bone thinning, birth defects, and skin irritation. This is important to note as multiple multi-vitamins and beauty supplements contain Vitamin A.

Vitamin A may also interacts with some cancer drugs, anticoagulants & other medications. It is important to consult with your doctor prior to supplementing with Vitamin A.

Too much Vitamin A may lead to cell toxicity and liver failure. Here are some signs to be aware of if you are supplementing:

Hair loss
Dry skin, irritated skin
Headache
Muscle and joint pain
Nausea or diarrhea

Are Vitamin-A supplements the same as Accutane?

Taking Vitamin-A supplements in high doses can have the same effects as Accutane and carry the same side effects. So it is important not to combine both. All forms of Vitamin-A, especially synthetic, can become harmful very quickly when built up in the body.

This blog is a guide to help shed some light on the side effects of Retinoids, which are not to be treated the same way as your daily moisturizer or cleanser. If you choose to start a routine, including vitamin A or any of its derivatives, it is important to consult a physician. I personally recommend functional doctors as they are trained in nutrition, relative to health, and can offer a broader perspective than dermatologists and other M.

Be well. Be safe. Be beautiful!

Not sure what skincare to get? Book a consultation with Nadia here.

References and additional reading:

Differential effects of low-dose and high-dose beta-carotene supplementation on the signs of photoaging and type I procollagen gene expression in human skin in vivo

Retinol induces morphological alterations and proliferative focus formation through free radical-mediated activation of multiple signaling pathways

The Link between cell Division and cancer

Post-natal all-trans-retinoic acid biosynthesis

Overexpression of the Retinoic Acid-responsive Gene Stra6 in Human Cancers and Its Synergistic Induction by Wnt-1 and Retinoic Acid

Downregulation of STRA6 Expression in Epidermal Keratinocytes Leads to Hyperproliferation-Associated Differentiation in Both In Vitro and In Vivo Skin Models

Disclaimer:

As a blogger, my content may include affiliate links from advertisers. I may earn a small commission from actions readers take on these links such as a purchase, or subscribe. All my recommendations are based on my own research and personal trust in the products that I share. I am not a doctor or nutritionist. Please consult with your practitioner prior to using any products recommended.

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3 comments

Retinol can only force peeling/sloughing of skin. Note that they promote skin-cell turnover…NOT skin-cell recycling. That’s just a fancy way of saying the fresher layer rises up and the older one sloughs off. In no way does that mean an even fresher layer joins the back of the line to replace the lost one. You’re just stripping planar layers until none are left in reserve. There is no guarantee that it will peel evenly either. Any preexisting scars you think to “buffer” with retinols will only get broadened and deepened more noticeably. Wrinkles, divots and high-tension areas will get super-concentrated doses of retinol compared to raised surfaces. You’re nose will begin to look like icecream scoops exist behind it, Your pores will get wider and caved in, your chin and lip fold will begin to erode with water adhesion caused by gravity + emolients/oils that eddy the retinol into those recesses of hanging areas…like a dew drop hanging from your chin. lichenification can happen too where your face rashes and won’t stop peeling until your have sporadic spots of ultra rubbery reddened skin. Only corticosteroids or immuno suppressant creams can stop the uncontroleld sloughing. But then perioral dermatitis can happen from exposure to corticosteroids…which will scar you even more because corticosteroids thin the skin permanently…and because perioral dermatitis will cause nasty papular rashes. Once retinol has stripped your protective skin barrier…you will develope rosacia and then your face will peel uncontrollably from then on everytime it overheats. Causing further scars. My point is…retinol only makes scars worse. And causes new ones as well. Any inflamation whatsoever…is permanent damage. You can’t heal damage with damage. IT just equals damage.

Michelle on March 1, 2024
Retinol products horrifically scarred my face, irreversibly, with accumulative use. I now live with permanent atrophic rolling scars all over my face. I’ve been on retinol topicals multiple times over the years, spanning weeks to months every hopeful try. Each time I had to quit in horrid shame and misinformed confusion because it caused dermatitis rashes and uncontrollable peeling/sloughing that persisted so strongly that it required prescription Immuno-suppressant cream to stop each time. And what makes this worse…Dermatologists themselves told me to give it another go. Other dermatologists told me never to touch the stuff with my sensitive skin. My skin now is incredibly thinned, spider veined, sporting a cluster-fest of rolling scars and box scars. My skin is no longer smooth and looks like freddy kruger in a dress in my honest opinion. Problem is…now there’s nothing they can do to fix it. It’s too far gone I’ve been told. I used to be a model with porcelain smooth facial skin. Now I look like I kissed a cheese grater. And it’s permanent…FOR LIFE. I’ve been off retinol for two years now. Though my skin will never again be beautiful like it used to…being off of retinol products showed VAST improvement than being on them. Still, the atrophic scarring isa permanent reminder.

Michelle on February 23, 2024
This article is IT! I feel like an outlier in my industry because I don’t use retinols and I am constantly fielding questions from my clients, some as young as 2o, asking if they start using it for age management.

Jenny on January 15, 2023