15 years of research...Retin-A works to help your skin

The "amazingness" retinoid can do for our skin, if you can stand it. (Don't use it if you are pregnant or breastfeeding though). I've linked 2 articles that help to explain what Retin-A is and how it works. 

 

Correction Appended

THE beauty aisles of a typical drugstore are a veritable fortress stacked with lotions and potions that promise to turn back the clock, rejuvenate the skin and restore a youthful glow. Their labels list an arsenal of ingredients —alpha hydroxy acids, antioxidant vitamins, green tea, copper, caffeine, soy, peptides, among many others.

Yet within the walls of products and tiers of claims, one ingredient still stands out: Retin-A. It is available in prescription-strength products, including generic formulations, and under brand names like Retin-A Micro, Renova, Avage and Tazorac. Its less potent over-the-counter cousin, retinol, is found in products on department and drugstore shelves.

According to the Mintel Global New Products Database, nearly 300 retinol-containing cosmetics have hit the market since 2003. The latest crop includes Neutrogena Healthy Skin Anti-Wrinkle Intensive Eye Cream, RoC Retinol Correxion Deep Wrinkle Daily Moisturizer with SPF 15, Avon Anew Line Eliminator Neo-Retinol Line Plumper SPF 15, MD Skincare Alpha Beta Daily Face Peel and overnight creams like SkinCeuticals retinol 0.5 and 1.0 formulas.

With so many doctors and beauty companies on a hunt for the next big anti-aging product, why do Retin-A and retinol still have so much appeal? The answer, many dermatologists say, is simple: They work.Even better, unlike most other beauty products with lofty claims, there’s proof that they work.

“To my knowledge, this is the only drug for which there has been crystal-clear demonstration that it works on the molecular level,” said Dr. John J. Voorhees, the chairman of the dermatology department at the medical school of the University of Michigan.

Prescription Retin-A first became popular more than 20 years ago as an acne treatment. But doctors and patients soon noticed another benefit, one with enormous impact on those who were looking for a way to keep skin vibrant and smooth.

Retin-A users reported improvements in skin texture, including diminished wrinkles and brown spots. Early studies soon confirmed its anti-aging effects. In 1988, Dr. Voorhees and his colleagues at Michigan published the first double-blind study of Retin-A’s effect on photodamaged skin and found that all 30 patients who completed the 16-week study showed statistically significant improvement.

“There is so much historical evidence that this ingredient works better than anything else,” said Dr. Joel L. Cohen, clinical assistant professor of dermatology at the University of Colorado and a consultant for OrthoNeutrogena, the maker of Retin-A Micro. And the effects are more than superficial. “It actually works to remodel skin on a cellular level,” Dr. Cohen said.Retin-A, the drug known generically as retinoic acid or tretinoin, is derived from vitamin A. Retinol, a less potent form of Retin-A, also has some strong science to support its effectiveness.

Skin cells contain retinoid receptors that help regulate how the cell functions. As people age, their cells behave more erratically. “But consistent use of Retin-A helps normalize the cells,” said Dr. Min-Wei Christine Lee, a dermatologist in Walnut Creek, Calif. Retin-A can improve skin texture and fade dark spots and freckles because it causes skin cells to turn over more rapidly. It shrinks dilated pores and improves cell turnover within the pores so they are less likely to clog and become blackheads and whiteheads. But what has earned Retin-A its long-held reputation is its ability to affect the retention of collagen.

Collagen is what gives skin its structure, firmness and elasticity. Repeated sun exposure breaks down collagen and, with age, cells produce less and less collagen to repair the damage. Skin wrinkles, sags and loses fullness.Retin-A does double duty in helping to boost collagen. According to research at Michigan, it has the potential to stop photoaging before it starts. “The retinoids prevent the rise of collagenase after UV exposure,” Dr. Voorhees said. Collagenase is what breaks down collagen.

But regular use of a retinoid product also increases the amount of new collagen formed, research has found, and that new collagen will last for years.  Susan Hobbs, 56, of Royal Palm Beach, Fla., a retired firefighter, said she spends a lot of time outdoors, and has been using Retin-A for about 15 years. “And I really don’t have a lot of wrinkles, compared to other people my age," she said.  “I think that using Retin-A has made a big difference,” Ms. Hobbs said. “I think if I didn’t use it, the sun damage would have really taken its toll.”  The results are not just cosmetic. Dr. Voorhees said that retinoids have been used to treat precancerous skin cells. Studies show that after two years of use, those abnormal cells returned to normal.

So if Retin-A is so effective and so well studied, why isn’t everyone using it?

 Many dermatologists blame a lack of patient education. “It’s one of the most misunderstood drugs,” said Dr. Kenneth Beer, a dermatologist in Palm Beach, Fla., and a clinical investigator for Allergan, the maker of prescription Avage and Tazorac. He is also an Allergan shareholder. People use Retin-A too much, use it too often, experience negative side effects and then give up on it too soon, doctors say.  The problem with Retin-A is that it may actually make skin look worse — with redness, flakiness and peeling — for up to eight weeks. “But by 24 weeks, patients will see dramatic, marked improvements,” Dr. Lee said.

Ms. Hobbs said when she first started using Retin A, she broke out with severe acne. “I remember I called the doctor and told him I was going to stop using it because my face had never looked worse,” she said. But her doctor advised her not to give up. “And he was right,” Ms. Hobbs said. “In another couple of weeks, my skin cleared up.”

Manufacturers have come up with ways to make it more tolerable, less irritating and more effective. Brand-name prescription versions contain emollient moisturizers and have more-advanced delivery systems for getting the active ingredient into the skin. These additions are the main difference between generic Retin-A and the pricier name-brand versions (a large tube of a name brand will run about $150 versus about $80 for a generic).

But in every case, patience and common sense are required. “You need to take six weeks to ramp up very slowly, but people will glob it on every night from the start and then call their doctor in a panic that their skin is red and peeling,” Dr. Beer said.

Doctors generally recommend using no more than a pea-size dab for the entire face. They advise using the product once every three nights (or once a week if skin feels irritated) for a couple of weeks, then every other night, eventually working up to every night if the skin can handle it.

Dr. Cohen cautions that Retin-A is not recommended for pregnant women or people with rosacea (a condition that causes skin redness). He said it is wise to limit its use with other potential irritants, like glycolic acids and vitamin C. Many doctors recommend applying a moisturizer over Retin-A (especially the generic versions) to help soothe skin, but suggest first waiting at least 20 minutes for the product to be absorbed.

Doctors also warn that newly irritated skin requires vigilant sun protection, and there are some concerns that waxing while using Retin-A may tear the skin.

“I can’t say there’s anything on the horizon that will rival Retin-A,” Dr. Cohen said. “It’s exciting to see all the research going into this area, but kind of funny that the thing we’re still recommending most is something that’s 25 years old.”

Correction: December 21, 2006

The Skin Deep column on Nov. 30 about the anti-aging effect of retinoid products referred imprecisely to one of them. Retin-A is a brand name for the ingredient tretinoin, part of a family of related products known as retinoids. It is not itself an ingredient.

And...if that wasn't convincing enough, Oprah's article below

Your Skin’s New Best Friend: retinoid

Your Skin’s New Best FriendFive reasons you probably don’t use a retinoid (and why you should consider it)By Jenny Bailly
O, The Oprah Magazine  |  From the July 2009 issue of O, The Oprah Magazine

1. You have no idea what a retinoid is. The term describes vitamin A derivatives that unclog pores, boost collagen to reduce fine lines, and speed cell turnover to even out discoloration and smooth the skin—sometimes in as little as four weeks. The first retinoid—tretinoin—was FDA approved (under the brand name Retin-A) almost 40 years ago as a prescription acne treatment. Dermatologists soon noticed that patients on Retin-A experienced not just clearer but softer, brighter, less-lined skin. Today there are three prescription-strength retinoids: tretinoin (brands include Atralin, Avita, Retin-A, Retin-A Micro, Renova), tazarotene (Avage, Tazorac), and adapalene (Differin). Many dermatologists find tazarotene stronger (and potentially more irritating) than tretinoin; adapalene is the gentlest but may be less effective.


2. You don’t want to go to the dermatologist. While prescription formulas yield the most impressive results, an over-the-counter retinoid, called retinol, can also improve lines and discoloration. Because retinol is gradually converted into retinoic acid (the active ingredient in the prescription creams) it is less potent. Count on 12 weeks before seeing results. 

3. You think a retinoid will make your skin sun-sensitive. ”This is one of the biggest retinoid myths,” says Doris Day, MD, clinical assistant professor of dermatology at New York University Medical Center (and a Tazorac user herself). “The ingredient itself is sensitive to sunlight, which is why you should apply it before bed at night.” A retinoid shouldn’t make your skin any more vulnerable to UV rays than it would be after buffing away dead skin with a face scrub. Summer is actually a good time to start a retinoid: Humidity makes your skin less likely to dry out as it adjusts. Of course, apply sunscreen (SPF 30, at least) as diligently as you always do.

4. You’re afraid your skin will look worse before it gets better. Retinoids can cause dryness, redness, and flaking—but if you ease in, you can avoid a rough transition. For the first two weeks, apply a retinoid every third night, says Leslie Baumann, MD, director of the Cosmetic Medicine and Research Institute at the University of Miami (who uses Atralin). If your skin isn’t irritated, ramp up to every other night for two weeks. Not dry or flaky? Go for it every night. A few other irritation-mitigating guidelines: Wait 15 minutes after washing your face before you apply a retinoid, and use one pea-size dab to cover your whole face. After a few minutes, apply a basic moisturizer to prevent dryness. 

5. You think you can’t afford it. Insurance coverage of a prescription retinoid, like Retin-A, varies by plan, and a 20-gram tube will cost about $75. But generic tretinoin costs about $40—not bad for a product guaranteed (by decades of science) to work. (For now, only tretinoin is available in a generic version.) Some drugstore retinol products are even less expensive. Look for ones with 0.1 percent retinol packaged in aluminum tubes (to protect the formula from air and light); we like RoC Retinol Correxion Deep WrinkleNight Cream ($22). 

Caveat Emptor

• Don’t use a retinoid if you are pregnant or breastfeeding.
• Benzoyl peroxide and alpha hydroxy acids may deactivate retinoids, so don’t layer them.
• Waxing can cause excess redness on retinoid-treated skin; don’t use a retinoid for several days before a treatment.
• A small percentage of people with ultrasensitive skin can never tolerate a retinoid; if you’re one of them, use a gentle physical exfoliator twice a week to soften your skin, and be extra-conscientious about sunscreen to prevent collagen loss in the first place.