Retinol is a product that no beauty therapist or aesthetic practitioner committed to remedial skin care should be without. It has a versatility and efficacy which addresses the most prevalent and persistent skin conditions of concern to our clients including acne, ageing, pigmentation, irregular texture and scarring.
It is, however, a product to be respected and used with care, so a full understanding of its nature and application protocol is essential to avoid adverse skin reactions.
Retinol comes from a family of compounds called retinoids which are derived from Vitamin A and they have been used medically in both oral and topical forms over the last century to treat a variety of dermatological conditions. Indeed there is evidence that retinoids are efficacious in the treatment of over 125 skin diseases and disorders. These include acne, post acne scarring, psoriasis, ichthyosis and, more recently, for addressing the ageing process and photodamage of the skin.
The benefits of Vitamin A on acne skins was first discovered in the 1920s and subsequently Nobel Prize winning research led to the structure of Retinol first being determined in 1931. In 1943 Retinol was first synthesized and became commercially available, both in its pure form of All Trans Retinoic Acid (ATRA) and now available in varying strengths and in the less potent derivative forms such as retinyl palmitate.
Equally, modern retinols are now very refined having undergone molecular modification to be more photostable and less sensitizing. Whilst the stronger forms of pure retinol over a 1% strength remain prescription only medicines, the advent of cosmeceutical retinol and its milder cosmetic forms such as retinyl palmitate now make this potent product available to the skin care therapist.
So how does retinol work?
The natural actions of Vitamin A in the body include the control of growth, cellular proliferation and differentiation and to promote homeostasis which is the regulation od the body’s natural internal environment and so maintaining a healthy balance. It also controls apoptopsis, the term given to programmed cell death as in keratinisation
In 1987 All Trans Retinoic Acid was discovered to be a hormone and as such acts as a regulator of cellular activity. It is thus able to rebalance and correct certain aspects of skin dysfunction – for example in an acne skin it slows down cell turnover and epidermal keratosis responsible for comedogenesis, whilst conversely in an ageing skin it will speed up a sluggish cycle of cell renewal.
The effects of retinol are therefore deeply impacting for corrective skin care. Looking first to its effects on the epidermal tissue, Retinol regulates epidermal cell renewal by normalising DNA activity in the keratinocytes and so rebuilds or redefines the epidermis. The stimulation of cell renewal in the basal layers fortifies the barrier function of the epidermis making it more resilient to environmental aggression and so less reactive, while at the same time increasing surface desquamation to give a smoother and more refined skin texture. This can result in light sheathing of the skin in the initial stages of treatment but with continued use this side effect will subside.
Still on the surface epidermal tissue, retinol will compact the layers of dead skin cells in the Stratum Corneum giving the skin surface a firmer and younger appearance with the smoothing of fine epidermal lines. In addition, in the photodamaged skin retinol will help to break down superficial melanin staining in the skin to give relief from hyperpigmentation irregularities.
In the dermis retinol is both preventative and corrective to the degradation of the dermal matrix. It inhibits the action of the Matrix Metalloproteinases which are enzymes stimulated by sunlight and responsible for the breakdown of collagen and elastin and at the same time retinol will stimulate the new synthesis of collagen by the fibroblast cells, so firming the skin, improving tone and reducing dermal wrinkles.
With regard to its specific action on the oily and acne skin, Retinol will regulate the production of sebum, refine open pores and through its collagen regenerating effect will address acne scarring. Equally its ability to reduce pigmentation is useful in the treatment of post inflammatory marking of the skin in the darker Fitzpatrick skin types.
The question of skin absorption of a product must always be understood if you are to be able to explain the benefits of using a product to today’s discerning and well informed client. Retinoic acid is a lipid soluble molecule and as such has an affinity with the skin enabling its absorption both through the lipid bilayer structure in the epidermis or via the pilo-sebaceous unit.
However, to increase its absorption capability retinol is often liposome encapsulated which means that the retinol molecule is wrapped in a lipid ‘bubble’. This encapsulation increases its permeability into the skin while at the same time increases the stability of the product and provides a time release mechanism whereby the ‘bubbles’ burst their contents into the deeper layers of the skin one by one, in a similar way to a child blowing soap bubbles. This has the effect of reducing skin sensitization which is of benefit for most people as pure retinol is, by nature, irritating to the skin and during the first phases of its use can cause erythema, flaking and sensitivity, especially to sunlight.
The consideration of this normal reaction is essential when the skin care practitioner is advising clients on the use of retinol in their home care regimen. Managing the client’s expectation of slight redness and mild peeling will prevent them from worrying that their skin is adversely reacting to the product. However equally this reaction should not persist beyond a couple of weeks’ use and should not involve extreme redness, stinging or burning. In such a case an adaptation to the frequency of use or the termination of the treatment must be implemented. Retinol is not for everyone.
That having been said, if a client does not show a skin reaction it does not mean that the product is not working. In terms of the efficacy of retinol, a research study was carried out by Griffiths et al in 1995 which showed that the benefits of retinol on photoageing are not relative or dependent on the degree of redness and irritation. Thus with well tailored treatment, results can be achieved with minimal skin irritation.
It is vital to the success of a retinol treatment programme that a regime of gradual introduction of the product is followed to avoid over treatment and extreme skin reactions. This is particularly the case when using pure retinol products of strengths from 0.1% up to but not including 1% (remember that at 1% pure retinol is pharmaceutical in strength and for medical use on prescription only).
Sometimes a manufacturer’s statement of percentage can be misleading stating retinol percentage strengths of 4%, 8%, 12% for example. These levels are not representative of the total percentage strength of the pure retinol contained in the product and precise information as to the formulation is needed. It may also be that a derivative of retinol has been used which might well be more suited to your client – derivatives such as retinyl palmitate which is efficiently absorbed due to its combination with the free fatty acid palmitic acid present naturally in the epidermal lipids. This formulation will be efficacious while at the same time is less sensitising to the skin.
The key to giving the correct advice to your client in the use of their retinol product is to follow the manufacturers instructions. As a rule of thumb however, when using pure retinols a client should be advised to commence at lower strengths such as 0.3%. The product is applied two to three times a week at night only and this frequency is gradually increased over the following weeks to between four to seven times weekly depending on the clients tolerance and skin reaction. The erythema and flaking should subside with the first two weeks of treatment.
Throughout their course of retinol treatment a client must wear a broad spectrum sunscreen of SPF50 and preferably also use an antioxidant serum to protect from harmful ultra violet rays. Retinol is significantly photosensitising and without the appropriate sun protection, issues of hyperpigmentation will occur.
Courses of retinol treatment may be approached as a pulse therapy to provide perhaps two courses of three months’ duration per year. This is ideal for the client wishing to address mild issues of ageing and sundamage or to act as a maintenance programme for healthy skin regeneration. If the condition of the skin is more progressive or severe such as acne skins, advanced ageing and irregular texture or scarring then the client may progess to higher percentage strengths, within the cosmeceutical parameter, and longer courses of treatment up to six months at a time may be indicated. However always be guided by the individual skin condition and its reactions to treatment and consider that best practice is to give the skin a rest period between treatment programmes of strong retinols, to avoid over treatment and compromisation of the epidermal barrier function.
Finally, having assessed your client’s skin to be indicated to retinol therapy, do of course consider its limitations. It is unsuitable for any client who is pregnant, trying to become pregnant or breast feeding due to its ability to enter the blood stream and its potentially harmful effects on the unborn child. Always refer to your product specific instructions in relation to using retinol alongside chemical or enzymatic exfoliation, microdermabrasion or laser resurfacing treatment, as these treatments will become more aggressive if a retinol product has been used prior to these clinical applications.
Having said this, retinol is very efficacious, within the appropriate protocols, in combination with clinical skin procedures it has been proven to improve the beneficial effects of skin regenerative treatments such as fraxel or pixel laser, skin needling and chemical peeling where manufacturer protocol allows.
In summary therefore, retinol is the answer to many skin care concerns, which as beauty therapists we have previously been unable to address. It marks the welcome move of our industry into results driven clinical skin treatment whereby we can, with the right level of training and education, not only safely address the most prevalent and persistent skin complaints, but also look to provide ageing retardation and improve long term skin health