Retinoid, retinol, tretinoin, Retin-A, isotretinoin—These are very similar-sounding names of completely different medications. While some are common ingredients in over-the-counter anti-aging creams, others are prescription medications to be used under the supervision of a healthcare provider. Please continue reading to learn more about retinol, tretinoin, and isotretinoin to be better informed with various options for your skincare routine.

What are retinoids?

Retinoids are vitamin A derivatives. This class of medication speeds up skin cell turnover, exfoliates the skin rapidly, and promotes the growth of healthy, new skin cells. Retinoids help to clear acne by unclogging skin pores. They also soften fine lines and wrinkles. Dermatologists generally prescribe topical retinoids to treat acne and as part of an anti-aging skincare routine.

Retinoid is, therefore, a broad term that includes the prescription medicine tretinoin (common brand name Retin-A) and retinol (which is one of the most common ingredients in cosmetic products), as well as other medications such as adapalene (brand name Differin), retinyl palmitate, and tazarotene (brand name Tazorac), among others. 

What is retinol? How does it treat acne? Can it reduce fine lines and wrinkles?

Retinol is one of the best-known ingredients in skincare products. It is an over-the-counter retinoid, which, as noted, is a vitamin A derivative. Retinol is primarily used to treat acne and reduce the visible signs of sun damage and aging. It is not as potent as prescription retinoids, but it is the strongest over-the-counter version of retinoids available on the market. In addition, retinol is more powerful than other OTC retinoids, such as retinyl palmitate and retinaldehyde. 

How does retinol treat acne? Clogged pores are responsible for the development of acne. Retinol gets rid of acne over time by exfoliating dead skin cells, dirt, and oil from the skin’s outer surface, which helps unclog pores. It also allows acne creams and gels to penetrate the skin better.

Is retinol anti-aging? Retinol reduces fine lines and wrinkles by promoting collagen production in the skin. Collagen is an essential protein that gives the skin its soft, smooth appearance. The anti-aging effects of retinol also include the formation of new blood vessels in the skin that help to improve skin cell turnover. Additional benefits of retinol include fading of age spots, smoothing of rough texture, and improvement of hyperpigmentation.

What is tretinoin?

Tretinoin is a prescription retinoid that is prescribed by a dermatologist after a patient’s health status has been reviewed. It is available in the generic form (tretinoin) and brand name Retin-A (other brand names include Avita, Renova, Refissa, and Retin-A Micro). 

Also known as retinoic acid, tretinoin is prescribed to treat acne and other skin diseases. Tretinoin works by keeping the pores in the skin clear. It also treats sun-damaged skin by reducing fine lines and wrinkles, fading dark spots, and smoothing uneven tone and rough texture. 

Tretinoin or retinoic acid plays an important role in cell growth. The anti-aging effects of tretinoin are achieved by its actions of lightening dark skin and replacing the old skin with new. Retin-A (which contains tretinoin as the active ingredient) can significantly improve sun-damaged and aged skin. However, it cannot completely or permanently erase these skin blemishes, particularly deep wrinkles. 

What is isotretinoin and how is it different from tretinoin?

Another similar-sounding medication is isotretinoin, also available from a dermatologist by prescription. While both are vitamin A derivatives, that is where the similarity between isotretinoin and tretinoin ends. 

Isotretinoin is commonly known by the popular brand name Accutane which has been taken off the market. Other brand-name products of isotretinoin that are currently available with prescription are Absorica, Claravis, and Sotret. Isotretinoin is used to treat deep, painful cysts in people with severe inflammatory acne (nodular or cystic acne) that have not responded to other treatments such as benzoyl peroxide, topical clindamycin, and oral tetracycline or minocycline. Isotretinoin is an oral medication. In contrast, tretinoin (Retin-A) is a topical cream that treats moderate acne with anti-aging benefits and improvement of hyperpigmentation. These two medications are not interchangeable.

One important thing to know is that patients who receive isotretinoin products must be enrolled in the iPLEDGE program, while this is not a requirement for tretinoin products. Isotretinoin is a pregnancy category X medication, meaning that isotretinoin can cause severe birth defects if taken during pregnancy. iPLEDGE is a risk management program that was put in place by the FDA to prevent pregnancy in female patients taking isotretinoin. 

Is tretinoin similar to retinol?

Tretinoin and retinol are both derived from vitamin A. However, tretinoin is a powerful, prescription-strength retinoid. Retinol is a less potent topical retinoid commonly present in over-the-counter cosmetic and skincare products. 

What is the difference between tretinoin (Retin A) and retinol?

The first difference between tretinoin and retinol is that tretinoin requires a prescription, while retinol is available over-the-counter. In terms of potency, tretinoin is more powerful compared to retinol. 

Retin-A (tretinoin) is derived from retinol, or you can say retinol is a precursor of tretinoin. In other words, retinol must undergo a series of chemical reactions to become tretinoin or retinoic acid. Retinol, therefore, requires the help of skin enzymes to make it usable, while tretinoin is already in usable form.

Retinol is weaker and less stable. It is also more prone to degradation on exposure to air and light. However, since retinol is not as harsh as tretinoin, sensitive skin tends to tolerate retinol better. As a result, it may take longer for retinol to exert its effects. 

Is tretinoin or retinol better?

Tretinoin is up to 20 times more powerful than retinol; It can produce visible improvement in the skin’s overall appearance faster than retinol. When a dermatologist prescribes tretinoin for acne or photoaging (premature skin aging due to repeated and prolonged sun exposure), the treatment can show results in 4-6 weeks. In comparison, retinol needs 12 weeks or more to show benefits in smoother skin with improved tone and texture and fading of fine lines and wrinkles. 

However, tretinoin may have more side effects, particularly in people with sensitive skin. Common side effects of tretinoin include unusual skin dryness (this may be offset by using a moisturizer), redness, irritation, peeling, and pain. If the side effects are severe and do not improve over time, you will need to talk to your dermatologist about other treatment options. Skincare products containing OTC retinol are usually better tolerated because the retinoid component is less powerful.

Why is tretinoin prescription only?

As noted, tretinoin is a powerful retinoid that can quickly improve the skin by speeding up the skin’s turnover, promoting collagen formation in the skin, and unclogging pores. Tretinoin is available by prescription only because while it is more potent than retinol, it also has an increased potential for side effects. Therefore, treatment with tretinoin has to be under the supervision and medical advice of a healthcare provider. 

Do retinoids in over-the-counter (retinol) skincare products work?

It can take 3-6 months for over-the-counter retinoids to work in improving fine lines and wrinkles. The best results are typically observed after 6-12 months of use. You will need to continue using the retinoid-containing cosmetic products to maintain the benefits. 

Because retinoids can cause skin dryness and irritation, you should start applying the products every other day and slowly work your way up to application every night. Also, remember that retinoids increase the skin’s sensitivity to UV radiation in sunlight, so it’s important to be incredibly diligent about wearing broad-spectrum sunscreen while using these products. 

References:

1. https://www.health.harvard.edu/staying-healthy/do-retinoids-really-reduce-wrinkles#

2.https://www.mayoclinic.org/drugs-supplements/tretinoin-topical-route/description/drg-20066521

3. https://medlineplus.gov/druginfo/meds/a681043.html

4. https://pubmed.ncbi.nlm.nih.gov/18046911/