Skin Journal
Prescription retinoids and retinol: what’s the difference?
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Retinoids are one of the most effective skin care ingredients available. Used to treat everything from acne to ageing to hyperpigmentation (and more), retinoids are a true ‘gold standard’ treatment.

Prescription retinoids are particularly in demand, and skincare forums are full of retinoid users singing the praises of their prescription treatments. But are prescription retinoids really so different to retinol, its over-the-counter cousin? How do we decide if we need one or the other? And how do retinoids work, anyway?


All retinoids are effective, but there’s a big difference between the retinoids you can buy in stores and those prescribed to you by a doctor. So we’re going to look at the difference between prescription retinoids and retinol, and then we’ll help you decide which one is right for you.


What are retinoids?

Retinoids are active skincare ingredients derived from Vitamin A. We go into the difference between retinoids and Vitamin A in-depth here; but essentially Vitamin A is a nutrient that—among other things—helps keep our skin healthy and refreshed. So it makes sense that retinoids, as a derivative of Vitamin A, perform a similar function! 


There are a number of ingredients that are classified as retinoids: retinol, tretinoin, adapalene, and isotretinoin are some of the more common ones that you might hear about. All of these ingredients are effective, but there are a few important differences between each. To understand what these differences are, we need to know a bit about how retinoids work.



How do retinoids work?

We’ve previously talked about what retinoids can do for your skin, and the benefits are many. But today we’re going to delve a bit deeper into the science behind the skincare and find out how retinoids work on a cellular level.


Before our body can use any retinoid, it has to convert it into retinoic acid3. Different kinds of retinoids can take longer to convert, and all retinoids (aside from prescription retinoids) lose some of their strength during the conversion process. Generally speaking, the more steps it takes to convert a retinoid into retinoic acid, the weaker the retinoid will be by the time your body is able to use it. 


Caroline Hirons offers a great explainer in which she compares retinoids to coffee: retinoic acid is a rich double espresso and retinol esters are mild lattes, because they take longer to convert and are therefore weaker in their final forms.


Once our body has made retinoic acid, it's able to bind that acid to a retinoic acid receptor—think of it as a key fitting into a lock. When the retinoic acid meets its receptor, it can begin working! 


The retinoic acid encourages our body to begin replicating relevant genes and reproducing DNA, which in turn speeds up the production of skin cells.


When new skin cells are produced, they move up to replace the old ones which might be damaged or dead. These old cells are shed and literally flake off our bodies, and they’re replaced by the brand new skin cells that the retinoic acid has encouraged our bodies to make. This is a natural process that happens to our body anyway, but it can take between 40-56 days4—retinol makes it happen a lot faster. 


The increase in new skin cells makes our skin thicker and plumper, because it has more skin cells to fill it out. It also pushes out any comedones—or acne lesions—that are forming underneath the skin, and forces their contents out to the skin’s surface (this is why some people experience ‘purging’ when they begin using retinoids).


Retinoids also reduce our corneodesmosomes, which is the sticky glue that holds our skin cells together. This can make our skin flakey in the short-term, which is a common side-effect of retinoid usage, but it means that in the long-term there will be fewer dead cells hanging onto our skin because there’s less glue to keep them stuck there. This is also how retinoids work on acne: they replace the overactive skin cells in our hair follicles while also reducing the corneodesmosomes, or sticky skin glue, on our skin. This makes our pores far less likely to become clogged, which reduces the chances of acne lesions forming.


Lastly, retinoids do a few other nifty things as they work: they keep our skin hydrated; they protect the collagen and elastin in our skin from damage; and they disperse our skin’s melanin, which evens out hyperpigmentation without changing the overall colour of our skin.


So what’s the key to making sure all of these changes happen to our skin, as quickly as possible and with minimal side effects? We have to look at the type of retinoid we use—and it’s at this point that we need to compare prescription retinoids to over-the-counter retinoids.



What do prescription retinoids have that over-the-counter retinoids don’t?

Quite simply, prescription retinoids are all made of retinoic acid. This means they can bind directly to our retinoic acid receptors without having to be converted first and losing some of their strength in the process. 


Going back to the coffee comparison from earlier, prescription retinoids are a double-strength espresso—and OTC retinoids are the lattes and cappuccinos of the skin care world. 


Prescription retinoids are measurably stronger, and have also been studied in laboratories and controlled studies to measure their efficacy. Basically, they’re proven to work. 


This doesn’t necessarily mean that OTC retinoids don’t work, but they don’t have to pass the same tests that prescription retinoids do. Our Therapeutic Goods Administration (TGA) reviews OTC products for their safety, to make sure they won’t harm you if you use them; but the TGA doesn’t test whether or not OTC products really do what they claim to do. It does, however, run those tests for prescribed products.


So, will OTC retinoids work? Probably. Will prescription retinoids work? Definitely.


There are a few other benefits to using a prescription retinoid, as well:

  • Getting the right dosage. Like any other medication, it’s important to have the right dosage of retinoid. When you speak with your doctor about a prescription retinoid, they’ll be able to assess your skincare needs and give you a dosage that’s right for you.
  • Shelf-stable packaging. Retinoids are sensitive to light and air, and can lose their strength if exposed to either. Prescription retinoids will always come in airless, opaque packaging, but some OTC retinoids don’t and the product can degrade because of it.
  • Discussing other solutions. Retinoids can be used in conjunction with many other skin treatments, some of which are only available by prescription—such as antibiotics and oral treatments. Your doctor will be able to let you know if they think it might be a good idea for you to try multiple treatments.
  • You’ll know if retinoids are right for you. We think retinoids are excellent, but they’re not a cure-all. There are many causes of acne and ageing skin, and your doctor might want to talk to you about some other steps you can take to treat your skin aside from retinoids. Also, if you’re someone who can’t use retinoids (if you’re breastfeeding or pregnant, for example), your doctor can suggest an alternative.


If you’re wondering why anyone would choose an OTC retinoid when they could just as easily have one prescribed, there are a few reasons:

  • They want to try a few different options. There are heaps of retinoid products out there—serums, moisturisers, oils, and lotions galore. It definitely can’t hurt to try a couple, even if you decide later you’d rather use a prescription treatment.
  • Prescription-strength retinoids are too strong. Some people prefer to use a milder retinoid treatment, so they might decide that an OTC retinoid is all they need.
  • They’re interested in retinoid alternatives. If someone can’t use retinoids, they might want to explore a product that works very similarly, such as bakuchiol



The most important thing to remember is that skin care is never a one-size-fits-all solution. What works for someone else won’t necessarily work for you, so don’t worry if it seems like everyone around you is using prescription retinoids and you’re not (or vice versa).


Prescription retinoids are a highly effective ingredient, but the best ingredient is the one that works for you. Software doctors are highly experienced with skincare and can help you find the right treatment to suit your skin, and can personalise a treatment to meet your unique skin care goals.


References

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