When it comes to anti-aging, retinoids are on everyone’s lips, both in the public and medical profession. Go to any dermatologist’s office or skin care seminar and you’ll hear about them everywhere.
But is it really possible to “reverse” the signs of aging with a topical ointment?
What’s behind skin aging?
As detailed in the 2023 review: BiomoleculesSkin ageing is caused by intrinsic factors such as genomic instability, telomere shortening and cellular senescence, and extrinsic factors such as UV radiation, pollution and lifestyle choices.[]
These processes lead to collagen breakdown, slow cell turnover, oxidative stress and inflammation (aka inflammatory aging), resulting in visible changes like wrinkles, pigmentation issues, thinning of the skin and affecting the skin’s integrity and barrier function.
Related: How to protect your youthful glow from “inflammage aging”
While no topical treatment can completely reverse the signs of skin aging, topical retinoids have the strongest evidence to reduce these effects.
Definition of Retinoids
This class of compounds derived from vitamin A includes all-trans retinoic acid (tretinoin), retinaldehyde, synthetic retinoids (adapalene, tazarotene, trifarotene), retinol, and its metabolites (retinalaldehyde/retinal, retinoic acid, etc.).[]
Pharmacologically, retinoids bind to retinoic acid receptors (RARs) and retinoid X receptors in skin cells and modulate gene expression. This process promotes skin cell turnover, reduces keratinocyte clumping (leading to desquamation), prevents collagen degradation by inhibiting matrix metalloproteinase activity, and stimulates collagen production, improving skin texture and reducing fine lines and wrinkles.
Behind the hype
Tretinoin was the first retinoid approved in 1995 to treat fine lines, photoaging, and hyperpigmentation.[] Other topical retinoids have since been found to have similar anti-aging effects, although most, except for retinol and adapalene, are available only by prescription.
Consider the following study:
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In a split-face study, after eight weeks of daily use in 20 women ages 34-65, both 0.15% and 0.30% retinol improved skin discoloration and facial wrinkles, and improved skin smoothness.[]
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In a study comparing retinol with retinoic acid, after four weeks, both treatments increased epidermal thickness and upregulated genes for type 1 and type 3 collagen, with retinol achieving more than half the effectiveness of retinoic acid. After three months, retinol use resulted in a clinically significant reduction in facial wrinkles.[]
assignment
Dose-dependent side effects often limit the use of retinoids. The most common side effects are localized dryness, peeling, photosensitivity, and pruritus. Although retinol is generally milder and better tolerated than prescription retinoids, it can still cause irritation, especially in patients with sensitive skin.
Retinoids are also contraindicated for pregnant and breastfeeding women due to potential teratogenic effects. In fact, the European Union (EU) plans to restrict the amount of retinol allowed in skin and body care products by November 1, 2025, due to concerns over skin irritation and systemic absorption. Face and hand products will be limited to a maximum of 0.30% pure retinol, and body lotions will be limited to 0.05% retinol.[]
Due to the above factors, researchers are increasingly exploring viable alternatives to retinol.
Natural Retinol Alternative
Bakuchiol
Origin Psoralea corylifolia Bakuchiol is a plant-derived ingredient that works by regulating retinoid response genes in the skin that are involved in collagen production, hyaluronic acid synthesis, and skin moisturization. Furthermore, bakuchiol has no effect on the genes that code for RARs (responsible for the irritating properties of retinoids).[]
Other notable benefits include its antioxidant, anti-inflammatory and antibacterial properties.[] A small study of 44 participants found that bactiol was just as effective as retinol on fine lines and skin tone, but was less irritating.[] In another study, 12 weeks of bactiol therapy produced significant improvements in fine lines, wrinkles, firmness, elasticity, pigmentation, and photodamage.[]
Most other studies on bakuchiol have been done on skin cells or substitutes rather than humans, limiting evidence of its effectiveness.
review Skin Health and Disease We highlight some of the retinoic acid alternatives from the plant kingdom that have demonstrated efficacy in test-tube studies.[] Leading candidates include squalene (derived from olive oil and marine microalgae) and phytol (derived from a South American herb). Bidens pilosa).
Other options include pimaric acid, pimaradienoic acid, and abietic acid, which AraliaIt grows in Korea, Japan, and eastern China. The best thing about these natural, plant-based retinol alternatives is that they are all available over the counter.[]
Rosehip Oil
Rosehips are a natural source of trans-retinoic acid, along with B-complex vitamins and vitamin C. Although it contains less retinoic acid than prescription medications, it has been shown to be effective at reducing collagen breakdown. A randomized controlled trial showed that taking 45 grams of rosehip powder orally daily for eight weeks significantly reduced crow’s feet and improved skin elasticity and hydration.[]
Research on oral alternatives
Oral retinol
Some retinoids are available as supplements, such as the rosehip powder mentioned above. Oral retinol (vitamin A1) has been shown to provide similar anti-aging benefits as topical retinoids, but due in part to the fact that oral vitamin A and natural alternatives have not been well-studied, the topical version remains the gold standard for reliable anti-aging benefits.
However, certain patients can benefit greatly from oral retinoids.
In a 12-week randomized trial, cosmeticsIn patients with moderate to severe facial skin aging, topical retinoic acid gel combined with oral vitamin supplements (vitamin A 50,000 IU and vitamin E 50 mg daily) produced greater improvement, without any apparent adverse events, than did topical products alone or oral supplements alone.[]
Other oral retinoids, such as isotretinoin, acitretin, and bexarotene, have limited evidence of anti-aging effects, and one study found that low-dose isotretinoin was not superior to 0.05% retinoic acid for photoaged skin.[]
Furthermore, due to teratogenic risk (category X) and effects on the musculoskeletal system, liver, and lipid profile, its use is not recommended unless for the treatment of systemic conditions such as severe acne, hidradenitis suppurativa, psoriasis, and mycosis fungoides.
How to Advise Patients About Retinol Use
Topical retinoids are a great option for patients interested in anti-aging. Doctors can consider the following before prescribing or recommending a retinoid:
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Before recommending retinol, assess the patient’s skin type, sensitivity, and pregnancy or breastfeeding status.
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Patients with sensitive skin or new to retinol should start with a lower concentration, usually 0.01% to 0.05%, used once or twice a week, gradually increasing the concentration and frequency of use as tolerance develops.
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Monitor for signs of irritation and adjust accordingly.
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Combining retinol with moisturizing and soothing agents like hyaluronic acid and ceramides can help reduce irritation and boost the skin’s barrier function.
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Advise patients to only apply retinol at night and not mix it with other active ingredients such as AHAs or BHAs, although retinol can be used in combination with azelaic acid for patients with acne or hyperpigmentation.
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Retinol increases photosensitivity and the risk of retinoid dermatitis, so continued photoprotection is required during the day.
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For patients who are sensitive to retinol or for whom retinoids are contraindicated, bakuchiol can be considered due to its gentle nature and safety during pregnancy.
Patients interested in oral supplementation can be encouraged to include milk, eggs, and liver in their diet, which are rich in retinol and dehydroretinol (vitamin A2).
What this means for you
Treating aging skin is about improving it, rather than completely reversing it. As the skin care industry evolves, it is increasingly important to stay informed of new research and new ingredients. Although retinoids remain the gold standard in anti-aging due to their proven effectiveness, no anti-aging skin care routine is complete without photoprotection (daily sunscreen) with a moisturizer, as these steps reverse and prevent premature skin aging.
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