Confusion about Retin-A and thinner skin
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free skin care · Wed May 28, 2008 1:31 pm

There have been some questions on this forum lately about Retin-A (tretinoin) and thinner skin as a possible unwanted effect from long term use. Being a Retin-A debutant myself I would like to know if this is a risk.

Scientific studies back up the claims that Retin-A is capable of reverse signs of aging by erasing fine lines and increasing collagen production in the dermis. Retin-A has been offered as an anti-aging on prescription for nearly 30 years, and no other skin care product has got similar scientific backing.

The initial side effects are redness, irritation and flakiness. As no studies on possible side effects of long term use have been accomplished, I have not been able to find any warnings from medical expertise about long term/permanent thinning and fragility of the skin from Retin-A.

On the contrary, dermatologists are frequently recommending and prescribing tretinoin for anti-aging purposes, and FDA trials suggests that you can continue to use Retin-A for a lifetime to maintain the benefits.

I have read numerous testimonials both on this and other forums from long term users who are very satisfied and told this cream has taken years off their face. BUT some users have experienced thinner, more fragile skin from the use of Retin-A. The cream works by increasing cell turnover and thinning the few top layers of the skin. Collagen production increases and thickens the inner layers of the skin. I have been wondering how a proven collagen builder can cause thin and fragile skin in some women's skin.

I found this review on Smartskincare from a woman who experienced thinner skin and more wrinkles after one month of use. Perhaps she has got a point in this review (quote):

While some skin may answer the call for repair, low levels of Human Growth Hormone and other chemicals important to skin growth may be limited in older and damaged skin. So in the end, thinning the skin may not result in creation of new collagen - just thin skin. And thin skin wrinkles easily.

http://www.smartskincare.com/reviews/product/antiaging_cream_na_retin-a_20040105.html

The women on EDS forum who have been combining Retin-A with dermarolling (collagen-induction therapy with needles) have generally reported great results as thicker skin and less wrinkles. I intend to choose this route as it seems to be a winning combination.

Any views on these theories? Any input is appreciated. Smile

Wed May 28, 2008 4:05 pm

I have had concerns about dark under-eye circles in the past, and I have seen a doctor about what can be done to help.

The doctor gave me a prescription for Retin-A creme to apply to under-eye area in the evening, before bedtime.

-I had used it probably for about a month or so, and have noticed it make my under eye area a bit red. Over time, I had noticed it had thinned out the delicate skin under my eyes, and took away some of the elasticity from the skin. I did not see much difference in the darkness of my under-eye.

-Mind you, I am only 24 years old and my skin is supposed to 'spring back' as my collagen production is not supposed to have slowed down that much.

-I found it made my under eyes more hollow, so I don't recommend using it for that particular region...I am unsure of its effectiveness on other regions of the face.

free skin care · Wed May 28, 2008 4:13 pm

I can say yes it thinned my skin. I went to a new derm for redness and breakouts and he asked me what I was using since my skin was so thin. When I said the only thing I used for a few months was retin-a he told me to stop immediately. He diagnosed me with rosacea and told me to use only gentle products on my face. Now I know you'll get different opinions on the subject, but this is what happened to me. So I guess everyone's different.

free skin care · Wed May 28, 2008 4:25 pm

I've read, many times, that often skin will look worse for several weeks/months before it looks better, this includes skin looking more wrinkled, flaky, or irritated (or broken out if you are using for acne).

I think if you treat your skin gently and protect your skin during the day with a stable sunscreen, that you can use retin-a and like products with out damaging your skin (but this does not mean you wont have initial irritation when you first start).

Its important to start off slowly using retin-a, don't just start using nightly, start off a few times a week and work your way up to nightly or every other night. The nature of these products is to irritate the skin to exfoliate from the inside outward.

I read the article you posted. I think it was bad advice to (1st) start off with .1% (2nd) use nightly from the start. I would also like to know if she used sunscreen.

And of course there will always be some that retin-a just doesn't work great for. I'm one of them but tazorac is great for me.

I think this is a pretty good article on retin-a:
http://www.postgradmed.com/issues/1997/08_97/kligman.shtml

HTH.

free skin care · Wed May 28, 2008 6:18 pm

What a great thread! It's really good to have a balanced discussion of pros and cons of any treatment. I think practically any radical treatment that claims to reverse and not just prevent damage will carry some amount of risk. It's up to you to weigh the risks with the potential benefits and decide if it's something you're willing to do as this point in your life.

free skin care · Thu May 29, 2008 7:22 am

This thread hits home with me. I'm so flippy floppy about retin-a. I'll read an article about the benefits and start using it again. Then I think my skin is thinning and quit. Then start again, and quit. It's a terrible cycle for me! Brick wall

I've finally decided (this time) to use it twice a week.
I did read on Paula Begon's (SP) web site that niacinamide is supposed build the skin barrier so I started using that. It's the Oil of Olay products. Maybe this will help counteract some of that thinning.

free skin care · Thu May 29, 2008 8:33 am

Yes, i am confused too..I already ordered Tretinoin 0.025g. But I am hesitating now whether cancelled it or not...I read a lot of scary opinions from this forum..(Actually these days I research about this Retin A cream since I ordered and I got worried) I don't know..what to do... Shock

Thu May 29, 2008 9:03 am

Most of the negative comments I have read about retin-a were written by people who used the product for a short time only (ranging from 10 days to a month or so), or who used too strong of a dose too frequently. Retin-a does make your skin worse for a period of time and it takes months for your skin to adjust to it - mine is still adjusting after 8 weeks. I have also heard from a nurse/skin care specialist that her skin never adjusted to the .1% retin-a, but does fine on the .025%. I am much more likely to trust opinions based on proven medical evidence than those of folks who used the product incorrectly, and unsupervised.

free skin care · Fri Aug 08, 2008 5:08 am

According to a study I found on PubMed: Yes, Retin-A does cause thinning of the skin.

The study "Effect of myristyl nicotinate on retinoic acid therapy for facial photodamage" from Nov 2007 is based on the hypothesis that skin barrier impairment is a contributor to side-effects that are associated with retinoic acid therapy. Retinoic acid seems to be causing thinning of the upper layers of the skin, stratum corneum.

Quote:
Analysis of skin biopsies revealed that retinoic acid therapy resulted in stratum corneum thinning of approximately 25 %.

The study shows that myristyl nicotinate (MN), a lipophilic derivative of niacin (as found in f. ex. NIA24) may counteract some of the negative effect of retinoic acid.

Quote:
These results show that prior and concurrent use of MN can mitigate barrier impairment and improve the tolerability of retinoic acid therapy for facial photo damage without interfering with efficacy.

http://www.ncbi.nlm.nih.gov/pubmed/17927576

free skin care · Fri Aug 08, 2008 6:22 am

SeptemberGirl

I have read that the stratum corneum is the outer most layer of our skin - the one that sheds old cells naturally. What retoinic acid does is speed up that process for us - to get rid of the fine lines in that layer and the damaged skin.

free skin care · Fri Aug 08, 2008 7:04 am

Septembergirl, almost everyone out there advises exfoliation to remove the dead skin cells (and thin the stratum corneum), whether they are using AHAs, BHAs, etc., so I think Retin A is not alone in that regard.

However, RA definitely has positives that other products don't (see study below). But I do think that it needs to be used responsibly...most people jump in and use it every day because they think more has to better, but that is not the case with RA.

Two times a week is my norm, and I am now combining that with dermarolling and 302 Protein Drops to ensure that my epidermis stays as thick as possible.

Quote:

Loss of elastic fibers causes skin wrinkles
in sun-damaged human skin

3. Results

3.1. Correlation between elastic fiber
reduction and wrinkle severity in
chronically sun-damaged facial skin

3.2. Restoration of elastic fibers in
photoaged skin by topical retinoic acid
treatment

3.3. Positive correlation between elastic
fiber regeneration and wrinkle
improvement in RA-treated skin

In this study, we quantified the newly regenerated oxytalan fibers after 24 weeks of RA treatment and this regeneration with wrinkle severity. The topical application of RA reduced wrinkle severity significantly and also increased the lengths, widths, numbers and total areas of tropoelastin- and fibrillin-1-positive oxytalan fibers in photoaged facial skin. Interestingly, we found a strong positive correlation between the lengths of oxytalan fibers regenerated by 24 weeks of topical RA treatment and reduced wrinkle severity in photoaged facial skin. In general, the working model of photoaging (wrinkling)and restoration effect of RA treatment has been resolved by the change of the amount of collagen in dermis [3—6]. However, our results suggest that disruption of the elastic fiber network can cause skin wrinkling, and that the regeneration of the elastic fiber network by RA reduces wrinkle severity in photoaged skin. Therefore, wrinkle formation may be a composite results of both elastic and collagen fiber disintegration.

free skin care · Fri Aug 08, 2008 7:46 am

Thanks for your replies, foxe and bethany.

I started using Retin-A recently because I am also convinced about all the positive effects from using it, erasing lines, improving the growth of collagen and elastin etc.

I am a little worried, though, to see that retinoic acid therapy results in 25 % thinning of the stratum corneum (outermost layers of the skin), which may lead to more "translucency" and visible capillaries, as far as I can understand.

It's obviously a good idea to use products with barrier strengthening ingredients (f. ex. niacinamide) when using Retin-A.

free skin care · Fri Aug 08, 2008 11:23 am

Septembergirl, this is a great thread!...

While I was at PubMed, looking at the link you provided above, I started browsing around and came across information comparing Tazarotene 0.1% versus Retin-A 0.5% for photodamaged skin.

It seems, if I understand it correctly, that the Tazarotene offers superior results, and one of the side bar 'related' articles, goes so far as to say it thickens the stratum corneum by 70%.

Here's the link. Also check out the 'related topic' links;

http://www.ncbi.nlm.nih.gov/pubmed/15203997?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

I don't recall seeing any topics here about Tazarotene, but it definitely sounds interesting. Or maybe I've just missed it.. Rolling Eyes

ETA: Is Tazarotene in any relation to Tazorac?

free skin care · Fri Aug 08, 2008 9:48 pm

tazoratine is the same as Tazorac (generic name)

I've used Tazorac for years - 15 I think - for acne. (just switching to Retin A Micro now)

It is known to be stronger than Retin A (benefits are about the same, tho)

I'm switching bcz my derm thinks the Micro will give me less oily skin (I am hyper-oily).

I've used retinoids for at least 17 years for acne. I do not have the typical concerns most have using them - thinner skin, sun sensitivity. I believe those things wear off and your skin adjusts. I do remember, when I first started on Retin A, that I was told not to put it near (under) my eyes - that the skin was too thin there and it would thin THAT skin.

It does thin the outer most layer - but that's the one you want to thin. That's the one that needs to shed. And it will rebuild.

I have very few (if any) wrinkles. The aging my skin shows (for my 50 years) is facial fat loss/loss of elasticity. I do not look my age. Using retinoids all these years (in addition to not being one who's face would tan) helped me w/ this.

free skin care · Fri Aug 08, 2008 11:23 pm

On my part, I weighed the pros and cons on what I've read about RA and I decided I wanted to go the RA-route. Not right now, but soonish.

I really appreciate this thread.

I like that you ladies encourage skepticism and a balanced discussion.

free skin care · Sat Aug 09, 2008 2:54 am

Just to clarify: My concerns are about long-term/permanent thinning of the skin from Retin-A. I believe that most of us know that all acids, like AHAs and retinoids, will exfoliate and remove dead skin cells from the outer layers. What I don't want, is the look of a thin and fragile skin.

Kassy_A, interesting study on tazarotene. I know that some people alternate the use of Retin-A and Tazorac because they believe it gives the best anti-aging benefits. Tazarotene is apparently selective in what cell receptors it activates so that tretinoin and tazarotene might benefit the skin in different ways. There are some technical explanations about this that I don't quite understand, as my brain cells seem to be shedding, too. The studies on tazarotene are promising, and I think I will try it out some time.

free skin care · Sat Aug 09, 2008 9:35 am

Septembergirl wrote:

My concerns are about long-term/permanent thinning of the skin from Retin-A. What I don't want, is the look of a thin and fragile skin.

Kassy_A, interesting study on tazarotene. I know that some people alternate the use of Retin-A and Tazorac because they believe it gives the best anti-aging benefits. Tazarotene is apparently selective in what cell receptors it activates so that tretinoin and tazarotene might benefit the skin in different ways. There are some technical explanations about this that I don't quite understand, as my brain cells seem to be shedding, too. The studies on tazarotene are promising, and I think I will try it out some time.

I was very surprised to read in one of the studies that Tazarotene was 'more' effective than Retin A. One of the studies I saw was for 2 years, and the Tazarotene actually increased the thickness of the stratum corneum by up to 70%.

Alternating the two products might be the best of both worlds!

free skin care · Sat Aug 09, 2008 11:32 am

This is a very interesting thread and I am glad it was started.

About three years ago I stopped using Tazorac or Renova. I found a skin care line Elysse that short term really helped my skin glow (they have an oxygen product that is wonderful) and just the overall appearance of my skin looked great.

However, during the last year I started developing creepiness on the tops of my cheeks and my nasolabial folds were really becoming pronounced. This was not what I wanted to happen.

So now I have changed my skin care routine. I am back using Tazorac and Renova 3 times a week. What really helped my lines in my cheeks was Remergent DNA repair. And the Nasolabial folds well the answer was Radiesse.

And also for thinning skin there is the product from Isomers Advanced formula with Essenskin. Need to do more research on this product or if anyone else has information please post.

free skin care · Sat Aug 09, 2008 5:29 pm

This is a little OT but I have been thinking about going down the retinol route and am concerned about the breakouts that can happen initially.
Can anyone tell me more about this? I mostly break out around my chin area, so am I able to just apply the retinol product to certain areas rather than the whole face?
It is my eye areas and forehead that I have in mind for using retinol.

free skin care · Sun Aug 10, 2008 3:54 am

sal-star wrote:

This is a little OT but I have been thinking about going down the retinol route and am concerned about the breakouts that can happen initially.
Can anyone tell me more about this? I mostly break out around my chin area, so am I able to just apply the retinol product to certain areas rather than the whole face?
It is my eye areas and forehead that I have in mind for using retinol.

It should not be a problem using retinol only on your forehead and around your eyes (avoid eye lids).

I have not heard or experienced myself that retinol is likely to cause breakouts initially, but I am sure that can happen to some people. The skin around the eyes has got very few sebaceous glands, so breakouts would scarcely become a problem there, but the skin can get red and irritated.

I believe the only way to minimize reactions, is to introduce retinol gradually by starting out with application twice a week and gradually work your way up to be using it every night.

free skin care · Sun Aug 10, 2008 7:12 am

bethany wrote:

Septembergirl, almost everyone out there advises exfoliation to remove the dead skin cells (and thin the stratum corneum), whether they are using AHAs, BHAs, etc., so I think Retin A is not alone in that regard.

However, RA definitely has positives that other products don't (see study below). But I do think that it needs to be used responsibly...most people jump in and use it every day because they think more has to better, but that is not the case with RA.

Two times a week is my norm, and I am now combining that with dermarolling and 302 Protein Drops to ensure that my epidermis stays as thick as possible.

Beth is right about frequency. Many people use retin-A, retinols and retinoid way too often. Especially with Retin-A, 2 or 3 times a week should be the max. You are thinning the epidermis each time you apply it, and causing more potential for more sun damage that way. Even sunscreen will not prevent that totally. Vitamin A derivatives have been studied for a long time and are documented to help repair DNA damage, build new capillaries, even out skin tone, and help with acne. But it also has the potential to cause damage if overused, that is, the thinning, drying, and sun damage.

Also, as you age, your repair function slows down. You notice how young kids wounds heal so quickly. When you are over 30, this slows down considerably. The metabolism of the skin slows, just like your overall body does. So if you are exfoliating your skin, thinking it will kick start the repair mechanism, keep in mind it may take longer (or may never happen) because the skin is too depleted from any number of things, including environmental damage (sun), medication side effects, poor skin health, and cannot respond very well.

It's far better to preserve the epidermis as much as possible and try to improve how your skin functions through correctly using topicals, supplements, and diet.

free skin care · Sun Aug 10, 2008 8:19 am

boski wrote:

Beth is right about frequency. Many people use retin-A, retinols and retinoid way too often. Especially with Retin-A, 2 or 3 times a week should be the max. You are thinning the epidermis each time you apply it, and causing more potential for more sun damage that way. Even sunscreen will not prevent that totally. Vitamin A derivatives have been studied for a long time and are documented to help repair DNA damage, build new capillaries, even out skin tone, and help with acne. But it also has the potential to cause damage if overused, that is, the thinning, drying, and sun damage.

Also, as you age, your repair function slows down. You notice how young kids wounds heal so quickly. When you are over 30, this slows down considerably. The metabolism of the skin slows, just like your overall body does. So if you are exfoliating your skin, thinking it will kick start the repair mechanism, keep in mind it may take longer (or may never happen) because the skin is too depleted from any number of things, including environmental damage (sun), medication side effects, poor skin health, and cannot respond very well.

It's far better to preserve the epidermis as much as possible and try to improve how your skin functions through correctly using topicals, supplements, and diet.

I think the reason why many people prefer products with retinoic acid, is that retinoic acid has been shown in countless studies to be far superior to retinyl palmitate in combating signs of aging.

Retinyl palmitate is the least effective vitamin A derivative that's used in skin care products. As mentioned on this board many times before, it has to go through three steps to convert to retinoic acid in the skin:

Retinyl palmitate => Retinol => Retinaldehyde => Retinoic acid

Quote from Smartskincare.com:

The overall rate of conversion of retinol to retinoic acid is low and that of retinyl palmitate is lower still. Therefore a relatively large amount of retinol and even larger of retinyl palmitate needs to be delivered into a cell to boost retinoic acid levels and produce clinically meaningful effects...

The products with high concentrations do exist but may still not deliver the purported benefits for a number of reasons. In particular, a product with highly concentrated retinol may cause skin irritation, especially in people with sensitive skin. Highly concentrated retinyl palmitate is less irritating than retinol (at equivalent levels), but is also less effective...

Considering all these caveats, how should one use retinol/retinyl palmitate products (if at all?) As of the time of this writing, research indicates that the most reliable way to get all the skin rejuvenation benefits is to actually use retinoic acid, a.k.a. tretinoin.

http://www.smartskincare.com/treatments/topical/retinol.html

I believe that products with retinyl palmitate might be a good alternative for those with sensitive skin who experience irritation and other side effects from retinoic acid or retinol.

free skin care · Sun Aug 10, 2008 5:14 pm

Septembergirl wrote:

sal-star wrote:

This is a little OT but I have been thinking about going down the retinol route and am concerned about the breakouts that can happen initially.
Can anyone tell me more about this? I mostly break out around my chin area, so am I able to just apply the retinol product to certain areas rather than the whole face?
It is my eye areas and forehead that I have in mind for using retinol.

It should not be a problem using retinol only on your forehead and around your eyes (avoid eye lids).

I have not heard or experienced myself that retinol is likely to cause breakouts initially, but I am sure that can happen to some people. The skin around the eyes has got very few sebaceous glands, so breakouts would scarcely become a problem there, but the skin can get red and irritated.

I believe the only way to minimize reactions, is to introduce retinol gradually by starting out with application twice a week and gradually work your way up to be using it every night.

Thanks for your reply Septembergirl Smile

I will definitely start slowly and just work with those two areas initially...

free skin care · Sun Aug 10, 2008 8:06 pm

boski said

You are thinning the epidermis each time you apply it, and causing more potential for more sun damage that way. Even sunscreen will not prevent that totally. Vitamin A derivatives have been studied for a long time and are documented to help repair DNA damage, build new capillaries, even out skin tone, and help with acne. But it also has the potential to cause damage if overused, that is, the thinning, drying, and sun damage.

boski

retinoids will thin the stratum corneum which is the outer most layer of the epidermis. this is the layer that sheds the older skin continually. the retinoids help to speed that process up and are beneficial for that use. people can have problems w/ sun damage while using these products, but most people's skin adjusts to it's use and do not experience sun sensitivity for very long. precautions should be taken during this period.

I, for one, do not experience sun sensitivity at all and I've been a retinoid user for 17 years. my face does NOT have sun damage on it-(I turn 50 this year). no wrinkles, rough texture, sun spots or pigmentation - none of that.

I use my retinoids on a daily basis, but I use them for acne. for other use - it's not a bad idea to go on a maintenance schedule of 3X/wk after you've used them for a few months. you'd like to build up to them slowly, use for a while, then go on maintenance.

free skin care · Sun Aug 10, 2008 8:49 pm

Foxe, I think you may be the rarity there with no sun sensitivity (I'm JEALOUS!)

I have used Retin-A on and off for about 12 years (mostly on), and got FRIED today. I was wearing SPF 70 and just ran in and out of 4 stores...NO lingering outside at all. Oh, and I had taken 2 Helioplex too!

Tonight I look like Lobster Girl. Sad

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