I have a ton of videos on them and it is widely established that retinoids are a topical skin care ingredient that can go to work to improve the visible signs of skin aging, especially those that are caused by uv exposure. Fine lines model pigmentation now retinoid, is sort of an umbrella term for a few different types of retinoids of different generations were not going to delve into all that in this video for simplicitys sake, when i say retinoid, we are talking about the golden child, tretinoin retinoic Acid kind of the gold standard when were talking about topical retinoids that have been shown and have a lot of data behind them for improving the visible signs of skin aging but theres an issue. If youve ever used topical tretinoin, you know it can be pretty irritating for some patients. They simply do not tolerate it and therefore its just not a good option for them. It can be very drying and irritating a lot of people get used to that. It goes away after a few weeks, but for some people they just never get over that hurdle. So theres a lot of interest in retinoid precursor ingredients here in comes the ingredient retinol now retinol, unlike tretinoin, is something you can buy in the store. Theyre, a dime a dozen there are thousands of retinol products, creams serums. What is retinol retinol is a precursor of the active form of retinoid or treadmine. Basically, it undergoes serial conversion in the skin to retinoic acid.

The active form, which is what tretinoin is so your skin, has to do some work on. It ends up being a lot less irritating than tretinoin, but there is some evidence that retinol can serve as an alternative to retinoic, acid or tretinoin for improving the visible signs of skin aging and ive got videos on this channel going over my top retinol recommendations so Make sure you check those out, but as with any cosmetic ingredient, we are always kind of left to the mercy of the manufacturer. There arent a lot of studies on over the counter cosmetic products to say, which ones really are the best. Its got to be something that not only has biologic plausibility for efficacy, but you actually have to show that it gets into the skin and triggers the cascade of events. That leads to the objective and in this case its going to be improvement of fine lines and wrinkles. Unfortunately, because retinol is a cosmetic ingredient manufacturers, they dont have to demonstrate any of this. So when people ask me what are the best retinols, i try and go with those that at least have some literature, but its often very hard to come across literature backing these up. But weve got a new paper out that actually takes a look at an over the counter retinol product and compares it to the golden child tretinoin. This is a paper that came out this month in jama. Dermatology now jama.

Dermatology is a journal that publishes dermatology research and papers, but one thing about jama: dermatology is its actually one of the most influential dermatology journals. It has a high impact factor, theyre, pretty strict about the quality of papers that they accept and subsequently publish. This paper was an exploratory randomized controlled trial, comparing the efficacy of a retinol with tretinoin renova youve, probably heard of it contains a 0.02 percent tretinoin. What i like about this study is: not only are they comparing in a blinded fashion, meaning the subjects dont know what product theyre getting and the clinicians doing the measurements dont know who got one, but what i also like is not only is this looking at how Much their wrinkles improved just looking at the skin, but this paper they actually took skin biopsies and later did some analysis to confirm that biomarkers were activated. That suggest that the retinol in the product is actually getting into the skin and doing what its supposed to do. This study was very small, was conducted at a major institution in baltimore maryland and they aim to enroll patients over the age of 35. They excluded patients who had been on a retinoid by mouth, like a accutane in six months, leading up to the study or patients who had been using a topical retinol or retinoid, or salicylic acid or lactic acid or a polyhydroxy acid. Any time in the three months leading up to the study, if youd used one of those you couldnt be in it because those ingredients they have some anti aging benefits.

Obviously, they really tried very hard to get patients of all phototypes, but at the end it really ended up only getting patients who are skin phototypes, one through three, so basically caucasian. They measured improvement in terms of the signs of skin aging at baseline and then at four weeks, 12 weeks, 18 weeks and 24 weeks. They took both digital photographs and they did in person evaluation. Not only are they looking for degrees of photo damage, but theyre. Also, looking for signs of irritation, including redness, swelling dryness peeling. At those time points, they also asked the patients about their subjective feelings about the product that they think it was working and they also measured adverse effects at these time points now, as far as the skin biopsies, they took a biopsy at the very start of the Study before anybody had started any topicals and then they repeated the biopsy at the end of the study, which was at 24 weeks or six months at the end of the study, there was no statistically significant difference between tretinoin and the retinol product, but not surprising. Those who receive tretinoin showed redness six times more frequently than those who received the retinol product, meaning the retinoid was more likely to be causing redness for the people in the study in comparison to the retinol and again thats, not necessarily surprising. However, other signs of skin irritation were no different between the two groups. Keep in mind. The participants have no idea what they are getting.

They dont know if theyre getting tretinoin renova or, if theyre getting the retinol product at the end of the study. Eighty nine percent of those who got the retinol said they would keep using it, whereas seventy three percent of those who got trinoa and said they would happily continue using it. So thats not a huge difference between the two, but importantly, the biopsies that were taken. They then looked at biomarkers of retinoid activity, and they showed that both the retinol and tretinoin showed evidence of activation of one of one of the main markers. That is a clue that the pathways are being activated, and that is expression of something called crab bp2. That is a clue that the retinoid receptor is engaged and that the ingredient obviously got into the skin and is doing what its supposed to do. Basically, both are functionally activating the retinoid receptor signaling that later on is going to presumably lead to skin benefit which, as a reminder, they did show improvements between the two groups that were comparable in terms of improving fine lines and the skin signs of photo damage. Now one of the goals of using a topical retinoid is its been shown to improve collagen synthesis. Thats thought to be why you get an improvement in wrinkle, smoothing and interestingly, neither group really showed much of an improvement in type 1 collagen synthesis. Now there are enzymes that get activated to chew up your collagen, like when youre exposed to ultraviolet radiation, theyre called matrix metalloproteinases.

There are a variety of different types of them, theyre numbered and they looked at a few different types of matrix metalloproteinases. They showed that the retinoid or tretinoin suppressed matrix metalloproteinase 9 activity, whereas the retinol did not. Interestingly, retinol suppressed the expression of matrix metalloproteinase ii, which is known to chew up a different type of collagen, specifically its known to chew up a type of collagen called type 4 collagen, which is right at the junction between the epidermis, the top part of the skin, And the dermis, and what also was interesting, was that the degree of suppression of matrix, metalloproteinase, 2 activity was actually correlated with the degree of clinical improvement in the retinol group kind of suggesting that its suppression of this enzyme. That leads to wrinkle smoothing, at least in those getting a retinol, something that has always been appreciated, clinically think of it as a clinical anecdote is that people who have more severe wrinkling at baseline before starting tretinoin or retinol, they tend to have a more striking response. They get better wrinkle smoothing, provided they tolerate it. This study actually showed that those people in the study who had more prominent fine lines at baseline, they got the best results from either retinoid or retinol. So, at the end of the day, this study shows that both retinol and tretinoin can improve the visible signs of sun damage to the same extent, and there are biomarkers showing that both retinol and retinoid actually get in the skin.

Activate these markers to show that theyre doing their thing and those whose wrinkle severity is greatest at baseline are going to have the most striking improvement compared to those who, maybe just have mild to moderate wrinkle severity. Now, at the beginning of this video i explained to you all, i reminded you all that retinol has to be converted to the active form. Retinoic acid, in your skin, its a two step process, not everyones skin, is going to make that conversion to the same extent, and so one person may be more efficient at that conversion and they may get better results from a retinol, whereas other people may not. You know be as efficient. Maybe they see better results with tretinoin or retinoic acid, which is already in that active form. That being said, the retinal product that they use in the study had 1.1 retinol, so lets say, for example, you are really really good. Your skin, like just converts all that over to retinoic acid thats, going to be a 1.1 retinoic acid. In contrast, the actual retinoic acid product that they use that they compared it to renova has 0.02 percent, so in other words, the retinoic acid equivalents are technically possibly greater in the retinol product in comparison to the prescription products, so that that may explain some of the Discrepancy i mentioned already that i really like that this study, not only was it randomized controlled blinded, but i also like the fact that they actually took biopsies and confirmed that the biomarkers of retinoid activity are in fact there.

But some of the limitations are that its very, very small and that they did not control for the vehicle, meaning the other stuff in the product. Besides the retinol, they didnt compare the vehicle effects and thats important, because renova does not have the same other stuff in it as the retinol product that they used in the study. All of these things could explain the fact that the retinol caused less redness in that group. Interestingly, though, the other signs of skin irritation were not strikingly different between the two groups. Another major limitation, aside from it being small, is that while they tried to enroll all skin types, they only got skin types one through three, so they didnt get any any patients who are skin of color, so theyre, basically just evaluating clinical improvement in caucasian skin and Therefore, how generalizable these results in this very small study are to skin of color, which reacts very differently to uv to sun. In terms of you know, hyperpigmentation is much different. So to what extent these results are generalizable to the populations with skin of color. You know you cant, you cant, really say that ive been holding out on this for a while, because i didnt want to blur your vision too much. But what the heck is the retinol product that theyre, using sometimes they dont disclose, but in this paper they actually did and it is from skin medica. The advantage of using a retinol is that you dont have to go in and get a prescription and have it filled if you are using a topical retinoid for anti aging purposes.

Insurance is not going to cover that unless youre using tretinoin for acne or a medical condition, insurance is not going to cover it, so you are going to be paying out of pocket regardless. The skin medica product costs about 80 and you dont have to you know check in with your derm to have it refilled. You can buy it online on their website. Now, of course, many dermatology offices distribute it sell it in their office heres, something i need to point out that many people will have issue with, and that is. This study was funded by skin medica and anytime. There is a funding source, it calls into question. Is there potential bias, in this case its definitely worth considering that as a potential source of bias? However, skin medica was not involved in the study design, the collection of the data, the evaluation of the data, and this paper was published in a pretty top tier dermatology journal and in order for it to be published, it had to undergo peer review. So other. You know dermatologists had to critique the science and its not as though the funding source is going to influence the mrna results. That told you that the biomarkers were activated still worth pointing out, but i wouldnt chalk it all up to. Oh, this was funded by skin medica, so its you know there goes this credibility um. I think it has much less of an impact than you might actually think its not like.

If you went to skin medicas website – and they showed you a paper saying in our clinical studies, 90 of participants had an improvement in wrinkles and fine lines in you know six weeks or whatever um its, not its, not the same as that. This is a more rigorous way and a more unbiased way of evaluating the the product and it compares it to the standard of care. Treadmill, theyre, taking biopsies theyre, doing molecular analysis and its being peer reviewed by an outside source, its randomized and theres, blinding. That goes on so theres a lot more complexity to the way the study was done than just a plain industry study where you do have to question. To what extent the results are you know perhaps being influenced or the study design is influenced by the fun by the the source of funding all right yall, so that is the new update. Basically, this is a paper in a very credible journal and dermatology, showing the efficacy of an over the counter retinol comparable to prescription tretinoin for the improvement of the visible science of skin aging. This is a product that, if you had asked me prior to the study, what i recommended, i would say – well theres nothing about it. That makes me think it is any more convincing than the retinols. I typically recommend, but now that we have this paper at least showing that it gets into the skin, it activates the markers of retinoid activity and theres clinical improvement in the visible signs of photo aging.

I can actually recommend this product as a as a retinol, so skin medica, you know its one of those that markets itself as medical grade, but in this case at least with their retinol. There is now a pretty good paper demonstrating efficacy of their retinol. So i feel pretty confident that if you chose that you would at least be getting the benefits of a retinol and, according to you know, per this study, although its got its limitations, which we mentioned, it does appear to yield results. I will point out, though, a lot of the reason why people pursue retinol is that tretinoin can be pretty irritating and to what extent. This is going to be less irritating for you in comparison to tretinoin im, not completely convinced, because the only the only difference was less redness in the skin medica group dryness peeling that sort of thing they were comparable between the two anyways. You guys. Let me know in the comments if youve ever tried the skin medica retinol, if youre using it currently, what do you think about it? I hope to study and sharing it with. You was informative on the end slate im going to put a recent video where i review the uh skin, better science alpharette product, so check that out.