Advice on how to incorporate tretinoin and other retinoids into your routine (The Ordinary or otherwise).
This is a guide to incorporating tretinoin into your routine and how to alter your skincare to deal with the retinoid peelies. Retinoids are known to be the most effective skincare ingredient for treating sun related skin aging, acne and pigmentation. But because of their tendency to cause irritation and sensitivity to sunlight, they’re not that easy to get on with. But with a bit of extra effort anyone can use tretinoin, even those with sensitive skin.
The Ups and Downs of Retinoids
|Benefits of Retinoids||Downsides of Retinoids|
|Thickens the dermis and increases collagen over time||Peeling|
|Reduces pigmentation||Makes the skin more sensitive to the sun|
|Reduces inflammation and normalise skin turnover||Temporarily thins epidermis|
|Reduce wrinkles||Causes redness and soreness|
|Make skin smoother and more glowing||Not advised for those who are pregnant or breastfeeding|
|Help with blocked pores and acne||Isn’t very stable, breaks down under UV and artificial light|
|Can reduce stretch marks if used while they’re still red|
|Can help treat rosacea, skin precancer, eczema and psoriasis|
So, we know we want them, but because they cause side effects, there can be issues incorporating them into our skincare routine and there are a few things we must be mindful of. It can also be tricky getting hold of them. Dermatologist appointments are expensive and in the UK you will only get a prescription if your acne is very severe and if you’re female you need to be taking the combined pill. My GP won’t prescribe me any sort of topical retinoid for my acne because I can only take the mini pill, despite my pouting a lot. So here are all my tretinoin top tips…
- Types of Retinoid and what they each do and how to get hold of them
- The order of strength of the retinoids
- What is the ‘tretinoin peelies’
- Starting to use tretinoin
- Dealing with retinisation/peelies
- Which The Ordinary products can’t you use with retinoids
- Which The Ordinary products you should use with tretinoin
- How to put together your The Ordinary/tretinoin skincare routine
- Useful resources
Retinoids are related to vitamin A. In the skin (and in other places too) there are vitamin A receptors, called Retinoid Acid Receptors or RARs. There are different sorts of receptor and when a retinoid binds to them they make the skin cell behave differently.
The word ‘retinoid’ is the name given to the whole group of vitamin A derivatives- retinol, tretinoin, hydroxypinacolone retinoate, retinal, retinaldehyde… they’re all retinoids. Confusingly though, The Ordinary has called one of it’s retinoids Granactive Retinoid and we all refer to it as “retinoid”. Retinoids in general can be confusing, I know, I’ve broken it down to a couple of handy infographs for you to save.
Tretinoin binds directly to all the types of retinoid receptors and so has numerous effects on the skin, whereas other retinoids must be converted to retinoid by enzymes to have the same effect eg Retinol and some bind different receptors and have different effects eg Adapalene.
Retinoids are yellow in colour and oil soluble. They all cause irritation, to some degree, and all cause sensitivity to sun. So wear sunscreen, everyone should always wear sunscreen anyway!
Tretinoin is a prescription only drug (in the U.K. anyway) it comes in different strengths- 0.025%, 0.05% and 0.1% although you can get other percentages I’m sure. You can get tretinoin in an alcohol based gel (Isotrexin), a cream (Retin-A) and in microspheres (Retin-A Micro). Best to avoid the alcohol based one- it’s pretty drying.
Tretinoin, aka all-trans retinoic acid is the ‘strongest’ of the retinoids in that it binds all the receptors and there are no conversion steps. It is most likely to irritate the skin and cause peeling. There are a variety of ways to reduce the tretinoin reaction, I’ll go into those further down the page. Tretinoin is sensitive to sunlight and artificial light, so it is best used right before bed.
Tretinoin is prescription only, I get my Tretinoin from Dermatica, it’s an online dermatologist and it’s £19.99 for a monthly prescription. It’s a great service- all done online, you can cancel anytime and much cheaper than a private dermatologist appointment.
Also known as Retinaldehyde, this is a vitamin A aldehyde. It lies in between retinol and tretinoin in terms of effectiveness and irritation. It is available over the counter. It has anti bacterial activity to add to it’s list of positives. Retinal would be a fantastic ingredient for those looking to upgrade on their retinol without having to get a prescription. The only problem is that you don’t see it around much. I could only find it listed in a few very expensive products and it took me ages.
Retinol needs to be converted into retinoic acid (via retinal) in the skin in order to bind with the retinoic acid receptors. There are enzymes involved in this step. Enzymes are highly sensitive to pH, for this reason, you are better off not using retinol with strong acids like glycolic acid and vitamin C. There is some controversy about this (see Paula Begoun), but it stands to reason, in my view, that it is best not to combine acids and retinol. As well as the enzyme issue, acids can cause irritation.
Retinol has about 20% of the strength of tretinoin, because of the conversion step. Exactly what that means, I am not sure, does that mean you will get the same results only 20 times slower? Maybe. As with things skincare, I think the answer lies with the individual and the formulation. Retinol is meant to be less irritating than tretinoin, but some formulas are worse than others (remember The Ordinary’s old silicone based retinol?).
In a nutshell, retinol is effective against aging but less so than tretinoin. It is less irritating and easier to get hold of- you don’t need a prescription.
The novel retinoid that is the star ingredient of The Ordinary’s Granactive Retinoid. Hydroxypinacolone Retinoate is what they call an ester of all trans retinoid acid, which means that it has a very similar shape to the tretinoin molecule and can therefore link with all the retinoid receptors that tretinoin can without any conversion steps. Another benefit of Hydroxypinacolone Retinoate is that it doesn’t cause the same irritation or peeling as tretinoin or retinol. It is non prescription and freely available over the counter. It is more stable in light than retinol and tretinoin according to the manufacturer.
On the downside, there isn’t much quality evidence at the moment to compare Hydroxypinacolone Retinoate to other retinoids as either an anti aging or acne treatment.
The serum is called ‘Granactive’ after Tommy Grant of Grant Industries. In The Ordinary’s Granactive Retinoid Hydroxypinacolone Retinoate is formulated with Dimethyl Isosorbide and retinol to make a high strength retinoid product with less likelihood of irritating. We just need more studies on the stuff to compare it to other retinoids.
Another prescription only retinoid. This one only binds to certain receptors which means that it is likely to only be effective against acne and not aging or pigmentation. It’s a lot more stable and can be used in the daytime and with benzoyl peroxide. It is very non irritating, making it an excellent acne treatment.
Available with a doctor prescription and via Dermatica online dermatologist service.
Also prescription only. Tazarotene may well be more effective than tretinoin an adapalene at treating acne and possibly more effective than tretinoin at treating sun related aging. Tazarotene is more stable under UV light than tretinoin and can be used in the morning. It does have a tendency to cause more irritation than adapalene.
Available with a doctor prescription and via Dermatica online dermatologist service.
The Order of Strength of the Retinoids
We have only case reports and small non control studies to go by and therefore it is difficult to place Hydroxypinacolone Retinoate in order of strength.
In theory the strength of retinoids should go-
Tretinoin/All-trans Retinoic Acid > Tretinoin Esters > Retinaldehyde aka Retinal > Retinol > Retinyl/Retinol Esters
In terms of the effectiveness of anti aging skincare-
Tretinoin > Hydroxypinacolone Retinoate > Retinal > Retinol > Retinol Palmitate
But case reports and theory are not sufficient to make this conclusion and you have to go by your own skin’s response. If you’ve used retinol and your skin is accustomed to it and you want to move on, then try Hydroxypinacolone Retinoate next to see if you get more benefits and vice versa. There is no hard and fast rule on this- we basically just don’t have the evidence, Hydroxypinacolone Retinoate is so new. And good luck finding an affordable Retinal product, let me know if you do.
Tretinoid Irritation aka Peelies aka Retinisation
Tretinoin peels is what happens two to three days after your skin has been exposed to a hefty dose of an irritating retinoid like tret or retinol. I usually get it two days after I have applied too much and I look in the mirror in passing and notice some of my face coming off. It’s only the top layer of skin, but it looks a bit strange. You might also get stinging, redness, itching and soreness when applying products. Some unlucky people get blistering and swelling, this is unlikely.
Tretinoin peelies isn’t the same thing as the soreness you get when you over exfoliate. It’s something you have to get to the other side of to reach retinoid good skin nirvana. You may get ‘purging’ also.
Note- I’m going to refer to tretinoin a lot here but I really mean any retinoid as they can all cause the same sort of irritation.
Purging is a somewhat mysterious condition. I think it might be a myth designed to keep us guessing. It’s the idea that ‘a retinoid or an acid increases skin turnover and pushes all the badness to the surface’. I don’t know if I truly believe that skin poos out all the evil and then becomes good. It may well just be that the skin is irritated temporarily which causes a worsening in acne. There may be bouts of purging while the skin gets used to an acid or retinoid.
You are less likely to purge if your skin is good to begin with, so this is something to bear in mind. Purging should only last a short while- estimates are anywhere from 6 weeks to 6 months. It is said to be the same sort of acne in the same areas as you usually get acne. If you feel that your acne might not be purging, it could be something else causing it. Try eliminating thing from your routine or change your retinoid formula.
Before Starting Tretinoin
Studies have shown that making the most of your moisture barrier before starting tretinoin can minimise the irritation. So work on hydration and moisture before starting. Get your spf sorted and consider starting when it’s not very sunny.
If you have sensitive, eczema prone or dry skin to begin with you can still use tretinoin but just pay extra attention to your moisture barrier with the following tips.
How to Use Tretinoin to Minimise Irritation
- Cleanse with only the gentlest of cleanser, oils are good
- Use only at night, light will cause the tretinoin to break down
- The skin must be very dry otherwise the tretinoin/retinol will penetrate deeply and is more likely to irritate
- Apply Vaseline to the corners of the nose, lips, undereye and eyelid- these places are more likely to become irritated
- Dispense just a pea sized blob and dot evenly around the face. Don’t feel tempted to use loads, it may well ruin your week
- Gently massage into the skin
- Apply a thick layer of occlusive cream over the treatment
- Avoid anything irritating while your skin is getting used to tretinoin- no scrubs, benzoyl peroxide, vitamin C, glycolic acid or salicylic acid. No alcohol or fragrance either.
- Use just twice a week to begin with and increase slowly
The idea is to gradually increase the frequency and percentage over a long period of time to gently introduce, marathon style. You can use retinoids all your life (barring pregnancy and breastfeeding). When you stop using it, your skin will go back to normal.
(Side note for pregnants– While pregnant I had a lot of joy with 20% Azaleic acid as a retinoid replacement, it also helps with aging pigmentation and pores)
When the tret peelies get too much, there are ways to make things easier so you don’t feel tempted to give up. The first time I tried to use tretinoin was when I was a teenager with bad acne. I put a nice thick layer on, because my skin is bad and the cream is meant to be good. Two days later my face fell off and I didn’t use it again for years. So let’s not do that. Ideas you can try if tret is getting the better of you-
- Change formula, if you have the alcohol based gel or the cream, try the micronised formula, it’s the gentlest delivery system. I have tried both the cream and the alcohol gel and found the cream much better. The alcohol gel stung to high heaven and pilled terribly. You can also go down in percentage if you really can’t get on with the strength you’re on.
- Have a week off, give your skin a break and concentrate on building up you skin’s moisture barrier
- Reduce frequency if you detect that your skin is on the verge of a meltdown, pull back on the frequency
- Mix with a moisturiser, this one is from Reddit, you are essentially reducing the percentage yourself for a period of time until your skin has calmed down
- Use tretinoin after moisturiser, after cleansing, apply moisturiser, go about your business and let it fully absorb, and then apply the tretinoin. This tip was given to me by Dermatica’s dermatologist Natalia Spierings. Evidence shows that this does not reduce the effectiveness but will help with irritation
- Wash it off, this is called contact therapy, you just apply and leave on for a time then wash off. how long you leave it on depends on the sensitivity of your skin anywhere from a few minutes to a couple of hour. Then dry the skin and moisturise loads
- Increase! I like this one, rather than reducing, diluting or ceasing you basically pull off the band aid and charge through the retinisation process as quickly as you can. So you use the retinoid daily and or increase the percentage to get the job done as quickly as possible
It can take months for the skin to acclimate and you may get numerous bouts of tretinoin peelies- when you increase percentage or are feeling ill etc. It can take up to a year for your retinised skin to reveal it’s glory, so buckle in for a long ride.
Tretinoin and The Ordinary Skincare
Given that you have probably spent some money and inconvenienced yourself obtaining the tretinoin, you probably want to give it every chance of success. Here are the best products to pair it with.
What You Shouldn’t Use
I’ve already mentioned this but it bears repeating, it’s probably best to avoid strong acids with retinoids (lactic acid, salicylic acid, glycolic, vitamin C and the AHA/BHA peel) . Tretinoin because of the irritation and retinol because it may impede it’s effectiveness.
But it’s not a hard and fast rule, there is some evidence that tretinoin is more effective when used with glycolic acid and vitamin C. It really depends on your skin and how long you have been using tretinoin and acids. If you have been using tret for 7 years and have no issues, of course, try and use them in the same routine. For beginners, leave this stuff for later or you risk invoking a skin nightmare. I would start by using on alternate nights if you’re going to dip your toe.
I’ve also read reports of hyaluronic acid causing tret irritation, as it sort of traps moisture which draws the retinoid into the skin. Most people are fine with it but if your getting a lot of irritation you might want to think about cutting out the hyaluronic acid.
Which The Ordinary Products You Should Use With Tretinoin
Apart from products with low pH, as far as The Ordinary is concerned all is good. Peptides and antioxidants are good with tretinoin and vitamin C derivatives are fine. You want the rest of your skincare regimen to support your skin barrier, keep your skin supple and hydrated. Amino acids help hydrate the skin and provide the skin with tools to rebuild. Vitamins eg niacinamide and panthenol are known to help support a healthy barrier. Antioxidants help prevent tretinoin breakdown and oxidation.
The Ordinary products that work well with Tretinoin. You don’t need all of them, these are just all the ones that would work in a retinoid focused routine (you also need a sunscreen, I’m not going to recommend The Ordinary one though because I hate it)-
Here is my oil reference table again to help you pick an oil
|OIl||Comedogenicity||Main Fatty Acids||Skin Type|
|Argan||0||Oleic & linoleic||Most|
|B Oil||2||Numerous (blend)||Dry, sensitive, irritated|
|Borage||2||Linoleic & γ-lipoic||Sensitive|
|Chia||3||Linolenic||Dry, sensitive, inflamed|
|Marula||3-4||Oleic||Dry, sensitive, eczema prone|
|Rosehip||1||Linoleic, linolenic (high in vitamin A)||Oily, acne prone, inflamed|
|Seabuckthorn||1||Palmitic, palmitoleic, oleic||Most, dry, compromised|
|Hemi Squalane||0||Non polar hydrocarbon||All (also good for hair)|
Non TO Skincare for Tretinoin Sensitivity
Some other skincare gems you might want to stop up on for the peelies-
Sample The Ordinary + Tretinoin Regimens
If you don’t have any of the above already, and want to do a pre-tret Deciem shop, you could choose a hydrator, moisturiser, antioxidant and occlusive for a nice tretinoin support regimen. E.g. Amino Acids +B5, Niacinamide, Pycnogenol, NMF snd Hemi-Squalane.
The tricky part about a tretinoin/retinoid routine is that the skin needs to be dry when you apply the retinoid. So you can’t do the old hydration-active-moisture-occlusive routine like you usually do. There are a couple of ways you could choose to work it. You can either cleanse, wait for the skin to dry out (takes about 15 minutes, some recommend more, if you have that sort of patience try and leave it longer) then apply the tret and the rest on top. Or apply everything apart from the occlusive wait for it to absorb until your skin is dry, then apply the tretinoin. Retinoid first will give stronger results.
My advice would be to keep the evening routine simple as poss and use the morning routine as a time to add vitamins and antioxidants. I quite like to do it this way– split my evening routine in half. Cleanse, hydrate and moisturise at about 7 pm then after dinner/Netflix apply the retinoid and occlusive just before bed.
Only try adding the other actives like vitamin C and acids after a really long time, likes months or even years, at a point when your skin is totally chill.
Sample The Ordinary Routine with Tretinoin
|For Beginners or Those With Sensitive Skin||For People Who Are Used to Retinoids or Wish to Go Through the Retinisation Process Quickly|
|AM-||Hydration, vitamins, antioxidant, moisturiser, factor 50 broad spf||Hydration, vitamins, antioxidant, moisturiser, factor 50 broad spf|
|eg. Marine Hyaluronics, Niacinamide, EUK 134/Pycnogenol, MAP/NMF+ Hemi-Squalane, SPF||eg. Marine Hyaluronics, Niacinamide, EUK 134/Pycnogenol, MAP/NMF+ Hemi-Squalane, SPF|
|PM-||Cleanse, hydration, vitamins, moisturiser, *wait 20 mins+ until everything is fully absorbed*, tretinoin, occlusive||Cleanse, *wait 20 mins+ until the skin is fully dry*, tretinoin, vitamin, moisturiser, occlusive|
|Squalane cleanser, Marine Hyaluronics, Amino Acids +B5, NMF, *wait*, tretinoin||Squalane cleanser, *wait*, tretinoin, Marine Hyaluronics, Amino Acids +B5, NMF,|
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