SKIN HEALTH

GOLD-STANDARD RETINOIDS

Dr Ginni Mansberg explains why vitamin A derivatives remain the gold standard in dermatology for improving skin health and visible ageing

Vitamin A is a fat-soluble vitamin1 essential for numerous physiological processes including vision, immune function, reproduction and cellular differentiation.2 In the skin, vitamin A exists in several forms, including retinol, retinal (retinaldehyde), retinoic acid and retinyl esters.3 These compounds are interconverted within the skin, ultimately exerting their biological effects through retinoic acid.

THE ROLE OF VITAMIN A IN CELLS

Vitamin A is crucial for regulating epithelial cell growth and differentiation. It helps maintain normal keratinocyte turnover and supports the integrity of epithelial tissues in the body. In skin specifically, vitamin A:

• Regulates keratinocyte proliferation and differentiation5

• Promotes normal desquamation6

• Supports epidermal barrier function7

• Modulates immune responses8

• Influences collagen production and extracellular matrix turnover9

WHAT DOES TOPICAL VITAMIN A DO?

Normalisation of keratinisation:

Retinoids reduce abnormal keratinocyte cohesion in the follicle, preventing microcomedone formation.11

Increased cell turnover:

Accelerate epidermal turnover,12 which improves texture, reduces dullness and helps disperse pigment.

Collagen stimulation:

Retinoids stimulate fibroblasts and increase collagen production while inhibiting collagen degradation caused by UV exposure. This improves dermal structure and reduction of fine lines.9

Reduction in pigmentation:

By increasing cell turnover and inhibiting melanocyte activity, retinoids help improve conditions such as post-inflammatory hyperpigmentation.13

Improved dermal remodelling:

Retinoids increase dermal glycosaminoglycans and improve overall dermal architecture, contributing to thicker, more resilient skin.9

THE VALUE OF VITAMIN A

Retinoids address underlying cellular processes rather than masking symptoms.

Their key advantages include:

• Extensive clinical evidence spanning more than 50 years14

• Ability to treat multiple conditions simultaneously1

• Proven stimulation of collagen and dermal remodelling9

• Compatibility with other treatments15

For clinicians, retinoids represent one of the most powerful non-procedural tools available to improve skin health and visible ageing.

FORMS OF TOPICAL VITAMIN A

Retinyl esters (e.g. retinyl palmitate):

These are the weakest forms They tend to be very well tolerated but less clinically potent.9

Retinol:

A widely used cosmetic retinoid that converts first to retinal and then to retinoic acid. It offers considerably less efficacy than retinoic acid 16 and tolerability can be a problem.17

Retinal (retinaldehyde):

• Faster and more potent biological activity due to fewer conversion steps9

• Antibacterial activity against Cutibacterium acnes18

• Improved tolerability compared with tretinoin (and retinol)9

Because of this favourable balance between efficacy and irritation, retinaldehyde is increasingly valued.3

Retinoic acid (tretinoin):

The active form used in prescription products. It binds directly to nuclear receptors and therefore produces the most potent biological effects, but also the highest irritation potential.9

ADVERSE EFFECTS OF TOPICAL VITAMIN A

• Erythema

• Dryness and scaling

• Burning or stinging

• Increased skin sensitivity

• Temporary worsening of acne9

MANAGING ADVERSE REACTIONS

When patients experience irritation from topical vitamin A, clinicians should focus on barrier repair and gradual reintroduction. Practical but un-studied strategies include:

• Reducing application frequency

• Using a lower-strength formulation

• Applying moisturiser before or after

• Temporarily pausing treatment

• Transitioning to a better tolerated form Patients should be informed that mild irritation is common early in treatment with and usually resolves as the skin adapts.

CONCLUSION

Vitamin A derivatives remain one of the most powerful and evidence-based tools in aesthetic dermatology.

Retinaldehyde offers an attractive balance between efficacy and tolerability, making it a valuable choice for many patients.

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DR GINNI MANSBERG

Dr Ginni Mansberg is a GP, TV presenter, podcaster, author and columnist. She is a physician specialising in women’s health, menopause and all things skin. She is also the co-founder and medical director of science-based cosmeceutical skincare brand, ESK.