Cosmeceuticals-Anti Aging Retinoids

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Retinoids are a class of compounds derived from Vitamin A. Traditional indications include treatment for moderate to severe acnes and psoriasis. Retinoids come in oral as well as topical formulation. Oral medications require a prescription and need to be monitored closely. The purpose of this article is to discuss the role of topical retinoids in anti-aging.

Many over the counter preparations contain retinol or retinyl esters. These need to be converted in the skin to the active form which is retinoid acid. They have at best weak anti-aging properties. Therefore many over the counter preparations are not as effective as prescription strength retinoic acid. Retinaldehyde has moderate properties and may produce results because it is better tolerated and has less side effects.

Retinoids work at the cellular level to promote regeneration of the epidermis. Think of it as a normalizing agent which reverses the sign of aging. Ninety percent of premature aging is secondary to UV exposure. Therefore use of sunscreen throughout life should be an integral component of skin care. Signs of aging include fine lines and wrinkles, sun spots, vascular changes such as fine capillaries, freckles, and keratoses which are dry scaly spots seen on sun exposed skin.

Prescription strength retinoids may not be tolerated by some due to the side effects. Side effects primarily included dry skin and redness. Initially it may be prudent to start using it every other day at nighttime. If it is tolerated then use can be advance to daily nighttime use. The ultimate goal is to use it twice a day but this may take several weeks to get to this stage. Some people may not be able to tolerate the use and may be amenable to using retinaldehyde which although not as effective may still produce visible results from increased compliance. Throught use of retinoids it is important to realize that the skin is more sensitive and therefore sunscreen should be utlized as part of the skin care regimen.

Retinoid are also useful in acne use because they reduced comedomes (blackheads and whiteheads) through the normalization of hyperkeratinization seen in acne. As previously mentioned, oral formulations require close monitoring due to possibility of liver toxicity and should be avoided in pregnancy or women thinking of becoming pregnant. The same is true of topical formulations, which should generally be avoided during pregancy.

Retinoids can also be used to treat melasma as part of a formulation containing a bleaching cream such as hydroquinone and topical steroids. Melasma, which is tan or dark skin pigmentation, is multi-factorial but linked to excessive estrogen or progesterone as seen in pregnancy or use of contraceptive or homnone replacement therapy. Other conditions such as thyroid disease can also promote melasma. Melasma is cause by over stimulation of melanin producing cells. Melasma is primarily seen on the face including cheeks, forehead, jaw and nose but can occur in other parts of the body. Sun exposure can also worsen melasma therefore it is wise to use sunscreen.

Newer retinoids such as adapalene or tazarotene which are synthetic are also beginning to find a place in the anti-aging armamentarium. More studies are needed to assess the efficacy of these newer retinoids. Their side effect profile is similar.

In conclusion, retinoids are an integral part of the anti-aging regimen. They are becoming more ubiquitous and they have been shown to produce results in preventing and reversing signs of aging. While their side effect profile may preclude the usage, anyone who can tolerate them should consider their use to reverse the signs of aging and promote a healthier appearing skin.

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Hardik Soni, M.D.

Medical Director

Ethos Spa, Skin and Laser Center

89 Summit Ave

Summit, NJ 07950

www.myethosspa.com