Tretinoin, retinol, retinyl palmitate, retinaldehyde — however you describe or derive it, retinoic acid is the undisputed Darling of Dermatology. The vitamin A metabolite alters genetic expression to accelerate cellular turnover and increase collagen production; it's the most effective solution we have for pimples and wrinkles alike.
"Linked" as in, not conclusively proven to cause, but… under the right circumstances, maybe? Linked, like parabens are to breast cancer and phthalates are to hormone disruption — a weak-but-worrying connection, just strong enough for most modern brands to give up those ingredients altogether. You know, as a precaution.
Not that you would necessarily know this about retinoids. Because of the whole dermatological-darling thing, dermatologists — and beauty brands, and beauty editors and regular retinol devotees — tend to get defensive when confronted with the substance's purported pitfalls. It's understandable: These are among the most extensively studied ingredients in skin care, they're profitable and, above all, they work. Really well. So well that even "non-toxic" beauty brands shrug off the risks to revel in the rewards.
Take clean retailer Credo. The company's "Director of Mission" Mia Davis does believe that retinol has "potential health impacts." But, she says, "it delivers results that many customers are looking for." One of Credo's more incessant Instagram ads pushes "clean retinol" with a close-up of baby-plump skin and a blinking link to "shop now," but offers no mention of what separates this supposedly clean version from its implicitly dirty counterpart.
"It's unclear what a 'clean' retinol would be," says Nneka Leiba, the vice president of the Environmental Working Group's Healthy Living Program. She notes that "clean," "natural" and "non-toxic" don't have hard definitions from the Food and Drug Administration, so it's on each individual beauty brand (and consumer, for that matter) to figure out what constitutes a "safe" ingredient for itself. During this policy-making process, Credo and its contemporaries openly reference the EWG's Skin Deep Cosmetics Database, which rates ingredients based on toxicity. Retinol can rank anywhere from six to nine out of 10, making it a "high concern" ingredient. For reference, lead and formaldehyde — two undisputed toxicants — earn 10s.
"The overall product or ingredient score in Skin Deep is calculated from information drawn from the nearly 60 integrated toxicity, regulatory and study availability databases," Leiba explains. "Retinols get a high score in Skin Deep because government testing has shown that, on sun-exposed skin, these chemicals can increase the risk of skin lesions and other skin damage."
True, the EWG is often called out for "fear-mongering" — but it's not the only organization with concerns about the ingredient. "Both the European Union and Canada have restrictions around retinol," Lindsay Dahl, the SVP of Social Mission at Beautycounter, tells Fashionista. "It's not just one study, and it's not just that the EWG has a high score. There are clearly a lot of reasons Beautycounter has chosen to put retinol on our 'Never List.'" The brand goes so far as to lobby Congress for stricter regulation.
To play retinol's advocate: The studies on its side effects are hotly debated and mostly dismissed by experts. "One or two isolated studies show some degree of [cancer] association in animals, which gets extrapolated and blown out of proportion," says Dr. Steven Wang, a dermatologist and founder of Dr. Wang Herbal Skincare. "We have not observed an increase in the risk for skin cancer in clinical practice," Dr. Patricia Farris, a dermatologist with Sanova Dermatology, tells Fashionista of tretinoin (prescription retinoic acid, or active vitamin A, also known as Retin-A), tazarotene and adapalene (prescription retinoids better known as Tazorac and Differin, respectively) and retinol (the alcohol form of vitamin A, now available over-the-counter). Some derivatives are even said to treat skin cancer — although it's important to note that cause and cure often coexist in dermatology. Steroids, for example, can assuage or aggravate dermatitis, depending on the dose.
The one retinoid experts agree is semi-questionable is retinyl palmitate, a retinyl ester that's more chemically stable than retinol and therefore, more easily integrated into skin-care products.
"In mouse studies, retinyl palmitate was shown to increase the production of free radicals in the skin in the presence of UV radiation," explains Dr. Rajani Katta, the author of Glow: The Dermatologist's Guide to a Whole Foods Younger Skin Diet. It's perhaps a bit counterintuitive, then, that retinyl palmitate is routinely found in sunscreen — a product designed to absorb UV radiation — like Neutrogena Sensitive Skin SPF 60. "We don't have much data beyond that, although we have not yet seen concerning reports from human observational studies," she says.
For these reasons, the ingredient has made its way onto many a "no" list — but since the study in question only shows tumor formation when UV radiation is present, some "clean" beauty retailers feel fine selling it. For example, Goop's Replenishing Night Cream is spiked with retinyl palmitate and available at Credo and Net-a-Porter. (A palmitate-free version can also be found on Goop.com.) "We advise customers to only use retinol at night," Davis says, to avoid the concerns about increased risk of skin cancer.
That's not to say you're totally in the clear using Retin-A or Tazorac or Differin or regular ol' retinol exclusively at night, though. The official Rx fact sheet for retinoic acid cautions that it "may accelerate the tumorigenic potential of weakly carcinogenic light from a solar simulator." To be on the safe side, patients are told to "avoid or minimize exposure to sun." They're also told to discontinue use if pregnant or nursing, since retinoids absorb into the bloodstream and may cause birth defects. (California residents get a little reminder of the possible developmental toxicity danger when purchasing retinoic acid products, care of a Prop 65 warning.)
Again, there is no definitive evidence that topical retinoids lead to cancer or reproductive toxicity, but the evidence we do have is pretty much on par with that of parabens. (Read: Not agreed upon by professionals, requires more research.) So what's the difference between potentially-toxic parabens — largely shunned by both indie brands and drugstore giants as a precaution — and potentially-toxic retinoids?
There were 1,249,141 prescriptions written for tretinoin in 2016. At an average cost of $214.66 each, tretinoin alone puts roughly $267,316,174 in the pockets of pharmaceutical companies per year. And that's just one retinoid. Considering the well-documented and kinda-too-close-for-comfort relationship between "Big Pharma" and the FDA (the FDA division that approves new opioid drugs receives 75% of its funding from the opioid industry, as reported by the Guardian; nine out of the 10 past FDA commissioners have gone on to work for major drug corporations), it's reasonable to at least wonder why "long-term animal studies to determine the carcinogenic potential of tretinoin have not been performed," per tretinoin's Rx label.
Maybe because inconclusive research leaves room for generous interpretation (and generous paychecks)?
Far-out capitalist conspiracy theories aside: Say all of those studies on photosensitivity and cancer and birth defects are rigorously retested and effectively debunked. Some still wouldn't consider retinol a candidate for "clean" beauty for two reasons: sensitization and barrier degradation. "Knowing what we know based on the body of research, we think things like skin sensitivity are really important to think about," Dahl says. And yes, as the "retinoid uglies" have taught us, retinol and its relatives pretty much specialize in sensitivity.
"All retinoids can cause some 'retinoid dermatitis' during the first few weeks of use," Dr. Farris explains. "Dermatologists call this two-to-four-week process 'retinization of the skin.'" Retinization can involve dryness, redness, peeling, flaking and even increased acne Some users are fine with that, assuming all the peeling will eventually reveal bouncy, youthful skin. It (usually) will. The question is: Is that bouncy, youthful skin inherently healthier?
"Our brand's ethos is to protect against and minimize damage from environmental stress and optimize skin health, and we feel using retinoids at their effective concentration at this time would be counter to that belief," Porter Yates and Shani Van Bruekelen, the founders of sustainable skin-care line Ayond, tell Fashionista. Why? "There have been studies that show retinoids can weaken the skin's barrier function."
Dermatologists don't — and can't — argue there. "In my opinion, [retinoids'] benefits are more about the skin's appearance," says Dr. Katta. "The compounds in retinoids can help boost collagen, but they're not necessary for healthy skin. The most important factor in maintaining healthy skin is about protection and promotion." Research shows that although retinoids thicken the skin overall, they thin the skin barrier, the built-in protective layer that guards against invading pathogens and environmental aggressors and locks in moisture.
"Retinol basically increases your collagen, so it thickens the dermal layer as well as the epidermal layer," Dr. Wang clarifies. "It does weaken the skin barrier, and that is why you get desquamation, peeling, redness, irritation."
You're probably somewhat familiar with the skin barrier, or stratum corneum. It's home to your microbiome and acid mantle, and today's skin-care is all about building it up — from piling on the probiotic beauty products to chilling on the over-exfoliation to dousing it in fatty oils. "I see so many patients with impaired skin barrier function and this is definitely a big issue in dermatology, especially because some of my patients are attempting 10-step skin care regimens with resulting irritation," Dr. Katta says. "This is important, because a damaged skin barrier just doesn't protect you as well. You may experience increased moisture loss, leading to dry skin and eventually inflamed skin. You may also be more prone to developing allergic reactions to products applied on top of a damaged barrier."
She agrees that retinoids impair the barrier by speeding up cell turnover and prematurely shedding dead skin cells (it is, essentially, a sort of self-exfoliation), but doesn't necessarily have a solution. "This is a great question," she says. "Unfortunately, we don't have much data to really answer it well. It's possible that the increases in collagen and other skin changes that occur may help mitigate this effect."
There is another way to mitigate this effect, of course: stop using retinol.
The notion that you shouldn't have to hurt your skin to help it is gaining traction in the skin-care community, as evidenced by the recent bakuchiol boom. Alpyn Beauty Natural PlantGenius Melt Moisturizer, Herbivore Botanicals Bakuchiol Retinol Alternative Serum and Beautycounter's Countertime line all feature the plant-based ingredient, which has been hailed as "botanical Botox" and "natural retinol" — even by dermatologists.
"There was a study in the British Journal of Dermatology this year comparing bakuchiol to retinol," Dr. Farris says, "and they were found to be equally effective for improving wrinkles and hyperpigmentation. The retinol cream caused more irritation; bakuchiol has a great tolerability profile." It's also not associated with photosensitivity, tumors, reproductive toxicity or barrier impairment. In other words: Bakuchiol can more accurately be called "clean," no matter how you define it.
Natural rosehip and carrot seed oils are emerging as strong retinol alternative contenders as well; they're high in naturally-occurring vitamin A, as opposed to the lab-isolated vitamin A of retinoic acid (although the results are much more subtle). "We use an extract from the plant Orobanche rapum that is in our Rock Rose Face Serum and Taos Blue Day Cream," add Yates and Van Bruekelen. "It has been shown to increase stem cell rejuvenation and protection." Bonus: All three have the added benefit of building the barrier up, rather than wearing it down.
And, as Dahl puts it: "If there are alternatives on the market that can give us similar or even better results, why wouldn't we use that?"
If you're curious about those alternatives, in the gallery below, we rounded up 12 creams, moisturizers, serums and oils that rely on retinol alternatives to deliver skin-helping benefits. Click through to see them all.
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