When it comes to skin care, prescription-strength retinoids are revered as the gold standard amongst dermatologists, estheticians, and skin-care obsessives alike. Retinoids (an umbrella term for vitamin A–derived products) work by stimulating rapid cell turnover — forcing surface skin cells to expire and pushing new, smoother, and more radiant skin to the surface. As one of the best-researched ingredients in skin care, retinoids have been proven to combat a wide range of issues, from acne, to texture, to hyperpigmentation, and have even been shown to reduce fine lines and wrinkles by increasing your skin’s collagen production. They’re a serious workhorse, which is why so many people consider retinoids to be the MVP of their skin-care routine.
But not all retinoids are created equal. There are two types out there: over the counter (which include retinol-esters, retinols, and retinals) and prescription (known as Tretinoin and Tazarotene). According to Dr. Joshua Zeichner, a dermatologist based in Manhattan, when you apply OTC retinoids to your skin, they go through a conversion process that activates the formula, turning it into the retinoid we know and love. Because of this extra conversion step, Zeichner explained, they’re less potent than prescription retinoids, which are already active when you apply them. As far as results go, this essentially means that while OTC retinoids are good, prescription retinoids are even better.
There’s a reason why folks don’t jump into using Tretinoin willy-nilly, though. Zeichner explained when you first start a retinoid, your skin goes through a process known as retinization — which is basically your skin adjusting to the treatment — and can cause irritation such as dryness, redness, tenderness, and flakiness, and may even trigger breakouts. This is a possible side effect of all retinoid products, but considering their increased potency, it’s much more likely with prescription treatments like Tretinoin.
This is a classic skin-care conundrum — you want the incredible benefits of Tretinoin but you don’t want to inflict the uncomfortable early stages on your skin, especially if you know you’re sensitive. But luckily, there is a way to ease your skin into prescription-strength retinoids. According to Zeichner, starting an over-the-counter retinoid can help introduce and familiarize your skin with the ingredient. When it’s used regularly, this can help build up your skin’s tolerance to retinoids and ultimately reduce the possibility of irritation should you start Tretinoin in the future. As your skin has already experienced retinization with over-the-counter retinoids, the process will be less disruptive when you begin a prescription strength.
According to Zeichner, selecting the best retinol to use before moving onto Tretinoin is really dependent on your skin and your personal tolerance. He explained that there’s nothing wrong with going low and slow, as gentler, lower concentrations of retinol still introduce your skin to the ingredient, and therefore help it build a tolerance. However, according to Zeichner, the most rigorous approach would be to start with the gentlest OTC option (a retinyl ester), then move to slightly stronger vitamin-A derivative (retinol) and then on to the most potent over-the-counter option (retinaldehyde) before starting a prescription like Tretinoin. While this may be the most diligent way to build a tolerance with over-the-counter products, Zeichner says it might not be the most cost-effective method, and that simply starting with a mid-range-strength retinol and then moving on to Tretinoin is the most common treatment he recommends.
Below, a list of over-the-counter retinoids to help build up your skin’s tolerance.
Retinol Ester
Folks with ultrasensitive skin who are hoping to begin with a retinol-ester, the gentlest option on the market, should try the Daily Serum from Joanna Vargas. In addition to its use of retinol ester, it also incorporates hyaluronic acid, glycerin, and oat extract to soothe, hydrate, and calm the skin, helping to prevent that tight, flakey feeling often associated with retinoids.
Retinol
This formula uses encapsulated retinol, which means it’s wrapped up in a carrier system that helps release the retinol slower over time, making it less aggressive on the skin. It also incorporates lactic acid, so you’re getting that immediate brightening effect as well as the long-term results of retinol. This is the first retinol I ever tried myself, and despite my sensitive skin, I had no signs of irritation or flakiness.
Another one of my personal favorite retinols — and another I used to build up my own skin’s tolerance before starting Tretinoin—is this .05 percent retinol serum from Dr. Loretta. The formula incorporates tons of fatty lipids, which helps lock in moisture, reducing redness and dryness.
This drugstore retinol serum is a product Dr. Zeichner often recommends to his patients, as it contains pure retinol in a hydrating formula that helps hydrate the skin and protect the skin barrier, making it the perfect product for first-time users.
Retinaldahyde
This formula uses retinaldehyde, the strongest over-the-counter retinoid available. Medik8’s Crystal Retinal is the most potent product on this list, but the formula’s incorporation of water-trapping humectants hyaluronic acid and glycerin lock in moisture to minimize redness and irritation.
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