Wait—is Tretinoin bad for some skin types?
A derm explains why retinoic acid isn't beneficial for everyone.
I can’t tell you why exactly I didn’t listen to him. I certainly didn’t think I knew more than one of the top dermatologists in NYC. But on I went, using a product I was specifically told not to use—and sure enough, after eight months, my skin looked not smooth, plump, and youthful like it was supposed to, but flakey, splotchy, and old.
Let me rewind a bit.
Over the past few years, every dermatologist I’ve interviewed has told me retinol is the most effective skin-care product, after sunscreen. Countless studies (like this one and this one) have proved its age-reversing benefits, showing it accelerates skin cell and collagen production, which helps brighten skin and minimize the appearance of fine lines and wrinkles. Naturally, I wanted to give it a whirl. I tried Skinceuticals’ “Retinol for Beginners” (it contains just 0.3% of pure retinol), applying it in the sandwich method (a layer of moisturizer under and on top of it) just twice a week, as is recommended for those of us with sensitive skin. I then waited twelve weeks for my new toddler-like mug to appear.
Sure, my skin was a tiny bit glowier. And luckily, it didn’t purge (a common side effect of retinol in which the ingredient brings all the gunk in your pores to the surface in the form of fire-engine-red pimples). But it was also super dry and didn’t boast any particularly youthful results. Around this time, I started seeing TikTokers like @abbeyyung raving about their impressive experience with Tretinoin—a retinoic acid only available by prescription. The results were shocking: Skin was brighter, fine lines were gone, and in some cases, even dark circles were diminished.
At my next appointment with Dr. Robert Anolik—one of Manhattan’s most in-demand dermatologists responsible for Kelly Ripa, Olivia Palermo, and Justin Theroux’s fresh faces—I asked for a prescription. “If your skin can’t handle Skinceuticals’ 0.3%, it won’t be able to handle Tretinoin,” he told me, and recommended Alastin’s over-the-counter retinol instead. So I went home, emailed another dermatologist I knew, and asked her to give me a prescription.
Why didn’t I listen to Dr. Anolik? The only reason I can come up with is that I, like Cady Heron, was a woman possessed. Possessed by the promises TikTokers fed me about the power of this miracle product. I thought I knew what I was in for: You go through the Retinol Uglies phase, battle Peely Snake Skin, skip through the Garden of Dewy Glow, and reach the Fountain of Youth. Turns out, not everyone makes it.
I sure didn’t—and my skin was mad. For eight months it flaked and splotched, no matter what rich creams or soothing masks I applied. Finally, I had two aestheticians (one, I’m embarrassed to admit, still wasn’t enough), Jenn Hollander in Los Angeles and Barbara Sand in Paris, who ordered me to stop using Tretinoin. I finally listened.
So, why are some people good Tret candidates and others aren’t? I chatted with certified dermatologist and CDA member Dr. Malika Ladha to find out, and also to learn how us sensitive skin folk can best reap the benefits of retinol.
First things first: I call every reti-something product “retinol,” and I know that’s incorrect. What’s the difference between retinoids, retinol, and retinoic acids?
Retinoic acid is the most potent, then there’s retinaldehyde, retinol, and retinyl esters—they’re all retinoids. The further you are from a retinoic acid, the less potent it is.
So if I was using Skinceuticals’ most gentle retinol (0.3%) then I switched to Tretinoin’s most gentle retinoic acid (0.025%), that doesn’t mean I switched to a gentler retinoid?
That’s right—you can't compare them because they use different molecules.
But does retinoic acid, being the most potent, produce the best results?
This is a common misconception. We think a prescription-strength product is the best thing we can use. However, it comes with potent side effects—flaking, irritation, stinging, and redness. Although it’s good to start slow and work your way up, not everyone can tolerate a prescription-strength retinoid. This is where we’d use something like a retinol every day, which can work as well as using a retinoic acid once a week. Consistency is important.
Do you typically recommend patients try retinoic acid after getting their skin used to retinol?
It depends on their skin type. A lot of patients keep using a retinol and get good results from it. I might recommend it to patients who have thicker, more robust skin—they can typically handle a retinoic acid well.
What’s the best practice for tolerating retinol well and also getting the best results possible?
Starting slow and working your way up is key. You could use a retinol two to four times a week, and that's good because you're still getting the benefits. You don't need to jump up to retinoic acid, especially if your skin is sensitive to retinol.
What are your favourite retinols?
SkinCeuticals, Alastin, and for a drugstore option, Neutrogena.
How long should the Retinol Ugly period last? After a certain amount of time, can it be damaging to the skin since it’s causing inflammation?
It’s actually good because it’s helping with cellular turnover. So it’s delivering skin exfoliation and collagen production. It's a slow, consistent process that leads to results. And that dryness should not be seen as negative inflammation—I wouldn't even call it inflammation. It’s just a side effect. It’s temporary. But if you're using a retinoid for months and not seeing relief, you need to take a step back because you should be enjoying the skin you’re in.
What common mistakes do people make when applying retinoids?
You need just a pea-size amount. Applying more won’t be more beneficial—you’re just increasing your chances of irritation. I tell patients to apply it to their finger, and then split that amount over five areas—each cheek, the nose, forehead, and the lower face. If you’re sensitive to it, you could use the sandwich method, layering moisturizer onto skin before applying it, and again after.
This interview has been edited and condensed for clarity.
What am I using on my skin now? I’m letting it heal, applying only moisturizer and sunscreen in the morning and a thicker moisturizer at night. But the truth? I’m desperately trying to get my hands on a bottle of Alastin’s retinol, and kicking myself I didn’t opt for it when Dr. Anolik told me about it. Listen to your derm, kids!
Until next Sunday,
Renée