In eighteen years of nursing and several years of aesthetic practice, no ingredient comes close to retinoids in terms of clinical evidence for skin improvement. And yet, in nearly every consultation I have in Oxfordshire, I meet people who are either not using them, have tried them briefly and stopped, or are using them incorrectly and wondering why their skin is irritated.
This article is an attempt to explain, honestly and plainly, what retinoids are, what they can and cannot do, and how to use them in a way that actually works.
What are retinoids?
'Retinoid' is the umbrella term for a family of compounds derived from Vitamin A. They range from the mildest (retinyl esters, found in most high-street products) to the most potent (tretinoin, prescription-only and the most extensively studied).
The retinoid family, roughly in order of potency:
- Retinyl esters (e.g. retinyl palmitate) — very gentle, low efficacy. Found in most 'anti-ageing' moisturisers.
- Retinol — the most common over-the-counter retinoid. Must be converted by the skin to retinoic acid before it can act. Effective but less so than prescription options.
- Retinaldehyde (retinal) — one conversion step closer to retinoic acid than retinol. More potent than retinol, less irritating than tretinoin.
- Tretinoin (all-trans retinoic acid) — prescription-only. The gold standard. Works directly without needing conversion. The most studied and most effective.
"Tretinoin has more peer-reviewed clinical evidence behind it than almost any other topical skincare ingredient. If you can tolerate it, nothing beats it."
How do retinoids work?
Retinoids work by binding to specific nuclear receptors (RAR and RXR receptors) inside skin cells, which then directly regulate gene expression — switching certain genes on and others off. This is not a surface effect. This is a change at the level of the cell's DNA activity.
The practical results of this process include:
- Accelerated cell turnover — retinoids speed up the rate at which the skin sheds old cells and produces new ones. This is why the skin initially purges — it's processing a backlog of cellular turnover faster than usual.
- Stimulation of collagen production — tretinoin in particular has been shown to stimulate fibroblast activity and increase the production of Type I collagen — the primary structural protein in the skin.
- Inhibition of collagen breakdown — retinoids also reduce the activity of matrix metalloproteinases (enzymes that break down collagen), providing a double benefit.
- Normalisation of pigmentation — by regulating melanocyte activity and accelerating cell turnover, retinoids reduce hyperpigmentation and improve skin tone over time.
- Reduction of comedones — retinoids are also first-line treatment for acne because they prevent the formation of the blocked follicles (comedones) that lead to spots.
Why do people stop using them?
The most common reason is the retinisation period — the first 4–8 weeks of use, during which the skin often becomes red, dry, flaky and irritated. This is not a sign that retinoids are 'not for you'. It is the skin adapting to an ingredient that is genuinely changing its biology. Most people who push through this phase, with appropriate guidance on introduction, find their skin tolerates retinoids very well thereafter.
The mistake is starting too quickly or with too high a concentration. The correct approach is slow introduction: once or twice a week to begin with, on clean, dry skin, buffered with moisturiser, and gradually increasing frequency over weeks and months as tolerance builds.
Common mistakes I see
- Applying retinol immediately after washing the face (wet skin increases absorption and irritation)
- Using other active ingredients (acids, vitamin C) on the same evening
- Not using SPF consistently — retinoids increase UV sensitivity significantly
- Giving up after 2–3 weeks because 'it's not working' — real results take 12–24 weeks
- Using too high a strength to start — higher is not always better
Prescription retinoids: when does it matter?
If your skin concerns are primarily surface-level — mild dullness, very fine lines, early prevention — a good quality over-the-counter retinol, used correctly and consistently, will give you meaningful results.
If you have more significant concerns — moderate to severe hyperpigmentation, sun damage, noticeable collagen loss, or acne — prescription-strength tretinoin will produce results that no OTC product can match. As an independent prescriber in Oxfordshire, I can prescribe tretinoin as part of an Obagi Medical skincare programme, with a full assessment, structured protocol and ongoing support.
"The best retinoid is the one you can actually use consistently. Prescription strength is meaningless if it's sitting in the bathroom cabinet because it's too irritating."
Retinoids alongside aesthetic treatments
Retinoids and aesthetic injectable treatments work synergistically. Injectable treatments like Profhilo Structura, skin boosters and polynucleotides work in the deeper layers of the skin; retinoids work in the epidermis and upper dermis. They address different levels of skin ageing and together produce outcomes neither achieves alone.
I always ask about skincare at consultation. If a client is not using a retinoid and there are no contraindications, I will usually recommend one — because the best aesthetic results come from treating the skin at every level, not just the ones we can address with a needle.
Who should not use retinoids?
Retinoids are not suitable for everyone:
- Pregnant or breastfeeding women (topical tretinoin is contraindicated)
- Those with certain skin conditions (rosacea requires careful management)
- People using certain photosensitising medications (Clare reviews this at consultation)
- Anyone undergoing laser resurfacing or chemical peels (timing needs to be coordinated)
Want to discuss prescription skincare?
Clare offers full skin assessments and Obagi prescription skincare at her mobile clinic in Oxfordshire. Get in touch to discuss your skin.
Book a Skin Assessment