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Vitamin A: New Applications and Outcomes

Sam Dhatt April 2013 issue of Skin Inc. magazine
Vitamin A continues to evolve, helping it remain one of the most potent ingredients in a skin care professional

Vitamin A continues to evolve, helping it remain one of the most potent ingredients in a skin care professional's arsenal.

Editor’s note: As always, Skin Inc. magazine recommends that skin care professionals obtain the proper training before offering any new treatments in their skin care facilities.

Author’s note: Studies indicate that a daily dose of 50,000 IU provides safe protection against sun exposure and skin cancer, though it should be noted that excess doses of vitamin A can result in negative side effects, including hair loss, dry skin, nausea and liver damage, and pregnant women should not exceed more than 10,000 IU daily without a doctor’s supervision. Recommend that clients consult with their physicians before starting any supplement program.

Since Albert Kligman, MD, PhD, the late renowned dermatologist, patented the retinoic acid drug tretinoin in 1973, vitamin A is still recognized as the single most proven go-to ingredient for improving everything from acne, wrinkles and collagen synthesis to hyperpigmentation. Even today, following the advent of peptides, peels and stem cells, vitamin A and its retinoid-derivative family continue to reign as the unequivocal gold standard of skin care, particularly in treating photodamage. This tried-and-true ingredient continues to evolve with new applications and outcomes coming to light, helping it continue its reign as one of the most potent ingredients in the skin care professional’s arsenal.

How retinoids work

Years after Kligman started testing retinoic acid on acne patients in the 1960s, he began to notice patients were also exhibiting fewer wrinkles and a smoother skin tone. Additional research revealed that, by binding to specific receptors in the skin, retinoids encourage cell turnover on the top layers, producing a more even skin tone, while thickening the lower dermal layers, which has a smoothing effect on wrinkles.

Retinoids’ core competency—the organization, division and differentiation of skin cells—is at the very heart of addressing so many skin conditions, from acne and signs of aging to psoriasis. Indeed, many physiological responses of the skin, such as dermal aging, immune defense and wound-healing, are affected by vitamin A and its retinoids. This potent, water-soluble antioxidant not only encourages proper cell desquamation, but also helps maintain the skin’s structure by inhibiting the DNA damage that breaks down collagen.

In the correct molecular size, retinoids can penetrate the lower layers of skin where collagen and elastin are produced, DNA repair functions occur and the cell cycle is regulated. Once a topical retinoid is applied, enzymes convert the retinoid into retinoic acid, which binds to the DNA via receptors and activates the skin’s genes to promote healthier cell growth.

The retinoid range

Retinoids range from natural to synthetic, and pharmaceutical to nonpharmaceutical derivatives. This article will focus on the three basic nonprescription retinoid derivatives: retinyl palmitate, retinol and retinaldehyde.

Think of retinoids existing on a continuum with the lipid-based retinyl palmitate on the far left side of the spectrum, and representing the most stable and least irritating—but also the least potent—version. This derivative must undergo the most number of steps to convert to retinoic acid, the bioavailable form used by the body. It must first convert to retinol and then to retinaldehyde before converting to retinoic acid. On the other end of the continuum, pharmaceutical retinoic acid is far less stable and potentially irritating, but also highly effective at treating acne and signs of aging.

Although many mass-marketed products feature retinyl palmitate, most anti-aging cosmeceuticals feature either retinalydehyde, which exists one step away from retinoic acid, or retinol, which sits between retinyl palmitate and retinaldehyde on the retinoid continuum. Both offer a readily available, nonprescription source of topical vitamin A that’s easily converted into retinoic acid.

A randomized double-blind controlled study, published last year in the Journal of Drugs in Dermatology, found little difference in efficacy between a 1.1% retinol-based gradual-release cream and a prescription tretinoin (retinoic acid) 0.025% cream in women with mild to moderate photodamage. Following a three-month treatment, both test products significantly improved photodamage, including fine and coarse wrinkles around the eye, skin firmness, tone and texture, pigmentation and general photodamage. The subjects reported more than 93% overall satisfaction with both products at the eighth and 12th weeks.1

Retinaldehyde presents another viable option for acne and anti-aging formulations. A 2010 study published in the Aesthetic Surgery Journal concluded that, according to the current data, cosmeceuticals containing retinaldehyde had been shown in large randomized controlled trials to have the most beneficial affect on aging skin among the retinoid-based cosmeceuticals.2 In addition, in a large international study published in the Journal of Cosmetic Dermatology in 2011, researchers found that a combination of retinaldehyde and hyaluronic acid applied over three months showed significant improvement to photoaging, with more than a 30% improvement to elasticity and hyperpigmentation.3

For acne-sufferers, retinaldehyde may be a prime choice among retinoids for its less irritating profile and compatibility with other potentially irritating acne treatments, including alpha hydroxy acids (AHAs) and benzoyl peroxide. A 2007 Dermatology study showed favorable outcomes with a topical 0.1% retinaldehyde combined with 6% glycolic acid in treating acne.4, Another study published in Dermatology demonstrated that retinaldehyde at an 0.05% level may also offer some antimicrobial activity against Propionibacterium acnes bacteria.5

Improving outcomes

Although retinoids offer many benefits to the skin, they often come at a price. The more potent forms are unstable and light-sensitive, creating formulation issues in the wrong hands. Many clients also find retinoids—particularly retinoic acid—irritate their skin with daily use. An Italian study published last year in the Journal of Dermatological Treatment noted that irritation was the most frequent side effect of topical retinoids, occurring in 85% of nonprescription retinoid users and up to 95% in patients treated with tretinoin. As a result, 15% of the patients terminate their tretinoin treatment for this reason.6 In that study, the researchers found that short contact therapy with a 0.05% tretinoin cream applied once daily for 30 minutes during an average 12-week period demonstrated significant clinical improvement in acne treatment with very good tolerability and, as a result, improved compliance.

To overcome irritation and stability issues, retinol chemists have also used specialized delivery forms that encapsulate active retinol in a polymer system to slowly “feed” the skin a more stable, bioactive form with minimal irritation. Chemists formulating with retinol must take special care to process the batch in a special controlled environment, with yellow lights and nitrogen gas-blanketing to reduce oxidation.

New research is revealing fresh insights regarding different combinations of ingredients. For instance, a soy-based active complex known as Allosteris from Barnet Products Corporation, makes the perfect partner with retinol by increasing its efficiency at a lower usage percentage, thus decreasing the potential for irritation. Whereas a formulation without Allosteris may need a 0.5% or higher level of retinol, formulators can use a 0.03% retinol to 0.5% Allosteris combination and achieve comparable results. Allosteris improves the skin’s reception to signaling molecules, such as retinol and peptides, allowing these molecules to enhance or inhibit a protein or enzyme. On its own in a 1% concentration, in vivo results showed Allosteris increased hydration, decreased wrinkles, improved clarity and firmness, and reduced flakiness in the skin.

Combining retinoids with UV filters may also help mitigate irritation. A Brazilian study published in the International Journal of Pharmaceutics in 2007 found evidence suggesting that photostable UV filters—in this case, octyl methoxycinnamate, benzophenone-3 and octocrylene—might help reduce skin irritation associated with a combination of vitamins A, C and E. They also concluded that the photostable UV filters combination yielded the highest recovery of vitamin A compared to a photo-unstable formula.7

Also, dermal needling has become a popular treatment in recent years. Using approximately 200–250 fine surgical steel needles, a roller mechanism is applied directly to the skin in a repetitive crisscross motion. It creates microchannels in the skin that encourage up to 80% product absorption. It also induces a controlled wound that triggers a slow wound-healing response in the skin and promotes desired scarless collagen to replace damaged collagen. Dermal needling yields complete preservation of the melanocyte cell and helps to regulate the melanogenesis promoting an even skin tone. It also triggers growth factors within the client’s kertinocytes, which encourages healthy cell-to-cell communication. (Editor’s note: Dermal needling may not be within your scope of practice. Contact your state board and obtain the necessary training before adding this treatment to your menu. Log on to for complete contact information for your state’s board.)

Coupling a dermal needling procedure and vitamin A (retinol 4%) serves as an impressive anti-aging treatment. Retinol encourages epidermal thickness and inhibits metalloproteinase (MMP), which is an enzyme that degrades collagen. Pairing the two refines skin texture and tone, reduces fine lines and increases cellular turnover. (See Treatment How-to: Retinol Facial with Dermal Needling.)

Beyond acne and aging

Although retinoids have been used traditionally to treat acne and aging, researchers are now finding new applications for vitamin A derivatives. A 2006 study published in the Journal of Cosmetic Dermatology found that a retinol-based cream coupled with intense pulsed light may help improve cellulite by enhancing collagen and improving smoothness in the affected areas with minimal side effects.8

Retinoids may also help treat skin cancer. A recent study in the Journal of Investigative Dermatology that analyzed melanoma risk among nearly 70,000 people found that vitamin A supplement-users were approximately 40% less likely to develop melanoma than the nonsupplement users.9 The news is particularly encouraging for those at high risk for melanoma, such as fair-skinned individuals with a history of sunburn and numerous moles.

Although researchers continue to search for the next best ingredient to fight acne and aging, it’s likely that retinoids will remain trusted, proven ingredients in the skin chemist’s formulary for acne and anti-aging, as well as additional applications in the future.


1. ET Ho, NS Trookman, et al, A randomized, double-blind, controlled comparative trial of the anti-aging properties of non-prescription tri-retinol 1.1% vs. prescription tretinoin 0.025%, J Drugs Dermatol 11 1 64–69 (Jan 2012)

2. K Babamiri and R Nassab, Cosmeceuticals: the evidence behind the retinoids, Aesthet Surg J 30 1 74–77 (Jan 2010)

3. A Corderom, G Leon-Dorantes, et al, Retinaldehyde/hyaluronic acid fragments: a synergistic association for the management of skin aging, J Cosmet Dermatol 10 2 110–117 ( Jun 2011)

4. B Dreno, A Katsambas, et al, Combined 0.1% retinaldehyde/6% glycolic acid cream in prophylaxis and treatment of acne scarring, Dermatology 214 3 260–267 (2007)

5. M Pechère, JC Pechère, et al, Antibacterial activity of retinaldehyde against Propionibacterium acnes, Dermatology 1 29–31 (1999; 199 Suppl)

6. S Veraldi, M Barbareschi, et al, Short contact therapy of acne with tretinoin, J Dermatolog Treat (Jan 20, 2013) (E-pub ahead of print)

7. LR Gaspar and PM Campos, Photostability and efficacy studies of topical formulations containing UV-filters combination and vitamins A, C and E, Int J Pharm 343 1–2 181–189 (Oct 1, 2007)

8. JS Fink, H Mermelstein, et al, Use of intense pulsed light and a retinyl-based cream as a potential treatment for cellulite: a pilot study, J Cosmet Dermatol 5 3 254–262 (Sep 2006)

9. MM Asgari, TM Brasky, E White, Association of vitamin A and carotenoid intake with melanoma risk in a large prospective cohort, J Invest Dermatol 132 6 1573–1582 (Jun 2012)

Sam+DhattSam Dhatt is an award-winning cosmeceutical chemist who serves as the CEO and president of DermaQuest Skin Therapy and Allure Labs, a product formulation company, both of Hayward, CA. During his more than 20-year career, he has developed and manufactured skin care products for more than 700 companies. Dhatt is a frequent expert author of articles featured in many trade journals and skin care publications.

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For Best Results ...

Although retinoids offer multiple skin benefits, many derivatives are light-sensitive and unstable materials. Follow these usage tips for best results.

Apply in the evening. Retinoids are sensitive to sunlight and degrade in light, and they also can make the skin more sensitive to sunburn; therefore, retinoids are best applied at night. Counsel clients to pay extra attention to avoiding sun exposure or, at least, wear a good broad-spectrum sunscreen during the day while using retinoids.

Avoid irritating ingredients. Because retinoids can be irritating to the skin by themselves, it’s wise to avoid combining them with other potential irritants, such as benzoyl peroxide, sulfur, resorcinol and salicylic acid.

Pay attention to packaging. The light-sensitive nature of retinoids makes packaging a key factor in the preparation and filling of a retinoid product. Retinol, for instance, is extremely unstable in heat, light and air, making an airless or aluminum tube with a narrow opening a good choice.

Stick with the program. Retinoids often create flakiness and redness among first-time users. Counsel clients to “pulse” their use by applying every other day to build up to daily use. Generally, it takes about three to six months of daily use to see the full effects of nonprescription retinoids.

Treatment How-to: Retinol Facial with Dermal Needling

This facial treatment helps reduce and prevent pigmentation; brightens and evens skin tone; reduces fine lines and wrinkles; and soothes and reduces irritation.

Duration: 60 minutes

Cost: $125

Contraindications:Do not perform on clients who are pregnant/nursing, or have active acne or compromised skin.

Supplies and equipment needed:

Treatment table

Rubber gloves

Gauze pads

Dermal needle device—0.3 mm

Products needed:

Glycolic cleanser

Alcohol/glycolic acid prepping solution

Retinol (4%)

Loose powder with SPF 30

Step 1: Complete a thorough consultation with the client and have her sign a consent form.

Step 2: Emulsify the cleanser with warm water. Apply to the face, and then remove. Repeat.

Step 3: Complete a thorough skin analysis of cleansed skin.

Step 4: Place gloves on hands, and prepare the skin with the prepping solution by applying the solution to a gauze pad. Wipe the face with the gauze pad, beginning with the forehead, followed by the cheeks and nose, and work down and around the face. Avoid the eye area, ears and lips. Allow the application to dry for two minutes.

Step 5: Using the dermal needle device—0.3 mm, start to roll at the forehead, remember to roll vertical, horizontal and diagonal in both directions. You should roll 4–5 passes in each direction until even erythema is achieved. Gauge the amount of pressure you should use depending upon your client’s sensitivity and skin response. Any wrinkles or sagging skin must be held taut, and the skin should be stretched with your fingers and flattened before rolling. Divide face left and right, and repeat for each side.

Step 6: Apply the retinol 4% to the skin. This enhances the overall results of the dermal needling treatment and expedites the peeling process. Do not apply moisture to the skin for five hours after the peel application.

Step 7: Apply loose powder with SPF 30 on the skin for appropriate sun protection.

Step 8: Have client schedule a follow-up appointment in 7–10 days to assess the skin’s progress through a peel and hydrating facial. Provide the client with post-treatment home care products and written instructions. A gentle cleanser to aid in the healing process, a strengthening serum to help maintain and reconstruct collagen, a hydrating moisturizer that contains antioxidants to assist is the skin’s natural healing process and finally a physical sunscreen with a protection of an SPF 30 or higher should be included. This treatment should be done in a series of three, 3–4 weeks apart, so be sure to schedule additional appointments before the client leaves.

















Credit: Photos courtesy of DermaQuest Therapy.


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