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Do retinoids thin your skin?

Every week, a patient tells me that their skin care consultant has said, "Retinoids thin the skin." This statement drives me crazy because it is partially true, but is not really correct. Since retinoids are the only topical cream proven to fight wrinkles, I want you to know the facts. Retinoids actually thicken the dermal layer of the skin. First you need to understand the skin's basic structure, and then I can explain where the confusion comes from.

Understanding the structure of the skin

The skin has two layers: The top layer is the epidermis and the bottom layer is called the dermis.

The outer surface of the epidermis, the part that is exposed to the environment, is made up of a thin film of dead skin cells known as the stratum corneum (SC). Cells are born in the bottom layer of the epidermis and slowly mature and rise to the surface of the skin. At the top layer of the epidermis, the SC, these cells die and form the outermost layer of the skin. These dead cells cling to each other and tend to build up, forming heaps and valleys that prevent the skin from properly reflecting light. This makes the skin look dull and "sallow".

The source of the confusion

Retinoids loosen the bonds between these dead cells in the SC, allowing them to let go of each other and flake off more easily, exposing the smoother, more radiant skin beneath. So I suppose it's true to say that "retinoids thin the dead layer of skin." They make the dead cell layer of the SC look more compact so that it can more easily reflect light. Alpha and Beta Hydroxy Acids (AHAs and BHAs), scrubs, chemical peels and microdermabrasion all have the same effect. This is the reason that you should be especially conscientious about using a daily sunscreen if you use any of these products or treatments, because they remove a bit of sun protection (about SPF 4), that's normally offered by the dead skin cells.

Retinoids thicken the dermal layer of skin

Retinoids may thin out that dead superficial layer of epidermal skin, but they actually help thicken the living dermis underneath. The dermis is the important layer when it comes to skin aging because wrinkles occur in the dermis. The dermis contains structure-giving collagen, elastin to keep skin elastic, and hyaluronic acid (HA) to give skin volume by helping it hold on to water. As skin ages, it loses all three of these properties, becoming thinner and more fragile. Retinoids are the only substance proven to increase production of collagen, HA and elastin, which in turn thicken skin and smooth wrinkles. They can even help treat stretch marks.

Numerous studies have shown that retinoids are particularly powerful in boosting collagen production. Exposure to ultraviolet light (UV) causes loss of collagen, but retinoids help prevent loss of collagen due to UV exposure. Retinoids also help prevent wrinkles from forming by stimulating the dermis to make more collagen. Retinoids have even been shown to repair and thicken atrophied skin after it has been thinned by steroid use.

Prescription retinoids (also known by the brand names Retin-A, Tazorac, Differin, Ziana, Atralin, etc.) are the most powerful, but studies have shown that even over-the-counter products containing less concentrated retinol can significantly improve wrinkles--even when the subjects are 87!

So while it's true that retinoids can reduce the numbers of dead cells on the surface of the skin, that's not the whole story. Retinoids lead to an increase in the size of the dermis and the amount of collagen, and HA that it contains. This in turn leads to a more supple complexion with fewer wrinkles. In other words, retinoids thicken the skin. I challenge you to give me a good reason not to use retinoids. Come discuss this with me. I am have no financial relationships to any retinoid products.

Wishing you great skin!

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