Why You Should Not Use An Over-The-Counter Retinol

When it comes to skincare I fully acknowledge there is a lot of nonsense out there. “Medical-grade” is a marketing term, not a regulated one. If you’re going to buy sunscreen I would rather you buy a large bottle of broad-spectrum 50-plus SPF over-the-counter so that you apply it properly (i.e. you slather it on and you are not stingy with it because it cost you £70!) There are great cleansers out there with brands like CeraVe that don’t mean you need to break the bank. And unless you have very problematic skin you can get a beautiful moisturiser for very little money.

So where should you spend your money?

If you are going to invest in decent skincare - and trust me it is worth investing in - please do so with your active skincare ingredients. There is a huge difference in formulations and delivery vehicles. Today I am going to focus on the most important skincare ingredient of all - your retinoids. And I’m going to tell you why you do NOT want to buy these over-the-counter. You need to get these from a skincare clinician or medical professional, and the retinoids need to be formulated by a cosmetic chemist or be a prescription product.

What is a Retinoid?

Let me briefly refresh your memory as to what a retinoid is. But if you want all the in-depth details, read our article here. Retinoids are an umbrella term for all Vitamin A derivatives. They have been clinically proven to improve increase collagen production and fibroblast activity. They are approved by the Food and Drug Administration (FDA) as an anti-ageing skincare ingredient to improve the appearance of fine lines and wrinkles.

Remember that retinol is not the active form of Vitamin A. The only active form is retinoic acid, so over-the-counter retinols will first need to be converted to retinoic acid by enzymes in your skin before it can even being to have any effect.

The Latest Evidence About Over-The-Counter Retinols

A systematic review was published by The Journal of Aesthetic and Clinical Dermatology in 2021 by Dr Natalia Spierings. In her paper she defined retinols as non-prescription products, differentiating them from biologically active retinoids approved by Food and Drug Administration (FDA) in the United States. It is important to remember that retinols are cosmetics, and cosmetics are not medicines, meaning they do not have to prove that they work in the same way a prescription product does.

9 randomised control trials were identified, and there were major flaws in all of them. Most did not describe their randomisation method, were not blinded (inviting bias), and had no designated endpoint. Without going into the nuances of clinical research and trial design here, the bottom line is that no meaningful conclusions could be derived from any of them!

“Nine randomized, double-blind, vehicle-controlled clinical trials were found. Four of these trials reported no statistically significant differences between the retinol-containing treatment and vehicle. The remaining five trials provide weak evidence for retinol potentially having a mild ameliorating effect on fine facial skin wrinkle lines only. However, these five trials showed major methodological flaws, which were critically analyzed in this review, calling into question the validity of any positive results.”

So What Does This Mean?

The bottom line is there is very little research-backed evidence the over-the-counter retinols make any meaningful difference in your skin. This is in contrast to topical retinoic acids (tretinoin), which are prescription, and are the most researched skincare ingredient in history.

The key line from the study is as follows:

“It can be suggested that, in the case of retinols, the "positive" trials should not inform clinical decision-making but rather may serve as tools for advertising. Until at least one high-quality clinical trial of retinol-containing products in the treatment of (photo-)aged skin is published, there is very little, if any, trustworthy evidence available to support the use of over-the-counter cosmetic retinol-containing products to improve the appearance of aged skin.”

It is worth noting that the evidence, although weak, is still positive. The current evidence is not saying that over-the-counter retinols in no way work. They may mildly improve the appearance of fine lines and wrinkles. But that claim has definitely not been proven in any of the current research.

The Bottom Line

As Dr Spierings points out in her review, cosmetic companies are not medical ones and do not have any incentive to spend the money on robust research to prove efficacy. Rather, they rely on the lack of understanding of the scientific method in consumers to create impressive-sounding marketing. That is why as medical clinicians we do have a responsibility to be honest and to critically evaluate the evidence when we make recommendations, and state when and if there is data lacking. It is fair to say that a product may be of some benefit and will certainly do you no harm if you enjoy using it. It is different to claim you know from the research something is proven to improve photo-aging skin - because you cannot say this about retinols at this current time.

So if you are going to spend your money on anything, spend it on a high-quality retinoic acid that is only available through a skincare clinic or prescriber.

Find our summary slides on this issue below:

References

Spierings NMK. Evidence for the Efficacy of Over-the-counter Vitamin A Cosmetic Products in the Improvement of Facial Skin Aging: A Systematic Review. J Clin Aesthet Dermatol. 2021 Sep;14(9):33-40. PMID: 34980969; PMCID: PMC8675340.