Retinoids for Hyperpigmentation

Retinoids are active ingredients in skincare that can help reduce unwanted pigmentation. This covers age spots, post-acne marks and even melasma. Retinoids are well-studied for treating pigmentation marks in melanated skin.

Retinoids "attack" unwanted pigmentation in the two main ways:

1. They suppress the activity of the enzyme tyrosinase that kicks off the production of melanin (the skin pigment).

2. They increase the cell turnover and this results in lighter skin getting to the surface.

If you are dealing with post-acne pigmentation, retinoids are particularly great actives. They work both against the active acne spots, prevent the new ones, and treat post-acne marks at the same time.

The main trouble with retinoids is that they are irritating. This is not good news if you are dealing with pigmentation. Irritation leads to inflammation. Inflammation, in turn, can trigger more pigmentation. This is especially true for melanated skin. So the task is to use retinoids in a way that reduces the existing pigmentation marks, but, at the same time, does not cause irritation (and new pigmentation issues as the result).

Topical retinoids are not shown to have negative effects for the baby development in pregnancy. (Retinoids taken orally do though). Still, many doctors recommend avoiding topical retinoids in pregnancy out of caution.

Before starting a retinoid product, make sure that your skin barrier is strong. Your skin shouldn't feel dry or sensitive. If it does, focus on treating it extra gently and moisturizing a lot for a couple of weeks. Avoid exfoliators, fragranced products, essential oils and use a gentle cleanser. Ideally cleanse in one step and once per day at night.

Your routine should stay gentle also when you are using a retinoid. It is a good idea to remove unneeded irritants and exfoliants from your skincare regimen. This is especially important when you are starting to use a retinoid for the first time or after a break.

Start your retinoid product slowly. For the first month, only use it 2-3 times a week. Only increase the frequency if your skin is tolerating the retinoid well. The good news is that the skin can build up tolerance to retinoids. If you are patient, your skin gradually adjust to the active, and you might be able to use it every other day or even daily. The slower you start, the better tolerance you'll get. And also, this way you'll reduce your risk of getting a serious irritation.

It is also best to start with a low concentration of the retinoid in your product. With time, your skin might be able to "take" a stronger punch.

Make sure you apply a good non-irritating moisturizer daily (or even several times a day) when using a retinoid.

Retinoids can make your skin sensitive to the sun (UV light). If it happens, it is a very, very bad thing both for looks and health. This is why it is crucial to use a daily broad-spectrum sunscreen with SPF 30 or higher the whole time when using a retinoid. You need a sunscreen even on the days when you are not applying a retinoid.

Besides that, if you are dealing with pigmentation issues, sunscreen is your best friend anyway. Sun exposure triggers pigmentation. Less sunlight getting to your skin = less pigment it will produce.

If you suspect that you have melasma, the best course of action is to get a medical consultation from a dermatologist. Skin with melasma is likely to be more sensitive. It means that it has a higher risk of getting an irritation from strong actives. Irritation, in turn, can lead to more pigmentation and make matters worse. This is why melasma-prone skin often needs more gentle approach with less concentrated actives. Dermatologists can also prescribe you a more effective combination treatment. These treatments are not available in cosmetic skincare.

Retinoids in skincare come in different formats. Some of them are efficacious, and some of them are pretty useless when it comes to reducing pigmentation.

The most studied and effective retinoid for pigmentation issues is Tretinoin. This is a medical type of retinoid. In most countries, it is only available on prescription. If you have access to a dermatologist, ask them if Tretinoin is right for you. Tretinoin almost always causes at least some irritation, so you need to be careful.

Adapalene is another form of retinoid. It holds the second place for pigmentation issues. It works, but is slightly less effective compared to Tretinoin. Adapalene is available over-the-counter in the US and some other countries. In Canada, UK and EU it is available on prescription.

"Cosmetic" forms of retinoids - those you can find in skincare in a store - are less studies for pigmentation issues. Still, some of them work similar to the "medical" ones, only weaker.

Among the "cosmetic" retinoids, these fours formats have the highest potential to work like the medical retinoids:

• Retinal

• Hydroxypinacolone Retinoate

• Retinyl Retinoate

• Retinol

You need a lot of patience for improving the pigmentation issues. It might take up 10-12 months of a consistent skincare regimen to see meaningful results. This is true for all kinds of pigmentation issues including post-acne marks and age spots.

For Adapalene, the concentrations starting from 0.1% (this is the percentage available over the counter in the US) are effective.

For "cosmetic retinoids", the best approach is to combine them in your routine with other anti-pigmentation actives. For example, with Azelaic Acid, Niacinamide, Arbutin, Tranexamic Acid, Kojic Acid.

The effective concentrations for the "cosmetic retinoids" start around 0.1% for Retinal, Hydroxypinacolone Retinoate & Retinyl Retinoate and 0.3-0.5% for Retinol.

Yes, combining exfoliating acids like Glycolic Acid and Retinoids in one product or in the same routine can help to get better results for pigmentation issues. But this combination also greatly increases the chances of getting an irritation. If you’ve decided to use both acid peels and a Retinoid in your routine, be extra cautious. Introduce one active first and make sure that your skin is tolerating it well. Only then introduce the other active, ideally only once a week. If your skin is tolerating this regimen well, you can slowly increase the frequency of the second active - but be careful not to push it to the limit. Be especially careful if your skin tone is dark and/or you suspect that you have melasma.

The answer is basically the same as for the Glycolic Acid. Yes, combining an effective concentration of Ascorbic Acid (10-20%) with a Retinoid in a routine improves the results for hyperpigmentation. You just need to watch out for the irritation.

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Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color: A Clinical Review and Implications for Practice

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Topical Treatment of Melasma https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807702/

The top 10 cosmeceuticals for facial hyperpigmentation

https://onlinelibrary.wiley.com/doi/abs/10.1111/dth.14095

Cosmeceuticals for Hyperpigmentation: What is Available?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663177/

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The Role of Topical Retinoids in the Treatment of Pigmentary Disorders

https://link.springer.com/article/10.2165/00128071-200910040-00005

Usefulness of retinoic acid in the treatment of melasma https://www.sciencedirect.com/science/article/abs/pii/S0190962286702478

The use of retinoids in the treatment of photoaging

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1529-8019.2006.00087.x