Fighting poor skin health, ageing and aesthetics is a constant battle, with every great approach to maintenance and rejuvenation inevitably following a multi-pronged program, due to the complex and multi-factorial nature of skin ageing and the deterioration process.
Just like maintaining the health of the teeth and gums, what the patient does at home is more than half the battle – you can use all the fancy treatments and technologies you like, but none of it will last or look as good as it could if the patient isn’t doing their part at home each day.
Previously we have seen how daily sunscreen use is imperative and is the most important product patients can use at home every day to ensure ongoing skin protection and the avoidance of skin health and aesthetic issues. But when it comes to actively reversing damage already done and treating existing issues, is there a magic bullet, non-negotiable product to use for this as well?
During AADFA’s “FACE” training program, Dentists are educated on the best types of at-home skincare products for different types of patients; their different skin types; and their different clinical problems. From cleansers and serums, through to moisturisers, there are several key, scientifically proven, active ingredients that Dentists need to instruct patients to use, that combine synergistically to achieve the best results. Imparting this information allows patients to cut through all the marketing hype of the thousands of products that do little and cost a lot – proper skincare doesn’t need to be expensive.
Chief among these proven ingredients are a group of naturally occurring beta-carotene or Vitamin A derivatives called Retinoids that are considered the gold standard of skincare and a MUST HAVE in any at-home regime that is serious about achieving results.
When applied to the skin topically, retinoids are a potent anti-oxidant and act on certain skin receptors to achieve their benefits by regulating normal cell activity at a molecular level. By regulating gene expression, Retinoids can normalise growth and differentiation of keratinocytes (fundamental skin cells); stimulate the manufacture of Collagen and Elastin (two fibers that give skin its elasticity); aswell as inhibiting the production of Collagenase (an enzyme that breaks down collagen and elastin). Retinoids therefore combat skin deterioration by both building proteins that strengthen the skin and inhibiting proteins that cause skin breakdown.
The first topical retinoid product—Tretinoin—was approved, under the brand name Retin-A, over 50 years ago as a prescription acne treatment. Dermatologists soon noticed that patients on Retin-A experienced not just clearer skin but softer, more vibrant skin with less pigmentation and fewer wrinkles.
Tretinoin is the acid form of Vitamin A and is also known as Retinoic Acid or all-trans retinoic acid. Only available on prescription, it is the most signicant and well-researched topical anti-acne and anti-wrinkle agent, with decades of research proving its efficacy in reducing fine wrinkles, smoothing rough skin and lightening brown spots with as little as 4 weeks of daily use.
While Tretinoin is the most potent Retinoid, other Vitamin A esters exist, such as Retinyl Palmitate, Retinol and Retinaldehyde,which are available in over-the-counter preparations. These esters must first be converted to Retinoic Acid by the skin, before they can be utilized, thus their considerably lower potency with results from these forms typical taking at least 12 weeks.
Above: Resolution of acne after daily tretinoin use for 12 weeks
Above: Improvement in periorbital lines and pigmentation following 4 weeks of Tretinoin use daily
Above: Reduction in pigmentation and fine lines with daily tretinoin use.
Tretinoin is the best form to use, if possible, and it comes in a variety of strengths and forms such as gels and creams, with a small amount being mixed and applied to the skin with moisturiser each evening. However, one of the major potential issues of Tretinoin is that it can result in initial skin irritation, dryness, redness and flaking, until the skin becomes accustomed, at which stage these side effects will likely diminish.
If a patient has sensitive skin and these symptoms are too intense or do not cease after a couple of weeks of use, this is where the less potent forms, such as Retinol, can be used which will likely avoid these issues, balancing tolerance with less immediate results.
Above: DO NOT MISS THE "SKIN TALK" WITH AADFA WEBINAR! You can pre-register by emailing [email protected]
By stimulating and normalising keratinocyte migration and desquamation, Retinoids thin the stratum corneum layer, which leads to the desired clinical benefits, but can also make the skin more photo-sensitive. For this reason, patients MUST be instructed to apply sunscreen daily. Concurrent use of products containing Alpha or Beta Hydroxy Acids may reduce the efficacy of Tretinoin and these ingredients should not be immediately layered, nor should Retinoids be used during pregnancy or breast-feeding.
Dentists and Dental Teams can provide an invaluable service to patients by helping them negotiate the barrage of skincare product claims and directing them to products with a scientifically proven track record of real results, that don’t cost the earth. There is no ingredient that comes close to Retinoids, especially Tretinoin, in delivering the knock-out punch against skin ageing.