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Retinoids Ruined My Skin Barrier: To Hell & Back

June 6, 2023

Why a dermatologist ditched retinoid skincare products for good

Retinoids Ruined My Skin Barrier Visual

The retinoid family of chemical compounds includes Vitamin A also known as retinol, derivatives of which are — retinaldehyde, retinoid acid and retinyl esters, amongst other synthetic versions of retinoids. Retinoids are essential to various biological processes.

I’m a Dermatologist & I’ve Stopped Prescribing Retinoids

Retinoids ruined my skin 8 years ago. I’ve healed it but….retinoid worshippers, pay attention.

This is a story about how I broke my decade-long addiction to retinoids. At first ashamed, I tell of how I regained my dignity. Seven years ago, the day I decided to banish my tubes of tretinoin to vanity drawer purgatory….

Flaky, An Observation

It was 2015 and I was already out in private practice. One afternoon, a surgeon colleague of mine commented that my (usually pristine) facial skin was flaking.

“Do you mean my sunscreen? Or my…ill-fated BB cream? It does pill sometimes, you know.”

“No. It’s your epidermis.”

He was right. Later that evening, I skipped my usual dose of tretinoin 0.05% (0.1% typically causes a chemical burn like reaction — never met someone who tolerated it), and applied copious amounts of moisturiser before going to bed.

Three days later, my skin did look less angry, less painful but just…slightly flaky. That though, was enough to convince the addict in me that my epidermis was ready again. But the good dermatologist decided to halve the dose of tretinoin this time — just 0.025% will do. Lots of moisturiser too.

By the way, skin cycling was invented the same time retinoids were — over 2 decades ago. So we already knew what to do.

Retinoids for beginners
Retinoids for beginners, are they worth it?

The reason retinoids are recommended by dermatologists are:

  1. Retinoids treat comedonal acne
  2. Retinoids help reduce scarring and post-inflammation hyperpigmentation (PIH) by regulating cell turnover
  3. Retinoids before and after: Retinoids are known to enhance skin glow aka the “retinoid glow” which is due to the multiple actions on the epidermis and dermis. Namely, cell renewal rates, enhancing collagen formation for a tighter and more lifted appearance of skin.
  4. Retinoids stimulate collagen production and targets aging skin processes

Flaky Mind, Flaky Skin

Except that I never expected that it wouldn’t go away. One month later. Even with 0.01%.

I had but gone through 4 cycles of stop/start-moisturise-stop/start — the vicious cycle of a dermatologist going insane with practising what she preached. That didn’t work. So you see, whenever the addict did see that her skin was less angry, she couldn’t resist her fix.

“Your skin. Is looking flaky again.” Surgeon friend muttered. Half mocking, always.

“It’s retinoid dermatitis,” I cursed.

That evening, I put away the tube. Stuffed it into the recesses of vanity drawer abyss — praying to God for strength…to never touch it again. It worked. Flaky, red, painful skin never came back. And my repentance was for good.

Why I’ve Stopped Prescribing Retinoids

I was what you might call a retinoid worshipper. From my early twenties, I religiously slathered on tretinoin nightly after a bout of teenage acne — also when its merits were preached to me by my dermatologist.

When I entered dermatology residency, I too began chanting the mantra.

“Retinoids are good. Retinoids fight acne. And when acne is gone, you’ll find retinoids also keep you young.”

Also for credibility, you know? Since every dermatologist I apprenticed under said that. Congnitive dissonance is….

An uncomfortable experience. So the next 6 months I continued prescribing and preaching while my stockpile of 0.025% tretinoin languished in vanity purgatory. I wasn’t prepared for what came next.

Retinoid side effects
Retinoid side effects (what dermatologists don’t tell you until…) Well until they become victims themselves.

The Revenge of Retinoids

“You can cut down on the dose when your skin gets irritated. Use the 0.01% instead of the 0.025%.”

“You shouldn’t stop using it. Your acne will come back.”

“All dermatologists have that…retinoid glow. Where’s yours?” I imagined.

So like a heretic I searched for retinoid alternatives on PubMed. The search threw up OLIGOPEPTIDES (never heard that mentioned throughout my entire residency program!). Must be fake news…except…that I was now desperate. For a panacea….My conscience. It did quiet a little bit.

At that time, the international dermatology community wasn’t quite into K-beauty yet. So I was careful never to talk about my private meanderings into the dark side. By then I had also tried a K-beauty product formulated with a bunch of botanicals plus oligopeptides (no retinols/retinoids).

Retinoids ruined my skin and I’m never going back again

Retinoid Side Effects #1

Retinoid Lips

Retinol purging, retinoid purging (they are one and the same thing)

The theory is that while retinols and retinoids work by targeting comedone formation, it also triggers off inflammation. This is why dermatologists don’t recommend applying retinoids or retinols when you have active inflamed acne bumps. Ditto for acne cysts.

What happens if you do so? Well your angry pimple gets even angrier. I.e redder, bigger, more painful…and may even develop into a cyst.

Six months later.

“Hey, flaky’s been gone for a while now.” Surgeon mocked.

“Your skin…is glowing…what did you use?”

(Not retinoids.)

I wasn’t ready to give up my secret yet — I labelled my ventures as experimental. Almost…homeopathic (utter at your own risk).

My Obsession With Skin Barrier Repair After Retinoids Ruined My Skin

Little Skincare Book Skincare Journal
The Little Skincare Book for Women includes Korean skincare routines for skin barrier repair, skincare routine checklists and retinoid/retinol-free home facial protocols. In the series are workbooks harnessing the science of the brain-skin connection.

When you hear something repeated often enough, it starts getting stale. When you find yourself repeating something that isn’t true…it soon nauseates you.

In 2016, I left the private hospital I was working for and started my own practice. I stockpiled just enough tretinoin to soothe my outer dermatologist, but not so much that it would irk the inner medicine woman.

Getting Out of the Retinoids Cult

My dabbling soon turned into dipping. And dipping — into an uncontrollable urge. By the end of 2017 I was fully submerged. As dermatologist-homeopathic-in-private-practice, I found little reason to justify my recommendations beyond — it’s safe in pregnancy/breast-feeding. AND it doesn’t cause flaky skin. Why of course, my skin was glowing! Retinoid-free for 2 years!

Retinoids Ruined My Skin, Repairing the Skin Barrier Helps
Retinoids ruined my skin and skin cycling never helped, repairing the skin barrier did.

Retinoid Side Effects #2 Retinoid dermatitis

Retinoid dermatitis is an eczema-like reaction caused by retinol side effects. The skin barrier is disrupted in cases of retinoid dermatitis. Retinoids improve the quality of skin by exfoliating dead skin cells. But that also means it breaks down the joints between the superficial skin cells, known as corneocytes. This can cause skin to become sensitive, meaning that it reacts easily to allergens and changes in the environment.

This is also the rationale for skin cycling with retinols and retinoids — popularised by Tik Tok in 2022. Essentially, allowing your skin to break from irritating actives such as retinoids, retinoids, alpha hydroxy acids (AHAs) and salicylic acids. Skin cycling refers to alternating retinoids with moisturisers in between usage and reducing frequency of use.

The Dignity of an Iceberg

From my research in eastern ethnobotany, I found that selected botanicals were synergistic — targetting the skin microbiome in ways traditional pharmacology was unable to. The disrupted flora in dermatological conditions like acne, eczema and rosacea were responsible for chronic inflammation — and medical therapy like antibiotics, steroids and retinoids did more than just worsen it. Retinoid dermatitis, steroid induced-tachyphylaxis and antibiotic resistance were just the tip…

By 2021, I went public. My 2 papers on the skin microbiome (maskne was timely) were published in the Journal of the American Academy of Dermatology and the International Journal of Dermatology. I advocated the use of botanical-based cosmeceuticals and functional textiles to treat the microbiome and microclimate, over skin-sensitising retinoids and always-going-to-breed-resistance-antibiotic creams.

This is the story of how I broke my decade-long addiction to retinoids. (And also how I think I regained my dignity).

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I’m a board certified dermatologist with published original research on the acne microbiome and functional dermatology. I adopt a holistic approach to dermatology by integrating functional skincare with a focus on skin barrier repair. My podcast Dermatologist Talks: Science of Beauty focuses on skin science as well as the psychology and philosophy of aesthetics. Subscribe to my newsletter Skincare Blueprint: Glow Up From Within for free resources on skincare routines and skin science.

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