Doctor V – Which Vitamin A For Acne

So today’s topic, I don’t know why we haven’t made this video before is how would you choose which vitamin A to use with acne? There are so many different forms of vitamin A, derivatives of vitamin A. We use them interchangeably. And I just feel like actually, I don’t think people really understand the safety profiles of each of them and the efficacy of each of them and which ones you start with and how do you work your way up. Because with skin of color, we have to be careful, as I always say one scratch, one bite or one burn and we hyper pigment. We cannot afford to unnecessarily irritate our skin because for skin of color, our melanocytes are large, those are cells that produce a pigment melanin.

And once they are triggered, they are producing hyper-pigmentation, which can take months or even years to get rid of. This is not a problem that Caucasians generally face. This really is an issue for skin of color. And this is a reason this whole channel exists so that you are educated and empowered when it comes to your skincare and your purchasing decisions. As you know, none of my videos have ever been sponsored and they will never be sponsored. This really is my love letter for my skin of color family globally. So that us and our children all have a reference library to go to, which is evidence-based information specifically for our skin. I no longer want you wasting your money on marketing when the ingredients don’t back the marketing. So today I’m so glad we’re doing this video. Please give me a thumbs up. Let’s dive right in

So what are the different forms of vitamin A’s? So most of us are going to be consuming vitamin A in our diet from fruit and vegetables. The other way of using vitamin A is topically. So a cream or a gel that you put on to the skin. The vitamin A actually has multiple different mechanisms of action that will help you when it comes to acne. Number one, it is an antioxidant. So mops up free radicals, which can damage collagen. Number two, it is thought to reduce inflammation associated with acne. Number three, it helps with a phenomenon called hyperkeratinization. Hyperkeratinization is basically when your skin cells become sticky and they clog up the pore. Now, imagine this is your pore. I know here comes the claw, this is the pore. So imagine this is your pore. A nice healthy pore is open, see them as coming to the surface and moisturizing the skin.

Now when you have hyperkeratinization, these skin cells become sticky and they start to clog up the pore. Now what you’ve done is you basically got sticky cells stuck together, and you’ve got an oxygen less or an oxygen deprived environment. That’s an anaerobic environment. Pea acnes, the bacteria pea acnes loves an anaerobic environment and it proliferates and it makes babies and it’s having a little party in there that leads to acne. Pea acnes also produces free fatty acids, which are very irritating to the skin. And that’s why not only are you feeling the plug and you’re feeling the pressure. You’re also getting the irritation as well. So what vitamin A does is that it basically increases cell turnover and so you have less of these plugs forming. The forth mechanism of action is because of the increased cell turnover, it’s also anti-aging. So vitamin A is one of those ingredients that has many benefits, but you really need to be careful with it.

For example, it’s very similar to say niacinamide, which also has many, many benefits but actually very few people are irritated with niacinamide. Vitamin A on the other hand, if you aren’t careful, you can irritate your skin and damage your skin barrier. So you really need to be careful and educate yourself on vitamin A before you start using it on your skin. So topical retinoids are used for mild to moderate acne lesions, and they were precursor for the acne lesion itself. So it tends to be first line, not just for treatment but also for maintenance. Right, so in order of preference for me, I would start off with retinaldehyde. Retinaldehyde is more effective than retinol, but it’s less irritating. The only problem with retinaldehyde is it’s a very expensive and it’s very hard to get hold of. So I formulate with retinaldehyde in basically all my tyrosinase inhibiting kits for pigmentation and skin of color.

And it’s probably my single most expensive ingredient that I purchased in bulk. And actually when you go to a local drug store, there are very few retinaldehyde based products, which is why it’s going to be hard to get your hands on it. It is still my favorite form of vitamin A for skin of color, because it is more effective than retinol and it’s less irritating. And for us that’s the holy grail, less irritation. The next ingredient I would say is retinol 0.5%. So retinol 0.5% is more effective than retinyl palmitate, but it’s less effective than say isotretinoin or tretinoin. So again, it’s a very good first line of ingredient to use for your acne. Of course, you get the same benefits that you would get with vitamin A, with retinol or retinaldehyde. And those also include helping with melasma, with oily skin, with open pores. The next grade up would be adapalene.

So adapalene is a generic term and the brand names would be Differin or Epiduo. These can be found as a gel or a cream. 0.1% adapalene is a better tolerated than 0.025% tretinoin. The next lineup would be tretinoin. And the brand name would be Retin-A. So this can be irritating. It can lead to itching, stinging, flaking of the skin and it’s not first-line treatment for acne. I would avoid using this at the same time as benzyl peroxide, salicylic acid, or certainly denatured alcohol completely. If you do want to use those ingredients, I would just use them at different times. And then the next one up would be isotretinoin and that’s taken internally as capsules. And the brand name for it would be Roaccutane. So you might have heard of those two interchangeably.

So this is useful severe acne and has to be prescribed by a doctor. You have to take regular blood tests as well. And the side effects can be things like dry eyes, dry mouth. You can’t get pregnant while you on it because it can affect the baby. Can also lead to headaches, joint pain, muscle pain, and affect the liver too. This is why you have to do regular blood tests. They tend to give you 0.5 milligrams per kg of your body weight. I’ve done a whole video dedicated to Roaccutane for skin of color. So a plea, if you’re thinking about taking it, please can you watch that video first. Okay, so I’m very important things for you to note, if you’re going to take any of these forms of vitamin A is number one, you don’t take vitamin A when you are pregnant, not topically and certainly not intensity.

Number two is even off your acne has cleared up, it is worth continuing with your vitamin A for maintenance purposes. Number three, because it can be very irritating, I do recommend the sandwich method where you apply your moisturizer first, then your vitamin A and then your moisturizer on top. Yes, you’re going to get less penetration of actives, but you are maintaining your moisture barrier and your skin barrier, which is essential. As soon as you’ve damaged that skin barrier skin is now very sensitive and it can take months to recover. And then you’re in this vicious cycle where you’ve now got a damage skin barrier and you’ve got acne, which I absolutely do not want for you. The other thing to note is that your skin can become quite sensitive to light. So already, I know all of you are wearing your SPF 50 every two hours, but just in case you aren’t, you really have to be when you’re on vitamin A.

So just to recap for you, the order in terms of efficacy and irritancy profile. I’m always going to start with retinaldehyde, it’s less irritating and actually more effective than retinol but it’s harder to get ahold of. So that would be my first option. And the second option would be retinol, very easy to get ahold of, relatively cheap but it isn’t alcohol, which means it is quite irritating to the skin. Then adapalene, then tretinoin and then isotretinoin in that order.

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