Retinol is an Anti-Aging Favorite — But Will It Trigger Your Eczema?

Retinol and retinoids, whether in creams, lotions, or gels, are widely used in over-the-counter and prescription skin products. They’re also touted for many tantalizing benefits. Indeed, it seems that this family of ingredients can almost do it all: from fighting acne, fine lines, wrinkles, sun damage, uneven pigmentation, to boosting collagen and fostering a healthy “glow.”

But there’s a catch, especially for people with eczema.

Retinol and retinoids are part of the same class of chemical compounds derived from vitamin A, a key nutrient for boosting cell turnover and, in turn, helping to whisk away dead skin cells, clogged pores and dull skin. Unfortunately, however, retinol and retinoid products can also be irritating if used too frequently or if a formulation is too strong for your skin.

So if you experience eczema and are already prone to skin irritation, is retinol an option? And what should you expect? We asked Dr. Raj Chovatiya, assistant professor of dermatology at the Northwestern University Feinberg School of Medicine in Chicago to weigh in.

“Topical retinoids help the regulation of cell turnover, protein production and inflammation,” Chovatiya explained. “This is why retinol can be very helpful for anyone looking to treat acne or minimize wrinkles. However, several side effects often occur during the first several weeks of therapy, including skin irritation, scaling, redness, pain, burning, and itching.” Chovatiya added: “These symptoms are quite familiar to people with eczema! Unsurprisingly, these side effects tend to be more pronounced in individuals with baseline sensitive skin and eczema.”

Dr. Chovatiya generally recommends that patients with eczema avoid retinoids, or at the very least, use them only with extreme caution.

“If someone with eczema was interested in trying out a retinoid for the treatment of photoaging or mild acne,” Chovatiya said, “I would first recommend having a discussion with a dermatology healthcare provider to thoroughly review potential benefits and risks.”

Still wondering if a retinoid might be worth it? Chovatiya and other experts offer the following tips: 

1. Work closely with your healthcare provider to design a safe, effective and feasible skin care regimen to help tackle whatever your skin care concerns might be — eczema, acne, wrinkles, uneven pigmentation or any combination of these. “I encourage shared decision making between patients and dermatology healthcare providers,” said Chovatiya. “Care plans are different for every person living with eczema.” 

2. Choose milder versions. “Retinols are a better initial choice compared to prescription-strength retinoids,” Chovatiya said. “Because they are lower in potency, they tend to have milder potential side effects.”
   
3. Opt for a retinol product that’s also a moisturizer, such as a cream as opposed to a gel.
   
4. Start “low and slow” by applying, for example, a pea-sized amount of your retinol product only one or two days per week. If irritation doesn’t occur, and as your skin becomes more adapted to the retinol, it may be possible to gradually ramp up how much and how frequently you apply.
   
5. Know what’s “acceptable” irritation when starting a retinol and what’s not.  Mild symptoms like drier-than-usual skin, light peeling and sun sensitivity can likely be tolerated and “pushed through” while your skin adjusts. Not normal? Active, intense flaking, redness and burning. If you experience these symptoms, halt your retinol use or greatly reduce it. Consult your doctor if irritation persists or worsens.
   
6. As always, emollients, appropriate bathing, and trigger avoidance are the foundation of eczema therapy, and that shouldn’t change when using retinol. In fact, Chovatiya encourages his patients to be extra diligent about moisturizer use after applying retinols and throughout the day.
   
7. Be patient. According to experts at Harvard Medical School, retinoids can: reduce fine lines and wrinkles by increasing collagen production, stimulate the formation of new blood vessels in the skin for improved “glow,” fade age spots, block acne-related inflammation and soften rough patches. But it might take three to six months of regular use before such improvements are visible and best results can take up to 12 months to appear.
   
8. Remember the importance of prevention. While optimal moisturization and sun protection are always very important aspects of eczema care, these habits are also helpful in preventing many signs of skin aging — hopefully lessening desire for retinoids in the first place! 

If you think your skin is too sensitive for retinol, or if you’ve tried retinol and it wasn’t pretty, don’t worry. There are other anti-aging ingredients you can try. 

“One option,” Chovatiya said, “for those who cannot tolerate retinol, are antioxidants like vitamin C and E. This class of products can help to prevent fine lines and pigmentary changes by neutralizing free radicals in the skin.”

Another antioxidant option for sensitive skin might be bakuchiol, from the seeds and leaves of the Indian babchi plant. A study published in the British Journal of Dermatology showed that bakuchiol was comparable to retinol in its ability to improve photoaging but with less skin irritation. Another study found that bakuchiol functioned similarly to retinol with twice-daily application for 12 weeks resulting in improvement in lines and wrinkles, pigmentation, elasticity, firmness and photo damage. 

One more choice: Choose to admire the lines of distinction on your face as a testament to a life well lived. As Mark Twain said, “Wrinkles should merely indicate where smiles have been.”