What are retinoids?

Retinoids and the products that contain them are often praised for their ability to reduce wrinkles and clear acne. And with the rise of skincare influencers and viral beauty trends on TikTok, Instagram and other social media platforms touting retinoids as “must haves,” they’ve become a staple in the routines of younger users. 

Tweens and teens are helping fuel rapid growth in the beauty market. But as more of these younger consumers add them to their daily regimen, concerns are growing about their health risks.

Retinoids are a group of chemicals derived from vitamin A that can increase skin cell turnover, leading to a “desirable” skin appearance. But they also have links to several health problems, including skin damage, reproductive harm, and a greater risk of some types of cancer, especially with long-term or improper use. 

But some doctors caution that anti-wrinkle products containing retinol might be unnecessary for younger users and can even damage the skin barrier. Depending on the type of retinoid, products with retinol may not be recommended for those under 18.

Many parents and caregivers may not know their kid regularly uses a skincare product linked to heightened sensitivity to sun damage. As these products surge in popularity, it’s important to understand more about how they work and their possible side effects. 

How retinoids work

Retinoids typically need to be converted into retinoic acid before your body can use them.

They enter skin cells in the epidermis, the top skin layer, and stimulate cellular activity. This boosts the production of new skin cells, which helps increase the epidermis’ thickness. The process prevents water loss and collagen degradation, common signs of aging skin. 

Retinoids also increase collagen production and stimulate the growth of new blood cells under the skin. So they may be used as treatments for skin conditions like acne and psoriasis.

But the increased cell activity can pose a risk of sun damage and skin cancer.

There are many types of retinoids, and they can be categorized through a hierarchy of their conversion to retinoic acid, the active form the body can use (see Table 1 below).

The fewer steps a retinoid needs to convert to retinoic acid, the stronger or more potent it is. In order of increasing strength, retinyl esters, retinol, retinaldehyde and retinoic acid are all types of retinoids in skin care and prescriptions.

As the least potent retinoids, retinyl esters take three steps to convert into retinoic acid. This makes them relatively gentler on the skin, so they’re used in many products. Retinyl palmitate is an example of a retinyl ester, and this ingredient can be found in products from serums and moisturizers, to lipsticks and shampoos and conditioners.

Retinol is also known as vitamin A and found in 830 products in Skin Deep®, EWG’s searchable database highlighting ingredients – including those of concern – in more than 130,000 cosmetics. Retinaldehyde is also known as retinal and found in 44 products in Skin Deep. These are two of the most potent retinoids available.

Table 1. Types of retinoids

*Individual ingredients, not groups 
** Not in Skin Deep, because prescription only 
† Requires prescription in some circumstances

Retinoic acids are the most potent form of retinoids, because they are already active. They require a prescription and they are often used to treat severe acne and sun damage. 

These products can accelerate how skin sheds dead cells and replaces them with new ones, also known as skin turnover. This process can treat the appearance of sun damage, such as sunspots and fine lines. But retinoids also make the skin more susceptible to the sun, which can lead to future sun damage.

You may have seen or heard about tretinoin, a topical form of retinoic acid, on social media. Isotretinoin, also known by its brand name, Accutane, is very potent and often used to treat severe conditions such as cystic acne. 

Both tretinoin and isotretinoin are available only through prescription.

Retinoids as a class are still developing, as researchers continue to improve on new types. For example, synthetic retinoids are becoming more common because of an interest in products that can target specific treatments while trying to minimize side effects. 

Another ingredient you may see is adapalene, regulated by the Food and Drug Administration as an over-the-counter topical retinoid used to treat acne. It does not need to be converted to retinoic acid to be active. 

Retinoids’ possible health effects

While these ingredients are praised for their potential to reduce fine lines and improve skin appearance, they can also give rise to troubling potential side effects. 

Retinoids can cause dryness and irritation of the skin and even result in itching or burning, redness and flaky skin. Data show that use of retinoids can increase risk of skin cancer and reproductive harm. 

National Toxicology Program scientists investigated the application of retinyl palmitate and retinoic acid to the skin of mice. They exposed the mice to ultraviolet light, and then retinoids, to see the effect of retinoids on the skin, while mimicking sunlight exposure. They reported that mice exposed to these ingredients developed a greater quantity of cancerous skin lesions and tumors.

The study also found these lesions and tumors developed faster in the mice that were exposed to retinoids.

While vitamin A is important during pregnancy for healthy fetal development, pregnant women typically get the vitamin A they need from their diet and prenatal vitamins. Excess vitamin A can have a teratogenic effect, meaning it can cause developmental abnormalities or birth defects. Therefore, retinoids, especially oral retinoids, may prove risky during pregnancy so they are not recommended for use during that time.

Oral retinoids, like isotretinoin, and others that are already active retinoic acid, can lead to elevated vitamin A levels in the body and transfer of retinoids across the placenta, which can affect fetal development. 

Although oral retinoids may pose the highest concern, many topical retinoids still contain warning labels advising against use in pregnancy and during breastfeeding. 

For example, the prescribed retinoids, adapalene and tretinoin, are Pregnancy Category C drugs that animal reproduction studies have shown can cause harm during pregnancy, though data in humans is limited. 

Isotretinoin is a pregnancy Category X medication. The FDA determined there is evidence of fetal harm to humans, so its risks outweigh its benefits. In fact, people taking isotretinoin, a popular oral retinoid for acne treatment, are strongly advised to also take birth control or other measures to reduce risk of pregnancy before and during use. 

How to minimize risks

If you’re using products with retinoids, here are some ways to reduce your exposure risks:

1. Speak to a dermatologist or a doctor. Different retinoids have different warnings, and use of multiple skincare products with potent active ingredients may be taxing on the skin. For a variety of reasons, it’s best to seek advice from a professional.
2. Consider limiting products. Use of too many products containing retinoids can lead to cumulative exposure that may increase the risk of skin irritation and other harms over time.
3. Apply at night. Most retinoids lose efficacy in sunlight and increase skin sensitivity during the day. To bypass this problem, it’s most effective to apply them at night.
4. Wear sunscreen daily. Retinoids increase skin sensitivity to sun damage. Check our EWG’s Guide to Sunscreen for the safest, most effective options.
5. Choose safer products. Use our Skin Deep database or Healthy Living app to identify products that score well. Look for items that bear the EWG Verified® mark, which have been reviewed by our scientists and meet our rigorous standards for health and transparency.