The world of skincare is full of conflicting information about preventing aging, treating acne, and promoting overall dermatological health. New ingredients and formulations are constantly entering the market, some at very high price points. It is important for providers to look past marketing and guide patients to evidence-based treatments. 

Vitamin A is one of the most researched compounds in the dermatological field and the gold standard for anti-aging and acne treatment (6). This ingredient starts working in the deep layers of the skin and makes changes on a cellular level. This article will explore vitamin A for skin health and give practical advice on incorporating it into skincare routines. This vitamin is effective topically, but adequate dietary intake of vitamin A is also vital for keeping the skin, nails, and hair healthy from the inside out. 

[signup]

What is Vitamin A?

The complex molecule has many forms, including synthetic compounds specifically formulated for the skin. Vitamin A has different classifications and efficacy depending on the structure of the molecule. These molecules undergo several conversions in the skin. The more conversions needed to take effect, the lower the potency. Early in the sequence, the molecule is in the form of retinyl palmitate, which then converts to retinyl esters. The retinyl esters include retinol and retinal. 

Retinol and retinal can be purchased in over-the-counter skincare products. These are not as clinically effective as retinoic acid products but are readily available and cause fewer side effects. If a patient prefers to use a vitamin A skincare product without a prescription, retinal (retinaldehyde) is the most effective ingredient. The final conversion is to retinoic acid, the most potent form of vitamin A. Because this molecule has progressed through multiple conversions, it is much more potent than over-the-counter retinyl esters. 

The most common topical form of retinoic acid is tretinoin (Retin-A). Tretinoin is the only form of topical vitamin A that is officially clinically indicated for treating aging from the sun and improving wrinkles. When vitamin A is ingested through diet, it can be preformed or provitamin A (carotenoid). This is a fat-soluble vitamin stored in the liver.

Vitamin A in Anti-Aging Skin Care

Vitamin A for anti-aging is one of the most impressive applications of the molecule. This vitamin in retinol form is the best treatment available for preventing and treating wrinkles and loss of elasticity. Retinol causes multiple changes in the cellular makeup and structure of the skin that improve signs of aging. The outermost layer of the skin, the epidermis, can become thicker after topical retinol application. This change starts in the basal layer of the skin and works its way up, causing cells to turn over more quickly. This causes epidermal thickening as well as improved cell turnover. Epidermal thickness helps improve the look of the skin. 

Secondly, topical retinol can increase blood vessel formation in the dermis (the second layer of the skin). Improved blood flow means more oxygen is available to the skin cells. Damage from the environment, specifically excessive sun exposure, causes the majority of skin aging. Excessive exposure to the sun depletes the vitamin A levels in the skin. Topical application of this vitamin prevents depletion and protects the DNA of the skin from damage. 

One of the most effective actions of retinol that differentiates it from other skincare is its ability to increase collagen production. The fibroblast cells in the skin help the body produce collagen, which gives the skin its elasticity and structure. Vitamin A works on fibroblasts and causes the skin to produce more collagen (3). 

The rate at which collagen is degraded is reduced, maintaining skin structure and a youthful look. The fibroblasts also produce natural skin moisturizing molecules into the spaces between cells on the outermost layer of skin. This helps the skin appear more hydrated and moisturized. Elastin also improves the elasticity of the skin, and as it becomes damaged over time, topical vitamin A can help the body remove ineffective elastin naturally. It is important to note that because retinol works in the deep layers of the skin, results are not immediate. Retinol takes several months for visible effects, but the results are worth the wait. 

The Role of Vitamin A in Acne Treatment

Retinoids are also effective for acne control and are supported by years of research. Acne can be an extremely distressing condition, especially in adolescence. Severe cases can cause scarring of the skin. Topical vitamin A binds to receptors in the skin and activates certain DNA components. This activation affects the keratinocytes, the cells on the outermost layer of the skin. In acne, these cells do not shed normally and can occlude hair follicles. These excess skin cells and oil (sebum) clog pores, leading to the formation of acne. Specifically, this process causes the formation of a microcomedo (pimple) (3). 

Topical retinols also calm inflammation of the skin, reducing acne breakouts. These compounds lessen sebum production. Sebum is important for skin protection and moisturization, but excess levels can lead to acne. Increased sebum can be caused by androgens, hormones for growth and reproduction. If androgen levels are not balanced, the skin can produce too much oil. Topical retinoids can modulate this process and help return sebum to a balanced amount. The most effective topical vitamin A treatments for acne are tretinoin (Retin-A), adapelene (Differin), and tazarotene (Arazio). Adapalene 0.1% (Differin) was recently made available without a prescription in the United States (3). 

Topical vitamin A can be used alone in the treatment of acne but is often combined with medications that kill acne-causing bacteria on the skin (antimicrobials). The choice of topical retinol and whether to combine medications depends on the type of acne and specific patient needs. Oral synthetic vitamin A, isotretinoin (Accutane), is a treatment for very severe acne. This medication requires extremely close monitoring and should only be used under the guidance of a dermatologist  (3). 

Safe Usage and Dosage

Safe usage of vitamin A requires appropriate intake and dosage. Topical vitamin A is generally well tolerated and safe. Dosages of prescription retinoic acid should be started low and increased based on patient tolerance. Tretinoin topical (Retin-A) dosages range from 0.025% to 0.1%, patients are typically started at 0.025%. For facial application, only a pea-sized amount of retinoic acid is necessary. Topical retinoic acid may be teratogenic, though the evidence is mixed. Most healthcare providers recommend avoiding topical retinol during pregnancy to avoid any unnecessary fetal harm. Oral isotretinoin is an absolute contraindication during pregnancy and can cause severe fetal harm. 

Topical retinols, especially retinoic acid (e.g., tretinoin), can cause some skin side effects. These typically include skin dryness, peeling, and irritation. Though these symptoms may occur initially, as the skin cells develop more vitamin A receptors, the irritation decreases. Proper moisturization after using topical retinols is very important. A moisturizer with no fragrances should be used after the application of retinols. Retinols should not be applied to damp skin as this can increase irritation. Retinoic acid can be used once or twice a week initially and then more often as the skin gets used to the medication.

Vitamin A intake needs vary according to life stage. The recommended amount of vitamin for an adult male is 900mcg and 700mcg for an adult female. This intake can be achieved through food or supplementation. Vitamin A is a fat-soluble vitamin, which means that excessive intake (typically from supplementation) can cause adverse side effects such as headaches and blurred vision. Attention to dietary intake and supplement dosages is very important for this vitamin. 

Dietary Sources of Vitamin A

Dietary sources of vitamin A are also important to consider when promoting overall skin health. Sources of vitamin A include orange, yellow, and green vegetables, fish (e.g., salmon), fruit, organ meats, eggs, and fortified cereal. Plant sources of vitamin A have beta-carotene, a precursor to vitamin A, which is especially effective at scavenging free radicals and preventing inflammation. Excess free radicals cause oxidative stress throughout the body, including in the skin. This oxidative stress causes damage to the cells and is the precursor to many systemic diseases. 

Beta-carotene is an active antioxidant that reduces free radical levels in the body. Proper vitamin A intake is also essential for maintaining healthy vision. Incorporating enough of this vitamin into the diet is important to promote healthy hair and skin from the inside out. If vitamin A intake is low, the outermost skin layer can become rough, and cellular regeneration is reduced. Additionally, collagen and elastin degrade, and blood flow to the skin is reduced. In the absence of adequate vitamin A, the DNA of the skin cells is more susceptible to damage from the environment. Dietary and topical vitamin A work synergistically to maintain healthy skin. 

Functional Medicine Labs for Vitamin A Testing

Assessing vitamin A levels can help functional medicine providers make appropriate dietary and supplement recommendations. Specific testing can assess vitamin and mineral status, such as with the SpectraCell’s Micronutrient Test. Balanced levels of vitamin A are vital across all body systems, including the health of the skin. Certain individuals are most susceptible to vitamin A deficiency, including infants, pregnant women, and individuals with inflammatory bowel disease. 

Vitamin A deficiency may manifest as dry, dull skin and increased signs of aging. In addition, the inability to see well in low-light conditions may develop (xerophthalmia). Anemia and increased risk of infections may also occur if vitamin A levels are not sufficient. Vitamin A toxicity can occur from inappropriate supplement use, and nausea, blurred vision, decreased coordination, and aching muscles may occur. Vitamin A supplementation in pregnancy requires careful planning and dosing because an inappropriate dosage can cause birth defects. 

A high dietary intake of beta carotene from carrots or other orange vegetables can cause the skin to have an orange hue. This condition is not harmful and reverses when intake is returned to normal levels. Testing vitamin A levels can help your functional medicine provider determine if supplementation or dietary guidance is necessary. Measuring levels of this nutrient can help the provider when assessing the overall status of a patient’s health.

Combining Vitamin A with Other Skincare Treatments

Layering skincare treatments can help address different skin care concerns and maximize results. Tretinoin (Retin A) should only be used in a nighttime skincare routine and should be followed by a moisturizer. Nighttime application is best because the vitamin A molecule is sensitive to light. Other active ingredients, such as vitamin C or glycolic acid, should not be used at the same time as this product. Combining active ingredients can increase irritation and make the products themselves less effective. Vitamin C can be used in the morning, and glycolic or salicylic acid can be used on nights when retinol is not applied. Niacinamide (nicotinamide) is vitamin B and can be used with retinol at night to improve skin texture. 

The retinol product should be applied to dry skin, followed by niacinamide, and a moisturizing cream should be applied on top. The use of occlusive moisturizers (such as Aquaphor), a process called “slugging,” should not be layered on top of retinol or other acids. This occlusive layer can cause irritation and dryness. Sun protection is very important when topical retinoids are being used. Increased cell turnover increases sun sensitivity, so protection with sunscreen, hats, and protective clothing is important. 

Vitamin A for Different Skin Types

Retinol is effective for all skin types, including aging, oily, dry, and sensitive skin. It is never too late to start improving skin quality, and vitamin A can provide great results for those with aging skin. For this skin type, starting at a lower potency and working slowly up to a higher potency can help improve signs of aging. Aging skin can be dry, so layering a thick cream on top of topical retinols is beneficial to prevent dryness. 

Topical vitamin A is a great choice for an oily skin type because it regulates sebum production and can reduce the appearance of pore size. Those with oily skin should use a moisturizing lotion after topical retinol. Individuals with oily skin may be tempted to skip moisturizer, but this can cause excess skin redness and peeling. Lotions are typically lighter weight than moisturizing creams and are a good choice for those with oily skin. 

Dry and sensitive skin types should start retinol at a lower concentration and increase their retinol potency slowly. A thin layer of moisturizer can be applied before and after topical retinol to prevent irritation. The product will still be effective, and irritation and dryness will be reduced. Using topical vitamin A in a stepwise approach can also prevent side effects in dry and sensitive skin. The product can be used once per week, then several days a week, progressing to nightly use as tolerated. 

[signup]

Vitamin A For Skin Health: Key Takeaways

Embracing vitamin A for skin benefits can provide great results for individuals with acne, aging skin, and those who want to prevent signs of environmental damage. When used correctly, topical vitamin A is very effective and safe. Optimal intake through a healthy diet and topical application work well together for the best results. Topical vitamin A is the most studied treatment on the market for aging and acne and is an optimal choice for addressing multiple skin concerns.