For Surgeons

Cosmetic Surgery

A perspective on Retinoids

Desmond Fernandes M.B.; B. Ch.; F.R.C.S.(Edin)


Vitamin A has a major function to protect us and has a particularly important role in maintaining normal healthy skin. With the increasing dangers posed by a thinner ozone layer, photo-damage of the skin and skin cancer have become more common and within the next decade or two, every person on the planet will be at risk for significant photo-damage. While sun-screens can give protection , the safety of the skin will depend to a large extent on adequate levels of vitamin A and other antioxidants in the skin. It is conceivable that a major public health programme could focus on replenishment of vitamin A in the skin. For this reason, we have to find a cheap, effective method of replacing vitamin A in the skin. Retinyl palmitate, an ester form of vitamin A offers us the most acceptable way to boost cutaneous levels of vitamin A with the greatest compliance. However, fashion and science have concentrated on the active metabolites of vitamin A or synthetic retinoids. Retinyl palmitate ultimately can be converted into every possible metabolite of vitamin A, so, when used topically at adequate dosage, it affords us the most acceptable, inexpensive method of vitamin A replacement.

Vitamin A is fundamentally one of the most important vitamins because it controls growth and differentiation of all of our cells right from the embryo through to full maturity. Vitamin A really seems to be a hormone derived from the diet and works in concert with other hormones e.g. Thyroid and adrenal hormones. Its effects are most easily observed on the skin because that is the most visible organ of the body and that is the area on which I would like to focus my attention.

Vitamin A is normally found in our skin in low concentration but is absolutely essential for healthy skin. However, vitamin A is rapidly destroyed by exposure to light, so our skin develops a chronic, unrelenting deficiency of vitamin A that manifests as pigmented blotches, wrinkles, thin skin, and pre-cancerous lesions that eventually develop into skin cancer. All of this simply because the skin is not kept at optimum levels vitamin A. Less vitamin A is released from the liver in winter compared to summer. This is most likely a feedback system to maintain healthy levels of vitamin A in the skin . Research is showing us that vitamin A plays a role in the prevention of skin cancer, but we need to know more about how to use it, and which form to use. I believe that in the next 10 to 20 years we will reach a state where topical vitamin A will be required for most of the world’s population to keep their skin’s healthy. This will not be a simple cosmetic, but a infinitive e health measure. Some statisticians have warned that melanoma will occur in one of 70 people born in 2000. We have to address this problem before these dreadful statistics become reality. Therefore we need a preparation a preparation containing vitamin A that people will use regularly with ease and safety.

What is the most suitable form of vitamin A?

If you scan the literature on retinoids you will be confronted by a conundrum: all the research focuses on retinoic acid and efinit and other complex retinoids and there seems to be no research on retinyl palmitate. This is a paradox because retinyl palmitate is the major form of vitamin A in the human body and skin . Surely we need to understand retinyl palmitate and how it affects the skin and the body? More than 90% of the vitamin A that we eat comprises long chain fatty acyl esters of efinit (retinyl palmitate is the most common acyl ester), which are the most stable forms of vitamin A. That must be why they make up more than 90% of the vitamin A in our own bodies.

Retinol is usually regarded as true vitamin A but efinit accounts for only a tiny fraction of the vitamin A in the body. It is also not the form of vitamin A that works on the DNA. Retinoic acid is another molecule reg

26 October 2002