Almost every dermatologist is a fan of topical vitamin A. Retinoids, the GOAT of skin care, have been proven to increase cell turnover leading to less clogged pores, more efficient exfoliation,  and a more radiant complexion. They minimize fine lines and wrinkles, increase collagen production, and fade hyperpigmentation. A form of retinoid called tazarotene has even been shown to improve plaque formation and inflammation in psoriasis.

It almost sounds too good to be true, but it isn’t. Mostly. There is one drawback to this wonder substance: skin irritation. Many people experience dryness, skin peeling, and irritation when they start using topical vitamin A.  

Dose

Most dermatologists recommend starting topical vitamin A “low and slow.” For example, start Retin-A at a dose of 0.025-0.05%, use a small pea sized amount, and apply at bedtime every two to three days to start. This gives you time to evaluate how your skin reacts.

Some people will have no problem with retinoids and can slowly increase their usage to every other night or every night and eventually increase their dosage. Others may never be able to do so.

Some people simply cannot tolerate vitamin A on their skin. Luckily, there are non-retinoid options for these sensitive souls. Azelaic acid, tranexamic acid, bakuchiol, and niacinamide are just some of the alternatives that can offer some of the same benefits of retinoids without the irritation.    

Because of the irritation that can occur with topical use of vitamin A, retinoids are not usually used at high dosages. The highest available dose of Retin-A, for example, is 0.1%.

Studies have shown that benefits to the skin are similar between doses of 0.05% and 0.1%. Higher doses work slightly faster but ultimately the end results are the same. If you get the results you want with less risk of irritation, there doesn’t seem to be a good reason to increase your dose of topical vitamin A.

Oral

What about the oral Vitamin A derivative know as Accutane? For intractable moderate to severe acne, it has been used to great benefit. Accutane, also known as isotretinoin, is an oral vitamin A derivative that is known as a retinoid, that is taken for four to five months. Dosage is usually 0.5-1 mg per kilogram of body weight.

Accutane can cause multiple side effects and must not be taken by pregnant women due to a risk of severe birth defects. 90% of people on Accutane develop extremely dry, chapped lips during treatment. Your skin might be more sensitive to wind and sun and be drier than normal. Some people experience a worsening of acne before it begins to improve, and Accutane can cause a temporary increase of lipids (fats) in your blood.     

It might sound like an uncomfortable ordeal you don’t want to go through, but consider that it is the number one most efficacious acne treatment we have available today. It works for most people for many years after treatment, with some enjoying permanent improvement of their acne.

Is Higher Dosage Better?

Possibly. One study was conducted using 1.6 mg/kg of Accutane on cystic acne patients rather than the regularly prescribed 0.5-1 mg/kg. After 5-6 months of treatment, no unusual adverse effects were noted and 100% of the patients were classified as “disease-free.”

Another study showed that higher dose Accutane resulted in a significantly decreased risk of relapse. The only downside was that the high dose study participants had an increased risk of rashes and skin irritation.

This study also suggested that because of the decreased rate of acne recurrence after a higher dose course, Accutane users may end up paying less money if they don’t have to repeat their treatment. Accutane doesn’t come cheap. If you don’t have insurance it can run $200-400 a month. Insurance usually covers it, but depending upon your coverage it could still end up costing a pretty penny.

What About Plain Old Vitamin A?

If the cost of Accutane turns you off, you might wonder if you can just take high doses of regular vitamin A you can find in your local drugstore. Vitamin A is a fat-soluble vitamin, which means that it can build up in your tissues and potentially cause an overdose.

According to the Mayo Clinic, taking high doses of vitamin A over time can cause many health problems such as liver damage, bone thinning, blurred vision, headaches, skin rashes, joint pain, nausea, vomiting, and diarrhea. And, again, vitamin A in high doses can be damaging to a fetus if you’re pregnant.

High dose vitamin A can also interact with many medications, and if you are taking supplements at home without the guidance of a physician, you may not know about potentially dangerous interactions.

One study showed benefits of over the counter vitamin A taken at 200,000 IU a day for four months in one subject with acne. That being said, the subject was monitored by doctors throughout the treatment, and with a study size of one there isn’t great confidence in the results.

Perhaps it merits further study, but until then the many serious risks outweigh any potential benefits, and it is not recommended you take high doses of over the counter vitamin A.

Conclusion

Test out your topical vitamin A with patience and care and stick with the dose that gives you the benefits you seek with the least amount of side effects. Discuss dosage of Accutane with your dermatologist to determine if a high dose might be of benefit to you. And, finally, please leave the treatment plan to your physician and don’t self-medicate at home with vitamin A.

Vitamin A in its many forms is proven to be an invaluable active ingredient to help keep our skin healthy and beautiful. When used correctly, it can be a game changer for your skin.