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Today we're talking prescription retinoids and who might need them! If you don't know about retinoids, I've done a ton of content on them here, so I won't rehash it, but in short: they're you're well-ageing must-have, with the ability to boost collagen production, increasing skin cell production and actually improve the look of existing fine lines, plus they're great for texture, scarring and uneven skin tone. Retinol and other similar products you can buy from beauty counters and websites are cosmetic formulas, but prescription options are also available, so I wanted to dive into what the deal is with them, the pros and the cons and hopefully help you decide if they're right for you...
There are two main kinds of prescription topical retinoids (isotretinoin or 'accutane' is an oral medication prescribed for severe cases of acne - this is a whole other kettle of fish that I'm not going to discuss because I'm not a doctor): ones aimed towards treating acne (namely, adapalene and epiduo, which combines adapalene with benzoyl peroxide) and ones more geared for well-ageing (namely, tretinoin). Retinoids were originally developed for acne and their well-ageing benefits were a happy accident. Both adapalene and tretinoin are forms of retinoic acid, meaning your skin doesn't have to convert them like it does retinoid, and potency is reduced with each conversion. In short: prescription retinoids are far stronger than what you get with a cosmetic product. For this post, we're focusing in on tretinoin, as it's the most accessible prescription retinoid here in the UK without you having to get a GP referral for acne (I know adapalene is available over the counter in the US) and my own personal use of retinoids is in the well-ageing sense.
Every country will have its own versions of this, but here in the UK, the main channels are Dermatica and Skin & Me. You log on, complete a questionnaire on your skin goals and to see if you're a suitable candidate (for example, retinoids are not suitable for those who are pregnant or breastfeeding so if you fall into this category, you'll be declined), you upload some photos of your skin and a dermatologist will review the information and create a prescription for you. Typically there will be a secondary active in the formula that's geared towards the skin concerns you've highlighted, such as hydroquinone (which is used for short periods of time on very stubborn discolouration) azelaic acid or niacinamide. You will receive your formula on a subscription basis for around £20 / month and it will contain the exact amount you need to cover that period with nightly use. You will usually be started on a 0.025% concentration and moved up month by month.
The pros are pretty obvious: this is an easy, relatively affordable way of accessing the most potent, most proven form of retinoid there is. If you have stubborn discolouration or you're over 40, it's likely that you'll see the most visible, impressive results with a prescription formula.
For some, it also simplifies the actives in their skincare routine; rather than having to wade through buzzy ingredients, confusing marketing and unclear percentage concentration claims, you just have one formula that does it all. The only other things you have to worry about are cleansing, moisturising and using sunscreen during the day. This is inherently appealing to those who want to look after their skin and see results without having to do the level of deep-diving into cosmetics that I get into on this blog.
For me, the main con was the inflexibility of the regimen. If you want to gradually introduce your formula in before making it a nightly thing (focusing on nourishment and your skin barrier on 'off' days), you're wasting product that will expire and more will be on the way by the end of your 4-week period. If there are other actives you want to use, such as an exfoliant, then you can't really use it, or you have to apply it during the day only (if your skin can even hack it).
This leads quite nicely into the other negative: it's rough going, at least for the first month or two. Even if you've used cosmetic retinoids and had no issues with them, you will probably find your skin feels dry, tight and easily-upset for good while as it adapts to tretinoin. Some even experience full-on peeling. Whilst it gets better with time, my skin never felt truly 'at peace' on tretinoin, to tell you the truth!
If you're looking at prescription retinoids, retinol esters and most standard retinols probably aren't going to be punchy enough for you. Instead, I prefer retinal / retinaldehyde, which requires just one conversion to become retinoic acid. It's one step down from tretinoin but comes in cosmetic formulas that feel easier to fit into my skincare routine and are nowhere near as drying.
Used every night, one of these serums should last you three months, for a price comparison. I personally enjoy:
This is a bit of a cop-out because only you can answer that question! Obviously, if you're pregnant or breastfeeding; you're out of the game. If you're under 30 and generally happy with your skin, it might not be worth it for you. If you've previously had significant acne and scarring or discolouration or melasma, it probably is worth looking into. If you're in your mid to late 30s, it's probably worth considering, particularly if you weren't quite so hot on the sunscreen back in the day.
But, ultimately: this is a prescription treatment for a reason, so no - it isn't for everyone! I find it a little puzzling when people in the skincare sphere are so hellbent on tretinoin being the be-all and end-all of skincare and tell you you're wasting your time if you use anything else. Nuance, please. People who are experiencing quite a bit of discolouration or photo-ageing are going to see some great results if they can stick it out, but not everyone is going to want to do their skincare in this way, and for some people the negatives might outweigh the benefits. Personally, I am happy with my retinal for now, but I think within the next few years, I will try to shift permanently to tretinoin. Whether I can hack it or not is another story entirely...
Do you use a prescription retinoid in your routine? Why / why not?