Everyone’s Obsessed With Tretinoin — But I Don’t Have A Prescription

Photographed by Sarah Harry Isaacs.
When 891 million people on TikTok are talking about a specific topical skin-care medication, it makes sense that you're curious and maybe asking yourself, Should I get on tretinoin?
You can't just go out and buy tretinoin; you need a prescription from a dermatologist. That said, if you've scrolled upon tretinoin TikTok recently, you can infer that it's more widely prescribed today than ever before. "I've been prescribing it for 15 years," says NYC-based dermatologist Michelle Henry, MD, "but there's been a constant uptick in interest as people have become more educated about it."
Similar to a skin-care medication like Accutane or spironolactone, tretinoin requires a doctor to write you a pharmacy prescription and teach you how to use it safely and accurately. But unlike Accutane or spironolactone (a diuretic used in the treatment of chronic hormonal acne), tretinoin is not an acne-specific medication. It treats acne in some people, but also helps treat fine lines and wrinkles, uneven skin tone, and reduces hyperpigmentation by blocking tyrosinase (an enzyme that helps create skin pigment) — benefits that make it transformative for a wider range of people than just those with acute acne concerns.
However, tretinoin's rise in popularity has divided opinion among skin-care experts. "I don't think tretinoin should have gone viral on TikTok," says Alicia Lartey, a London-based esthetician. In fact, she feels it is "irresponsible of influencers" in particular (the majority of whom she says have no background in skin care) to promote it. Why? Well, not many people are educating about the downsides, like the fact that this stuff is really strong and of course, not accessible for everyone.
So here's the real tl;dr on prescription tretinoin — and the best alternative OTC option if you want to avoid a copay.

What is tretinoin?

Tretinoin is topical retinoic acid, a vitamin A derivative that increases skin cell turnover. It's the most potent topical retinoid (more on that below). It helps to shed dead skin cells and encourage the regrowth of newer, younger skin cells. In that process, it can do a number of things. "Tretinoin helps treat acne, signs of aging, skin texture, and pigmentation," explains Lartey. It also stimulates collagen synthesis. Consultant dermatologist and British Skin Foundation spokesperson Dr. Adil Sheraz adds that tretinoin can improve skin elasticity (making it smoother and more plump) and help to achieve an even skin tone.

What's the difference between tretinoin, retinol, and retinal?

To understand exactly how tretinoin works, it pays to know about the pyramid in which it sits. Dr. Sheraz explains that tretinoin comes from the retinoid family, which includes a number of different forms, all widely available in topical skincare products. In order of potency it goes: retinoic acid (tretinoin), retinal, retinol, then retinyl palmitate.
Prescription tretinoin sits at the top of the pyramid. "It's the most potent form of a topical retinoid," explains Dr. Sheraz. Compared to retinal and retinol, both of which have to go through enzymatic processes of conversion, tretinoin is stronger and more active right away, so it works faster. There are several different Rx brands of tretinoin dermatologists prescribe; Altreno and Retin-A are two of the most popular, but it's also common to receive the generic version.
Below retinoic acid, there's retinaldehyde, also known as retinal. This ingredient has become increasingly popular over the years and, unlike tretinoin, it's available over the counter. For example, Peach & Lily, Youth To The People, and Naturium all offer over-the-counter versions of retinal. Without putting you through a science lesson, Dr. Sheraz explains that retinal is "converted" in your skin cells so that it becomes active and is able to perform its job. This enzymatic conversion process means that "[retinal] is weaker than tretinoin but stronger than retinol," explains Dr. Sheraz. Retinal is Lartey's preferred over-the-counter retinoid. "It also has an antibacterial property," she says, "which is great for those managing acne."
Underneath retinal, you'll find retinol. "This requires multiple conversions in the skin [for it to work] and is significantly weaker than tretinoin," says Dr. Sheraz. That's not necessarily a bad thing. "As it's less potent, it's less of an irritant, and it can be bought over the counter."
At the bottom of the retinoid pyramid, you'll find retinyl palmitate. This is the weakest form of retinoid and often the cheapest as well. Like retinal and retinol, retinyl palmitate is present in OTC skincare and while it's less potent and effective, some people prefer it. "Some people get better results using a less effective form because it doesn't irritate their skin as much, so they're more likely to use it more often," cosmetic chemist Randy Schueller of The Beauty Brains told R29.
Put simply, tretinoin is the most powerful of the four, though it's available at different concentrations, some much stronger than others. "Tretinoin is available in various strengths, both as creams and gels," explains Dr. Sheraz.

Who is tretinoin good for?

In her NYC practice, Dr. Henry prescribes tretinoin daily to a "wide range" of people. Some people use prescription tretinoin to treat adult-onset acne. "I have some patients who are oily, some who are acne prone," explains Dr. Henry, "but some [tretinoin patients] don't have acne at all. I have sensitive-skin patients who still want to derive those benefits who come to me for counsel on how to choose the right tretinoin formulation."
For people who are using tretinoin for the treatment of fine lines and wrinkles, Dr. Henry says that their skin-care routine may be very simple. "If someone's coming in for treatment of fine lines and wrinkles, they may just be on tretinoin and moisturizer and sunscreen and that's it," Dr. Henry explains, adding that it's really a case-by-case conversation. "Some patients on tretinoin are looking for a more sophisticated regimen depending on their skin concerns."

Where can you get tretinoin?

Don't buy tretinoin online. You need to see a dermatologist or healthcare provider for a tretinoin prescription. “It's a prescription because of the strength and the need for someone with more expertise to guide you in using it,” explains Dr. Henry. If you have access to a dermatologist, they will likely be able to prescribe you tretinoin if you're a good candidate.
In Dr. Henry's New York practice, she prescribes some form of tretinoin every day. The main reason someone might not be a good candidate is if they can't tolerate any form of retinol. However, today there are more low-strength tretinoin options. "There are lower concentrations, made with ingredients, like ceramides [and] hyaluronic acid, that really make it more tolerable so that it's an option for more people," explains Dr. Henry. The lowest prescription concentration of tretinoin is 0.01%, which could be just fine for someone with sensitive skin.
Getting to a dermatologist might not be feasible (which we'll speak to, ahead). Some newer personalized online dermatologist services such as Skin Medicinals and Agency may prescribe tretinoin. However, an extensive digital consultation with a qualified dermatologist will always have to take place first. In some cases, it's also recommended that you check in with your prescribing dermatologist on a regular basis.

How do you use tretinoin?

This is where you have to be careful. If you see someone on TikTok apply tretinoin like they would a moisturizer, that is wrong and dangerous. According to dermatologist, you only need a pea-sized amount to cover your entire face. Dr. Henry recommends the "sandwich method" of application: "You put moisturizer on first, then your medicine [tretinoin], then more moisturizer." Use it sparingly and only at night, avoiding sensitive areas, like around your nose, lips, and under eyes. “Start out every other night, maybe twice a week, then slowly increase as you tolerate," explains Dr. Henry.
In terms of the rest of your skin-care routine, Dr. Sheraz recommends that other "active" products be cut out for the time being. This includes any other retinol-based products and acids, as well as benzoyl peroxide.
Dr. Sheraz adds that when you are prescribed tretinoin, your dermatologist or doctor should always check that you have a good understanding of how to properly moisturize your skin. Though this may seem basic, retinoids can make skin feel dry, flaky, and uncomfortable, so getting your moisturizer right is a must. Look for gentle, hydrating, and soothing ingredients such as hyaluronic acid, glycerin, shea butter, and panthenol. Prescribers will also check that you're using a broad-spectrum sunscreen in the daytime, as retinoids make skin extra sensitive to harmful UV rays.

What are the downsides of using tretinoin?

The biggest downside to tretinoin is, you probably guessed it, skin sensitivity and inflammation. "It can result in significant irritation, redness, peeling and inflammation in certain individuals," explains Dr. Sheraz. If you've tried OTC retinol in the past and you're sensitive to it, you can expect to be sensitive if you switch to tretinoin, because it's even stronger. It's also important to note that due to its drying effect, tretinoin can occasionally cause eczema flareups. "This is why a substantial moisturizer should always be used alongside it," says Dr. Sheraz. Another disclaimer: Like retinol and retinal, tretinoin can't be used if you're pregnant.
Another obvious downside is the cost.

How much does tretinoin cost?

Dr. Henry explains that it's tricky to generalize cost because it's an individual insurance equation. "The range could be between zero dollars to $200 depending on the insurance plan, pharmacy insurance copay, and the type of tretinoin," explains Dr. Henry. Moreover, we have to note that access to a dermatologist is not always possible, which is a barrier to entry with prescriptions like tretinoin.

What are the alternatives to tretinoin?

If you're looking for what would be the closest alternative to tretinoin that you can get without a prescription, it's Differin Gel. “Differin is probably one of the robust options you can find over the counter," explains Dr. Henry. "That's what I recommend." Differin was FDA approved in 2016 for over-the-counter use. It's 0.1% adapalene — adapalene is an active form of retinoic acid — and has been widely considered a "game changer" in the topical skin care space.
According to the aforementioned pyramid, over-the-counter retinal would also be a good alternative — not as strong as retinoic acid, but stronger and faster than retinol. If you're super sensitive, Dr. Henry says you could also try an alt retinol like bakuchiol, or a serum or cream rich in peptides. "Peptides are similarly going to help stimulate collagen, get rid of fine lines and wrinkles, and help to improve facial scarring," explains Dr. Henry. "The side effect profile is really great, too."
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