Is it Time to Upgrade from your OTC Retinoid to Tretinoin?

Thinking about switching from over-the-counter retinoids to prescription tretinoin? Here’s what you need to know about the key differences, benefits, and potential downsides to find out if making the jump is worth it for your skin.

Look, I get it. When it comes to skincare, it’s tempting to jump to the strongest, most potent version of any ingredient. And with prescription retinoids getting easier to obtain (I got mine from an online pharmacy after a simple video consult), it’s easy to wonder if you should skip all those over-the-counter (OTC) products and just go straight for the hard stuff.

When I made the decision to switch to prescription tretinoin earlier this year—after years of using OTC retinoid products—I was surprised by how…umm, tricky…the transition ended up being. Turns out, despite my status as a retinol veteran, my skin was still woefully underprepared for the real step-up in potency that comes with a switch to the prescription stuff. For the first time in my life, I ended up with a damaged skin barrier, uncontrollable breakouts, itchiness, redness—all at once. It took me months to recover from the damage.

But here’s the good news. There was light at the end of this nightmarish tunnel for me, because I was able to eventually claw my way out of retinoid purgatory by taking a safer, more skinimalist approach to my skincare. Lucky for you, I’m here to share all the mistakes I made, so you can decide if a prescription retinoid is right for your skin, and how to incorporate it safely into your skincare routine.

But first, the basics: What’s the difference between OTC and prescription retinoids?

I’ve written a much more in-depth blog post about the different kinds of retinoids, and some good OTC product options for each, so do check that out if you’re totally new to this. But, in short, there are 4 kinds of retinoids that are currently popular and fairly easily available in most markets. They are:

Retinol (with an ‘o’): The most common retinoid in OTC products, it has to first be converted to retinoic acid (the active form of vitamin A) through a two-step oxidation process before it can fully be absorbed by your skin.

Retinal (with an ‘a’): Also known as retinaldehyhde, this increasingly popular OTC retinoid is a step closer to retinoic acid in terms of potency, requiring fewer conversions in the skin to become active. This makes it more effective than retinol, and potentially less irritating too.

Adapalene: Formerly prescription-only, adapalene is a synthetic retinoid that’s now available over-the-counter in many countries. Like other retinoids, it provides anti-aging benefits, but is much more widely used for its acne-fighting properties. It is already in an active form.

Tretinoin: The gold standard of anti-aging, tretinoin is a prescription retinoid that is highly effective for treating acne, reducing hyperpigmentation, and improving skin texture. It requires no conversion in the skin to become active.

The main difference between them all? To put it simply, most OTC retinoids need to be converted to the active form of retinoic acid before they can be absorbed by our skin. A prescription retinoid like tretinoin, on the other hand, is already in the active form. That means it works faster, potentially goes deeper into your skin, and can, in theory, provide quicker, more dramatic results. But, of course, there’s a catch. For most people, the prescription stuff is harsher, and far more irritating, especially at first. Some people with especially sensitive skin can never get used to the potency of a prescription strength retinoid, so it’s important to make sure your skin’s ready before making the switch.

How to know if a prescription retinoid is right for you

So, how do you know if the retinoid risk is worth the retinoid reward? Here are a few things I considered before stepping up to prescription strength:

• Exhaust your OTC options first: I don’t care what anyone says, jumping straight to prescription strength is a big no-no in my opinion. Tretinoin is something I worked my way up to only after using OTC retinol, retinal and adapalene first—and over a period of roughly 6 years. I started with the lower strength stuff, slowly building up my skin’s tolerance, making sure that I could use these products consistently without irritation. I only reached for a prescription when I felt like my results were plateauing.

• Evaluate your skin type and tolerance: If you have sensitive or dry skin, proceed very cautiously, and test out how your skin reacts to an OTC retinoid first. Start with lower concentrations, 1-2 times a week, and if your skin can’t come to terms with it, try the sandwich method of layering a moisturizer before and after your retinoid. If your skin still feels irritated, a prescription retinoid may just not be for you.

• Consider your skin goals: There aren’t a lot of actives that play nice with prescription retinoids, so be prepared to get rid of most other products—including AHAs, BHAs, and vitamin C—from your night-time skincare routine (and yes, please only use tretinoin at night!). If this isn’t something that works for your current skincare goals, I would reconsider if this is the right next step for you.

What if my skin never gets used to retinoids? If you’ve taken a safe and slow approach into retinoids, starting with low-grade, low-irritation ones (like retinal), and your skin just can’t get used to them, then maybe retinoids aren’t for you. The truth is that not everyone can handle retinoids—OTC or prescription—and that’s ok! There are plenty of alternatives which you can include in your routine instead—including: Bakuchiol (often called vegan retinol), peptides, and vitamin C—all of which offer anti-aging benefits, and can be far less sensitizing. Do what’s right for your skin.

How to get started with a prescription retinoid (without destroying your skin)

If like me, you’ve thought through all the concerns above, and have decided that a prescription strength retinoid is the right next step in your skincare journey, then let’s get ready for the tricky part. Here are all the things I wish someone had told me when I first got started with tretinoin. The lessons learnt from the major mistakes made. How you start with a prescription retinoid will determine how your journey with it goes, so these are some things you can do to make the transition easier:

• Start low and slow

  Most derms will prescribe the lowest percentage of tretinoin for first-timers (usually 0.01%), and no matter how experienced you think you are, I encourage you not to go for anything stronger. I started at 0.025%, and well…you know the rest. Cap the frequency of usage to about 2-3 times a week at most in the beginning, even if you were previously using an OTC retinoid every night (yep, been there too). Gradually increase the frequency of usage IF YOU NEED IT. Today, after nearly a year of usage, I use my prescription retinoid on every alternate night.

• Make sure your skin is completely dry before you go in

  For me, applying tretinoin first thing after cleansing has worked best, and there’s a reason for that. Applying it on damp skin can cause it to absorb faster than your skin can handle, and intensify irritation in the process. I wait about 5-10 minutes after washing my face, so my skin is absolutely dry before I apply tretinoin. The one exception to this rule is if you have extremely sensitive, dry skin and you’re using the sandwich method, which involves applying a moisturizer as a buffer before your retinoid to slow down its absorption (yes, it’s confusing, I know). In that case, make sure you’re using a thick, occlusive moisturizer before your retinoid.

• Apply the thinnest layer you possibly can

  You may have heard people talk about applying a “pea-sized” amount, and they’re absolutely right. Retinoids are not like moisturizers that have to be slathered on, all you need is enough to cover your skin with a thin layer. Seriously, a little goes a long way with this stuff, so get some peas out of the freezer to measure how much you need if you have to.

• Choose the right moisturizer to follow-up with

  Everyone tells you to follow your retinoid with a moisturizer, but which moisturizer you follow up with is just as important. I’ve found the best combination is usually a gentle formulation that’s hydrating (of course), but also packed with calming, soothing ingredients. Here are my current favorites:

PURITO Oat-in Calming Gel Cream

This is a great choice for those with oily, acne-prone skin. As the name suggests, the primary ingredient in this ultra-lightweight moisturizer is 77% oat seed water that hydrates and soothes dry, sensitive skin. Additional hydrating ingredients include panthenol, squalane and beta-glucan.

DR.G Red Blemish Clear Soothing Cream

If you like the feel of gel moisturizers but want something just a little bit heavier than Purito’s, then this soothing cream from Dr. G with 10 different types of cica extract(!) is a great option. Niacinamide, beta-glucan and a host of fermented ingredients round out a simple yet effective ingredient list.

CUREL Intensive Moisture Cream

This simple yet nourishing moisturizer from Curel has the light and airy consistency of whipped cream and is formulated using their patented Ceramide Care Technology. Designed specifically for dry, sensitive skin, this lightweight moisturiser intensely nourishes and comforts your skin.

• Strip down the rest of your routine

  On my tretinoin nights, my routine goes something like this: tretinoin, followed by a barrier support serum, followed by a moisturizer and an eye cream. That’s it, no other actives, no other anti-aging serums, definitely nothing else that can sensitize my skin. And to be honest, I don’t need anything else either. Tretinoin single-handedly fights all my skin concerns, so I don’t need anything more to supplement it.

• Sunscreen is non-negotiable

  All retinoids make your skin especially sensitive, and tretinoin is the mother of all retinoids—so expect the mother of all sun sensitivity the day after you use it. For maximum protection, make sure you apply at least SPF30 religiously during the day (and re-apply it every 3-4 hours if you’re going to be outside).

• Long-term consistency over short-term results (and irritation)

  I started this post by talking about how tempting it can be to rush headfirst into the world of prescription retinoids, and I’ll end this post with the same wisdom. Starting slow may not give you immediate, dramatic results, but it will give your skin the chance to acclimatize to this new and potent ingredient. That’s what you need to aim for. Targetting the big results led me into a vicious start-stop cycle, where I’d use my prescription retinoid for a couple of weeks, and then have to take a break from it for a couple of months because of how bad the irritation got. Today, I can use it every alternate night, without the side effects, and it’s because I prioritized long-term consistency over short-term results. I hope this post helps you do the same.

About The Skinimalist

Hi, I’m Mal, a 30-something recovering skincare addict, and this is my blog. A space where I attempt to de-influence you from chasing trends and buying more skincare products you may not need.

Related Posts: