And to keep our legal department happy... this guide is not medical advice. It is intended to let you know which options are out there. Always consult a licensed doctor before pursuing any prescription (I mean, a doctor would have to prescribe it regardless, but we have to cover our backs here)...
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PERSCRIPTION TOPICALS
We already went on a deep dive on retinoids a few months back, but here's a quick recap and a few other topicals that may suit your skin's needs.
Tretinoin is the gold standard for treating acne and anti-aging. Adapalene (differin) is a slightly gentler version. Lastly over-the-counter (OTC) retinols found in serums and creams is the distant well-meaning cousins (honestly, don't bother with this one). But retinoids aren't the only thing behind the counter, and they don't suit everyone:
Azelaic acid: We mentioned this ingredient in our redness and irritation piece. While the gentler OTC version works great for most people, for stubborn or severe rosacea or hyperpigmentation ask your doctor about the prescription strength (15-20%). In addition to clearing redness, this is a great option for acne if you can't tolerate retinoids.
Combination creams: combining retinoids and anti acne treatments like benzyol peroxide used to be a big no-no (as they neutralize each other). But thanks to the geniuses in big-pharma they have now formulated combination creams using encapsulated forms of the active ingredients, Epiduo is the most common one and it helps clear active acne faster than typical retinoids.
ISOTRETINOIN: THE HYDROGEN BOMB
So it's come to this. Nothing's working, or it works until it doesn't and the breakouts keep coming back well into your 30s. This is where the dermatologist reaches for isotretinoin.
Isotretinoin (aka accutane) is not a stronger cream, rather it's a concentrated pill of vitamin A (the same molecule as topical retinoids) that is strong enough to rebuild your skin from the inside. It permanently shrinks the glands in your skin that produce oil, and it's the only proven treatment that can put a permanent end to acne once the course is done.
It's a pretty serious commitment, the usual treatment involves 5-8 months of a daily pill. You have to take a blood test every few months to keep an eye on your liver. Expect it to get worse (in terms of breakouts) before it gets better.
Somthing that's been making the rounds among private dermatologists is the so called "hollywood regimen." which involves perscribing "microdoses" of isotretinoin. It involves a lower-concentration daily or weekly pill that still clears the skin with fewer side effects.
So why isn't everyone on this seemingly magical pill? Because of the next section...
THE FALLOUT
Retinoids are tightly regulated for a reson, and it goes well beyond dryness and irritation, that can be managed with a thick cream. A few things to weigh in before you say yes...
Vitamin A (topical or pill) can lead to severe birth defects. Female patients are held to strict pregnancy prevention programs with regular testing. While men don't pass the risk on, they can't donate blood during the course.
Along with the blood test to monitor vitals, your doctor will also check for mood changes. Whether the drug actually causes depression or anxiety is unsettled, this is something you want to keep track of and tell someone if it changes.
The "purging" phase is also more severe when taking the oral pill. Lips crack first so you need to be religious about chapstick several times a day. You're also more prone to nose bleeds and dry eyes, so contacts can become a nuisance. While we hate rules at Narcyss, for medical treatments some things are non negotiable:
And to close out so this entire piece doesn't read as a puff-piece for big pharma (though we do love the innovation they have brought to skincare)... For a fair share of people, especially at the microdose, the acne comes back after a while, so people switch back to a topical retinoid once they've healed. Even the nuclear option may bring you right back to the top of this letter... sorry!
As above: informational purposes only, not medical advice. Consult a licensed healthcare professional before starting or changing any prescription treatment.
