Sun Damage and Hyperpigmentation
 - 
4 minutes

Over-the-counter vs prescription strength: Which retinoid is right for me?

Retinoids are fast becoming buzzwords of the skincare world. Whether you’re familiar with their use or not, you may find yourself wondering – do you need prescription-strength or is over-the-counter OK? We’re here to help clear the confusion.

Written by
Reviewed by
Dr. Ai Nhi Bui
FRACGP, MB.BS (University of Sydney), B.Med Sc (University of NSW)
Disclaimer

What are retinoids?

Retinoid is the term given to a chemical compound that either comes from or has similar properties to Vitamin A.1 There are four types of retinoids: retinyl ester, retinol, retinaldehyde, and retinoic acid. Retinyl ester is the weakest (least potent), followed by retinol, retinaldehyde and lastly retinoic acid, which is the strongest (or most potent).1 This is because only the final type (retinoic acid) actually has an effect on the skin.1 In order to become retinoic acid, the other forms need to be converted, and the order they are converted in goes:

So, if a product contains retinyl ester it has to undergo three steps before it becomes retinoic acid, while retinol only has to undergo two steps, and retinaldehyde is only one step from retinoic acid.1 

What difference does potency make?

The more potent the type of retinoid, the higher its activity – meaning the more effect it has on the skin.1,2

Retinoid may be one of the most effective skincare ingredients you can implement, users often report a ‘worse before better’ experience. Therefore, on the flip side, the more potent the retinoid, the higher the risk of side effects such as irritation, redness or dryness.1,2

As a result, products containing less potent retinoids are available over-the-counter, while those containing more potent retinoids may require a prescription.1 If a product is claiming to contain a retinoid but does not require a prescription, it will contain a less active, but more tolerable type of retinoid.1,2

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How do retinoids work?

As mentioned above, it is retinoic acid that has an effect on the skin.1 These effects include helping to improve:3

  • Skin texture
  • Hyperpigmentation
  • Dryness
  • Fine lines and wrinkles
  • Acne and inflammation
  • Sun damage

Retinoids do this by speeding up cell turnover. This means that they promote the growth of new skin cells and the shedding of old skin cells in the topmost layer of the skin (the epidermis).3 For more information on how retinoids help treat sun damage and hyperpigmentation, see A guide to prescription retinoids.

What should I try first – over-the-counter or prescription retinoids?

You might already be using a skincare product that contains a retinoid. As noted above, if you bought it from a shop or over-the-counter in a pharmacy, it most likely contains a weaker type of retinoid.2 Ask yourself how your skin has reacted to the products you’re using – are you seeing improvements in skin texture, dark spots, or fine lines and wrinkles? Have you experienced any tingling, irritation, or redness? If the answers to these questions are no, consider talking to a doctor or dermatologist to see if a more potent form of retinoid could be right for you. 

How do I transition onto a prescription retinoid?

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Start with the lowest dose possible

In order to limit retinol side effects on skin, products should be introduced with care. Even if you are familiar with using over-the-counter retinoids, it’s important to start a prescription retinoid on the lowest dose possible and gradually increase your dose over several weeks. This will help to minimise skin irritation, which can typically occur in the first two weeks of treatment with prescription retinoids.2

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Moisturise and review your regimen

To avoid the common drying side effects of retinol, moisture intake should be increased. We suggest boosting your moisturiser by adding thicker-textured formulas alongside a retinoid routine.

Retinol and retinoid uglies are not an inherently bad sign – and are for the most part to be expected initially. In the first two weeks, you can mitigate retinol symptoms like discomfort and redness with gentle ingredients like niacinamide and vitamin B5.

Who should avoid retinoids?

It is recommended that retinoids be avoided when pregnant or breastfeeding – this covers both topically applied and oral retinoid options.4 

How do I access a prescription retinoid?

Because they require a prescription, a doctor or dermatologist needs to determine whether a more potent retinoid is right for you. This involves looking at your skin, particularly any areas of concern, and asking about your lifestyle. The reason for this is to figure out how much sun exposure you may be experiencing, as sun exposure can contribute to skin concerns such as fine lines, wrinkles, and sunspots – the very things you might be seeking a retinoid to help treat.3-5 In addition to treatment advice, they may offer advice on protecting yourself from further sun damage by using sunscreen as well as wearing protective clothing and a hat and avoiding sun exposure during peak hour of ultraviolet (UV) radiation.4,6,7

Meeting with a doctor or dermatologist doesn’t necessarily require a face-to-face appointment. Advice is also available virtually through Rosemary Health - start your online visit today.

FRECKLES? SUN SPOTS? WRINKLING?
Talk to a doctor online and get prescription-strength cream for your skin concerns now.
Start Online Visit
References
  1. Motamedi M, et al. J Cutan Med Surg 2022;26(1):71–78.
  2. Milosheska D and Roskar R, Adv Ther 2022;39:5351–5375.
  3. Zasada M and Budzisz E, Postepy Dermatol Alergol 2019;36(4):392–397. 
  4. Chien AL, Kang S. Photoaging [Updated February 2022]. In: UpToDate, Elmets CA (Ed) UpToDate, Waltham, MA [accessed December 2022].
  5. Choudhary S, et al. Cosmetic Dermatol. 2010;23(10):460–466.
  6. Therapeutic Guidelines. Solar Damage and Skin Cancer. August 2022. Therapeutic Guidelines Ltd [accessed December 2022].
  7. Cancer Council. About Sunscreen. Available: https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/about-sunscreen [accessed March 2023].
See more
Sun Damage and Hyperpigmentation
 - 
4 minutes

Over-the-counter vs prescription strength: Which retinoid is right for me?

Retinoids are fast becoming buzzwords of the skincare world. Whether you’re familiar with their use or not, you may find yourself wondering – do you need prescription-strength or is over-the-counter OK? We’re here to help clear the confusion.

Written by
Reviewed by
Dr. Ai Nhi Bui
FRACGP, MB.BS (University of Sydney), B.Med Sc (University of NSW)

What are retinoids?

Retinoid is the term given to a chemical compound that either comes from or has similar properties to Vitamin A.1 There are four types of retinoids: retinyl ester, retinol, retinaldehyde, and retinoic acid. Retinyl ester is the weakest (least potent), followed by retinol, retinaldehyde and lastly retinoic acid, which is the strongest (or most potent).1 This is because only the final type (retinoic acid) actually has an effect on the skin.1 In order to become retinoic acid, the other forms need to be converted, and the order they are converted in goes:

So, if a product contains retinyl ester it has to undergo three steps before it becomes retinoic acid, while retinol only has to undergo two steps, and retinaldehyde is only one step from retinoic acid.1 

What difference does potency make?

The more potent the type of retinoid, the higher its activity – meaning the more effect it has on the skin.1,2

Retinoid may be one of the most effective skincare ingredients you can implement, users often report a ‘worse before better’ experience. Therefore, on the flip side, the more potent the retinoid, the higher the risk of side effects such as irritation, redness or dryness.1,2

As a result, products containing less potent retinoids are available over-the-counter, while those containing more potent retinoids may require a prescription.1 If a product is claiming to contain a retinoid but does not require a prescription, it will contain a less active, but more tolerable type of retinoid.1,2

FRECKLES? SUN SPOTS? WRINKLING?
Talk to a doctor online and get prescription-strength cream for your skin concerns now.
Start Online Visit

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