OTC Retinol vs. Prescription Retinoids: Which Should You Use?

Even though many of us are clued in to the benefits of using retinoids — managing acne, warding off premature aging — exactly which form of vitamin A works best isn’t always so clear. So how do you decide whether to choose over the counter retinol, or to opt for a prescription-strength product? We’ve got the details, based on your skin type and concerns.

Over the counter Retinol Serum by SLMD and prescription retinoid tretinoin

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What’s the difference between OTC retinol and prescription retinoids?

While all of these ingredients fall under the vitamin A umbrella, they differ widely in strength and efficacy. You might already know the difference between over-the-counter retinol and prescription products: store-bought retinol requires a chemical conversion inside your skin cells before it’s available to work its magic. That’s why it takes a bit longer to achieve results.

But while prescription retinoids may work faster, they also carry a greater risk of side effects, including:

  • Redness
  • Irritation
  • Peeling

Typically, any side effects of retinoid use subside after the first month or so of use, but can persist in some cases. It's important to wear sunscreen every day, especially when using a retinoid product.

How to decide which retinoid is best

According to board certified dermatologist Dr. Sandra Lee (aka Dr. Pimple Popper) it’s always better to start with lower concentrations of active ingredients and work your way up if you don’t see results after a few months.

This philosophy works for most common mild to moderate skin concerns that retinoids might address, like breakouts and crow’s feet, for example. Here, we break down which retinoids work best, depending on your skin concern.

Non-inflammatory acne

Commonly known as blackheads and whiteheads, this type of acne typically responds well to a regimen that includes over-the-counter retinol. Look for a formula that’s non comedogenic (try SLMD Retinol Serum) so that it won’t clog your pores and potentially make acne worse.

Inflammatory acne

When clogged pores become a breeding ground for C. acnes bacteria, the skin’s immune response turns into inflammatory acne: papules, pustules, nodules and cysts. Some inflammatory acne responds well to over-the-counter systems that include retinol, like SLMD Acne System, while more severe acne may require a prescription.

Mild to moderate  

Breakouts that are mostly papules and/or pustules can typically be managed with over-the-counter retinol products, along with something like sulfur or benzoyl peroxide (used in the morning). If you’re starting to scar, or your regimen doesn’t make a meaningful impact after about three months, talk to your dermatologist.

Moderate to severe

Deeper acne — especially nodules and cysts — have a tendency to scar. Dr. Lee says that if you’ve tried an over-the-counter routine like Acne System and you’re not seeing much of a change, it’s important to visit your doctor to talk about prescription options. Options here include:
  • Tretinoin: a topical cream or gel available in generic form, commonly known by the brand name Retin-A
  • Adapalene: a topical gel with a slightly different chemical makeup, sold under the brand name Differin
  • Isotretinoin: a very potent vitamin A derived oral medication that requires signing an iPledge agreement under a doctor’s supervision

    Night Light Retinol Eye Cream for well aging by SLMD

    Well aging (preventive)

    Dr. Lee suggests that anyone trying to ward off the signs of premature aging should incorporate a retinol product as soon as possible — while you’re still in your twenties is ideal, though it’s never too late.

    There are many different options on the market, but look for one that’s appropriate for your skin type. Dr. Lee recommends these from SLMD:

    Aging/photodamaged skin

    If you’re already seeing signs of long-term UV damage — like hyperpigmentation, uneven texture/tone, wrinkling and loss of elasticity, it’s definitely time to try a retinoid product. Whether you choose an over the counter or a prescription retinoid depends on your skin type and goals.

    If you’re looking for a product that’s less likely to irritate your skin, Dr. Lee suggests an over-the-counter retinol like those listed above: Retinol Serum, Dream On and Night Light. Be patient, because while you’ll probably see some initial results within two to four months, retinol can take about a year to take full effect.

    If retinol doesn’t meet your expectations, and you’re open to pushing through the initial irritation that prescription retinoids can bring, there are a range of higher strengths that your dermatologist can talk to you about. Tretinoin is the most commonly prescribed retinoid for addressing the signs of aging.

    Dr. Lee’s last word

    Retinoids are an incredibly versatile group of ingredients derived from vitamin A and can treat a whole variety of skin concerns. If you’re looking to manage your acne, or you want to minimize the signs of aging, I usually advise patients to start with an over-the-counter retinol. Give it at least a few months — if you don’t see the results you’re after, talk to your dermatologist about whether a prescription option might work for you.

    —Dr. Sandra Lee

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