Should You Use the Powerful Wrinkle and Acne Cream That You No Longer Need a Prescription For?

Hayley Phelan

Acne-sufferers and fine-line-fretters, rejoice! For the first time ever in the United States, retinoid—a drug proven to effectively treat both conditions—will be available without a prescription, making the path to perfect skin a whole lot smoother.

The U.S. Food and Drug Administration recently approved Differin Gel 0.1% (adapalene), a once-daily topical retinoid gel that has been available by prescription since 1996 for the over-the-counter (OTC) treatment of acne in persons over the age of 12. But the announcement, made on July 8, buried the lede—because, as most of us know, retinoid is also one of the few active ingredients proven to diminish the effects of aging, including decreasing the appearance of fine lines and skin discoloration.

“It seems to be a very fortunate side effect that this medication helps with both pimples and wrinkles,” noted Dr. Doris Day, a leading dermatologist in New York City.  

For the uninitiated, retinoid is a chemical compound related to Vitamin A that has both exfoliating and anti-inflammatory effects. Retinoid works by increasing cell turnover, thereby stimulating the growth of new cells; it also slows the breakdown of collagen, and thickens the deeper layer of skin where wrinkles begin. Because of its exfoliating properties, it helps to decrease the appearance of discoloration caused by aging (ahem, looking at you brown spots) and acne alike. In other words: it’s preventative as well as reparative. It’s kind of like a one-stop shop for your skin.

For the uninitiated, retinoid is a chemical compound related to Vitamin A that has both exfoliating and anti-inflammatory effects. Retinoid works by increasing cell turnover, thereby stimulating the growth of new cells; it also slows the breakdown of collagen, and thickens the deeper layer of skin where wrinkles begin. Because of its exfoliating properties, it helps to decrease the appearance of discoloration caused by aging (ahem, looking at you brown spots) and acne alike. In other words: it’s preventative as well as reparative. It’s kind of like a one-stop shop for your skin.

“I’m delighted that Differin is now available OTC as it is so very similar to retinol, which has been over the counter for years,” said Dr. Gervaise Gerstner.

Indeed, retinoid has a lot in common with retinol, which is already well-represented in the beauty aisle of your local drug store. But while retinol can take up three to six months to produce noticeable effects, retinoid has been shown to work much faster—and effectively—in many individuals. Plus, did we mention it helps unclog pores and can cure breakouts?

“[Differin] is especially useful for those with adult acne who are combatting both [acne and the signs of ageing],” said Dr. Day.

Now you may be thinking, if Differin is so wonderful, how come it took the FDA twenty years to approve it for over-the-counter use? According to Gerstner, this is actually quite typical.

“The FDA always takes a long time as they do their due diligence,” she explained.

Yet there are a few things to know before you pick up a tube at the drug store—particularly if you’re expecting. “Vitamin A oral is Accutane, which can cause birth defects if taken by pregnant women,” said Gerstner. “Differin is topical so there is not this risk but still makes it worth noting. I would not use it in pregnant patients even though it is over-the-counter.” (The FDA recommends that “women who are pregnant, planning to become pregnant, or breast-feeding should ask a doctor before use.”)

More likely (and less scary) is that Differin could cause unwanted irritation or sensitivity, particularly after sun or heat exposure.

“Differin was prescribed to me by my doctor once I developed adult acne,” said Courtney, a 28-year-old who works in finance. “While it did help contain breakouts, it made my skin extremely dry. My skin was constantly peeling. It took a while for my skin to adjust to the strength of the medicine and while the dryness alleviated slightly over time, I found that my skin greatly improved once I stopped using it.”

For some patients, more serious reactions can occur. “I used prescription Differin almost as spot treatment throughout college,” said 31-year-old Jenna, who works at an online retailer. “It worked like magic, zapping breakouts overnight…Then, oddly, in my mid-twenties, I applied the medicine to some burgeoning blemishes, went to bed and woke up looking like Will Smith in Hitch. Two Benadryl and a missed work day later and I was fine. I thought it had been something I ate however the same thing happened again the next time I used the ointment. So then I was done forever.”

In other words, retinoid is no joke: the same properties that make it so effective in treating fine lines and acne, can also have a powerful impact on your skin. Don’t forget this is fundamentally a drug and should be treated with caution.

In order to avoid any mishaps, both Dr. Day and Dr. Gerstner strongly recommend starting off by applying a very small amount and gradually increasing it as your skin adjusts over time. If applying even a small amount every night still leads to irritation, Dr. Day advised, “to start slow by using every other night and building up to every night as tolerated and by using a moisturizer over it at night.” And don’t worry about diminishing its efficacy—when it comes to retinoid, more does not mean more. “A little goes a long way and if they use too much they will have increased risk of irritation but not quicker response to treatment,” said Dr. Day.

After her ordeal Jenna said she would urge friends to “spot test” the lotion before committing to it. “Dab a little bit of the stuff on the inside of your wrist and leave it on overnight. If you experience any sort of reaction, it’s safe to say you probably don’t want to use it on your face.”

Dr. Day also warns that, if combined with other potent skin products—even over-the-counter ones—Differin might be more likely to cause adverse reactions

“Patients should know that this product is in the same category treatment as retinol so they should avoid overlapping products with similar ingredients, especially if they are on prescription RetinA or using over the counter retinol as this can increase irritancy of the skin,” she explained.

Finally, even though you will now be able to pick up Differin without a prescription, a trip to the dermatologists’ office is probably not a bad idea. For one, unless a dermatologist has taken a good look at your skin, it’s easy to misdiagnose yourself. “[Patients] should know that they are treating acne and not another condition such as rosacea or irritation of the skin, which can look like acne,” said Dr. Day.

Even if you’re quite sure you know what you’re dealing with, it’s helpful to get a professional’s opinion. “[Even though it’s available over the counter] I would still prefer to seek the guidance of a dermatologist – that way they can suggest the most appropriate product for your face –and they can monitor the effects,” said Courtney.

The bonus, of course, is that once you get the go-ahead from your dermatologist—just to be safe—it’ll be easier than ever to pick up, and keep re-stocking, the miracle potion.