Prescription retinoids for acne: the options

The 2024 acne guideline from the American Academy of Dermatology (AAD) says that adapalene 0.1 percent gel is available over the counter while other topical retinoids are available by prescription only. That leaves a group of prescription products that people often ask about by brand name: Retin-A, Tazorac, Aklief and others. This guide sorts them by family and reads what each FDA label says about age, directions and pregnancy. It is part of Skinli's guide to retinoids for acne, and it is education and not a substitute for a prescriber.

Which retinoids need a prescription

The AAD says: "For acne treatment, adapalene comes in both prescription and over-the-counter formulations; tretinoin, tazarotene, and trifarotene are topical formulations available by prescription for acne, and isotretinoin is an oral medication available by prescription only for severe acne." The 2024 guideline says four types of topical retinoids, including topical tretinoin, adapalene, tazarotene and trifarotene, are FDA-approved for acne treatment in the US.

The guideline text was read from a copy archived in March 2025. A correction notice was published in July 2026, and Skinli has not seen what it changes.

The products side by side

The table follows the DailyMed labels as read on September 25, 2026. Pregnancy wording differs between sources, and Skinli's guide to retinoids during pregnancy and breastfeeding gives each one in full.

Family	Product	Form	Age on the label	Pregnancy on the label
Adapalene	Differin Gel 0.3 percent	Gel	12 and older	Data are insufficient to establish a risk
Adapalene	Adapalene cream 0.1 percent	Cream	Below 12 not established	Use only if the potential benefit justifies the potential risk
Tretinoin	Retin-A	Cream, gel	Below 12 not established	Use only if the potential benefit justifies the potential risk
Tretinoin	Retin-A Micro	Gel	12 and older	Published studies have not established a risk
Tretinoin	Atralin 0.05 percent	Gel	Below 10 not established	Use only if the potential benefit justifies the potential risk
Tretinoin	Altreno 0.05 percent	Lotion	9 and older	Published studies have not established a risk
Tazarotene	Tazorac	Cream, gel	Acne below 12 not established	Must not be used in pregnancy. Pregnancy test within 2 weeks before starting
Tazarotene	Fabior	Foam	12 and older	Must not be used in pregnancy. Pregnancy test within 2 weeks before starting
Tazarotene	Arazlo 0.045 percent	Lotion	9 and older	Must not be used in pregnancy. Pregnancy test within 2 weeks before starting
Trifarotene	Aklief	Cream	9 and older	Clinical trial data have not identified a risk

Adapalene by prescription

Adapalene has three prescription forms in the labels read: Differin Gel 0.3 percent, adapalene cream 0.1 percent, and the combinations with benzoyl peroxide covered below. The 0.3 percent gel label says to apply a thin film to the entire face and any other affected areas once daily in the evening, and the cream label says once daily at nighttime. Skinli's guide to Differin gel and adapalene strengths covers these products one by one, and its guide to adapalene vs tretinoin compares them with tretinoin.

Tretinoin

Tretinoin comes in the widest range of forms: cream and gel (Retin-A), a microsphere gel (Retin-A Micro, in 0.04, 0.06, 0.08 and 0.1 percent strengths), a 0.05 percent gel (Atralin) and a 0.05 percent lotion (Altreno). Most labels say to apply it once daily in the evening or before bedtime. The Retin-A leaflet says a doctor may advise, especially if your skin is sensitive, starting by applying it every other night, and it says to wait 20 to 30 minutes before applying the medication, because it is important for skin to be completely dry to minimize possible irritation.

Timing on the labels is similar across products. Retin-A says results should be noticed after 2 to 3 weeks but more than 6 weeks of therapy may be required. Retin-A Micro says improvements may be noticed after two weeks but more than seven weeks may be needed for sustained benefit. The 2024 guideline adds that some tretinoin formulations should be applied in the evening because they are sensitive to light, and should not be applied with benzoyl peroxide, so that the tretinoin does not break down and stop working. It says tretinoin microsphere formulations, adapalene and tazarotene lack similar restrictions.

Retin-A Micro lists local skin irritation, including excessive dryness, redness, swelling, peeling, itching, blistering, burning or stinging, and it says to apply a moisturizer. It also says that benzoyl peroxide, sulfur, resorcinol or salicylic acid used at the same time may increase the risk of dryness, redness and peeling. The Retin-A leaflet says the product should not be applied to other areas of the body.

Tazarotene

Tazarotene is the family with the strictest pregnancy rules. The Tazorac cream and gel labels, the Fabior foam label and the Arazlo lotion label all say the medicine must not be used in pregnancy, ask for a negative pregnancy test within 2 weeks before starting, and say treatment should begin during a menstrual period. Tazorac labels advise effective contraception during treatment. The 2024 guideline says tazarotene must not be used in pregnancy, and the AAD lists tazarotene among the medicines to stop if you are pregnant. MedlinePlus says that if you become pregnant while using tazarotene, stop using it and call your doctor immediately.

Tazarotene labels differ on where to apply it. Tazorac gel is indicated for facial acne of mild to moderate severity, and the Tazorac gel label says the safety of use on more than 20 percent of body surface area has not been established. Fabior foam is for the face and/or upper trunk. The Tazorac gel leaflet says to apply a thin layer to cover only the acne lesions, while adapalene and tretinoin labels say to treat the whole affected area.

The Tazorac cream label reports that the most common side effects, in 10 to 30 percent of patients with acne, are peeling, dry skin, redness and a burning sensation. On combining with benzoyl peroxide, MedlinePlus says to apply benzoyl peroxide at a different time of day than tazarotene, and the Arazlo label says to avoid using it at the same time as oxidizing agents such as benzoyl peroxide, or to apply each at different times of the day.

Trifarotene

Aklief is the trifarotene product. It is a retinoid indicated for acne vulgaris in patients 9 years of age and older. The directions call for a thin layer once daily in the evening on clean and dry skin: one pump for the face, two pumps for the upper trunk (the reachable upper back, shoulders and chest), and one additional pump for the middle and lower back if acne is present.

The label recommends a moisturizer as frequently as needed from the start of treatment. It says irritation reached its maximum severity typically within the first 4 weeks and decreased with continued use, and it says to avoid cuts, abrasions, eczematous or sunburned skin, and waxing on treated skin. On pregnancy, the label says clinical trial data have not identified a drug-associated risk, and it also says there are case reports of major birth defects in pregnant women exposed to other topical retinoids that do not establish a pattern or association.

Combination products

Several prescription products combine a retinoid with another acne medicine in one tube. The AAD lists retinoid and benzoyl peroxide products, including Epiduo, Epiduo Forte and Twyneo, and a retinoid, benzoyl peroxide and antibiotic product, Cabtreo. Epiduo Forte (adapalene 0.3 percent with benzoyl peroxide 2.5 percent) is indicated from age 12, Twyneo (tretinoin 0.1 percent with benzoyl peroxide 3 percent) from age 9, Ziana (clindamycin 1.2 percent with tretinoin 0.025 percent) from age 12, and Cabtreo from age 12.

The guideline recommends fixed dose combination topical retinoid with benzoyl peroxide, and fixed dose combination topical retinoid with a topical antibiotic, both with a strong rating on moderate certainty evidence. NICE offers a fixed combination of adapalene with benzoyl peroxide, or of tretinoin with clindamycin, as first-line options. Skinli's guide to using a retinoid with benzoyl peroxide covers combinations in detail.

Oral isotretinoin is a different medicine

Isotretinoin is often confused with tretinoin because the names are close. The AAD calls isotretinoin an oral medication available by prescription only for severe acne, and the NHS says it is a medicine used to treat severe acne, only available on prescription, that must not be taken during pregnancy. The topical retinoids in this guide are applied to the skin. Isotretinoin capsules are taken by mouth and follow their own rules.

Getting a prescription

The AAD says dermatologists prescribe tretinoin, tazarotene, trifarotene and adapalene for acne, and the NHS says a GP or skin specialist can prescribe acne treatments that are stronger than products sold in pharmacies and shops. The labels above turn on pregnancy, age, sun exposure and the other products you use, so those are the facts a prescriber will need from you. If acne is painful, cystic, getting worse, or has not improved after a few months of steady care, see a doctor. NICE says that if mild to moderate acne fails to respond to two different 12-week courses of treatment, referral to a dermatologist-led team should be considered.