Are Higher Doses of Retinoids More Effective?

I've been using 0.05% tretinoin cream for 5 months, and my mild-moderate acne still hasn't cleared up as desired. When I asked my dermatologist about increasing the dose to 0.1%, she dismissed it saying "I don't find higher doses more effective", and went on to suggest accutane. Was she correct? Or should I give retinoids another shot before using accutane? If so, should I try a different retinoid (adapelene or tazarotene) or just a different strength and formulation of tretinoin?

Doctor Answers 3

Higher retinoids aren't always a better option

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Even though many patients think a stronger or higher dose is better and will clear up acne faster, your physician is correct - it's not always the best choice. Accutane, by far, is my leading drug of choice to treat acne. I have been prescribing it for nearly 30 years. I've taken it myself, I've written it for nearly every member of my family, and I've had tens of thousands of patients on it. While retinoids can be effective, it is often not enough to just treat acne topically. You can try a different formulation, and there are a lot on the market, but if your acne isn't clearing up like you and your physician desire, it seems a topical treatment may not be enough for you, and something oral, like Accutane might be a better bet.

Think there are a lot of options between a mid-potency retinoid and accutane...

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for mild-moderate acne, a higher dose of Retin-A might work but you can improve your odds with some other topicals including a benzoyl peroxide and maybe some of the other available salves...and then there are antibiotics...while some doctors may blithely prescribe accutane, it's important to realize that it's the only acne medicine that requires a signed consent, acceptance of the possibility of a wide array of side effects and regular blood tests...just go online and look at the number of adverse reactions and lawsuits involving the appropriate cases it's a good option, but in my experience it's prescribed too frequently

Ken Landow, MD
Las Vegas Dermatologist

Topical Retinoid Strength is Patient Dependent

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When prescribing a topical retinoid, a patient's skin type and current acne regimen are critical factors in  deciding which retinoid is the "best fit."  Patients with oily skin can usually tolerate a higher strength Retin A and even the more potent Tazorac.  However, patients with dry or sensitive skin may respond best to a more mild retinoid-like medicine such as Differin.  Also, as patients use topical retinoids for prolonged periods, the skin can develop tolerance to the retinoid and a more potent topical retinoid or higher percentage may be tolerated.  As always, I recommend having a board certified dermatologist evaluate your specific condition so an optimal treatment plan can be devised.

Anthony Perri, MD
Houston Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.