Retinoids: the backbone of acne care

If acne treatment has a single workhorse, it is the topical retinoid. Derived from vitamin A, retinoids normalize how skin cells shed, which keeps pores from clogging in the first place, meaning they treat existing acne and prevent the next wave.

Adapalene (now available without a prescription) is the gentlest and a sensible starting point. Tretinoin is stronger and prescription-only. Both work, and both come with the same early hurdle: a few weeks of dryness, flaking, and sometimes a temporary worsening as deeper clogs surface, the so-called purge.

The way through is technique, not toughness. Start two or three nights a week, apply a pea-sized amount to dry skin, buffer with moisturizer, and increase frequency slowly. Daily sunscreen is non-negotiable because retinoids increase sun sensitivity. Going slow also protects the skin barrier, which is the other half of getting clear; see how to treat acne without wrecking your skin barrier for the full picture. Most people who quit retinoids do so in week three, right before the results begin. The patients who win are the ones who treat the first month as setup, not failure.

Related reading: Why your acne came back in your 30s.