Prescription-strength actives do things retail skincare cannot, and need a prescriber, an introduction plan and a review.
Some skincare actives are prescription-only because they are strong enough to require oversight. Tretinoin is the clearest example: unlike over-the-counter retinol, it is already in its active form, which makes it considerably more effective and considerably more likely to irritate if introduced badly.
Prescription-strength pigment inhibitors are the other main category. They can achieve results retail products cannot approach, and they need defined treatment periods, monitoring and a clinician reviewing your skin rather than indefinite use.
At Dr Ellie Sateei’s London and Sevenoaks clinics these are prescribed following a face-to-face consultation, as the law requires, and reviewed rather than issued once. Results vary between individuals.
Tretinoin acts directly on skin cell turnover and on collagen production. Over months it improves texture, fine lines, pigmentation and acne, and it has the strongest evidence base of any topical in dermatology. The reason it is not universally used is tolerance: started too high or too often, it causes dryness, flaking and irritation, and most patients who abandon it were introduced to it badly rather than unsuited to it.
Dr Sateei’s approach is to start at a strength and frequency your skin will tolerate, often twice weekly rather than nightly, and increase deliberately. The first four to six weeks involve an adjustment period which is expected rather than a sign of failure.
Prescription pigment inhibitors work by interrupting melanin production. They are effective and they are not for indefinite use, which is why a defined course and a review date matter, and why buying them without oversight is a poor idea.
Neither works without daily broad-spectrum sunscreen. Pigmentation treated without photoprotection returns, reliably, and no prescription changes that.
It may suit you if you are looking to:
Prescription products are not suitable during pregnancy or breastfeeding. Tretinoin in particular is contraindicated, so tell Dr Sateei if you are pregnant, planning pregnancy or breastfeeding so your routine can be adjusted.
Your consultation includes a clinical skin assessment, a review of everything you currently use, and a written plan setting out what to apply, when and in what order. Where prescription products are appropriate they are prescribed at that appointment.
Retinoids commonly cause dryness, flaking or mild irritation in the first four to six weeks. That is expected, it is managed by adjusting frequency rather than stopping, and it is the main reason supervision helps.
Texture and clarity typically improve over eight to twelve weeks. Pigmentation is slower, often three to six months. A review at eight to twelve weeks assesses response and adjusts the plan.
“Almost everyone who tells me they cannot tolerate tretinoin was started on too much, too often, by somebody who did not follow up. Twice a week at a low strength, building slowly, and most people get there. It is the single best-evidenced thing I can give you for your skin, it costs a fraction of what a course of treatments costs, and it is the least exciting conversation in the room.”
Dr Ellie Sateei has over two decades of experience in dermatology and aesthetics.
Yes. Prescription products require a face-to-face consultation, as the law requires. The consultation is £195 and is deducted from treatment on the day.
Retinol needs converting within the skin before it becomes active. Tretinoin is already active, which makes it considerably more effective and more likely to irritate if introduced badly.
Usually yes. Most patients who abandoned one were started too high or too often. Starting at a low strength twice weekly and building slowly works for the great majority.
Texture and clarity typically improve over eight to twelve weeks. Pigmentation is slower, often three to six months of consistent use.
No. Tretinoin is contraindicated in pregnancy. Tell Dr Sateei if you are pregnant, planning pregnancy or breastfeeding so your routine can be adjusted.
Yes. Pigmentation treated without daily photoprotection returns, and no prescription changes that.
Pescription skincare is often planned alongside these.
Prescription skincare is the best-evidenced and least glamorous thing available for your skin, and it needs a prescriber rather than a website. If you would like to use it properly, or use it again having found it difficult before, that starts with an assessment.
Our London clinic is located at 91a New Cavendish Street, London, W1W 6XF
We serve patients from London, Kent and the home counties as well as from all over the world. Our London clinic sits in the heart of Marylebone, within easy reach of the West End by tube, while our Sevenoaks clinic in Ightham is moments from the M25 and M26 for patients across Kent.
