Telehealth dermatology: what's worth it
Jump to section
Tretinoin: the centerpiece
Prescription topical retinoid. Stronger than OTC retinol by ~10-100x. Best evidence for acne, photoaging, and texture. Compounded with niacinamide, azelaic acid, or hydroquinone in many telehealth formulations. Causes initial irritation (the 'retinization' period) lasting 4-8 weeks. Effects on fine lines take 3-6 months.
Acne medications
Tretinoin + topical or oral antibiotics for inflammatory acne. Spironolactone (oral) for hormonal adult acne in women — 50-100mg/day, takes 3 months. Isotretinoin (Accutane) is highly effective but requires monthly bloodwork and iPLEDGE program enrollment — most telehealth platforms have stopped offering it post-2024.
Anti-aging vs marketing
The interventions with evidence: daily sunscreen, tretinoin, vitamin C in the morning, niacinamide. Everything else (peptides, growth factors, plant stem cells) has weak evidence. Telehealth programs that bundle 'anti-aging stacks' rely on tretinoin doing the heavy lifting; the rest is marketing.
Costs
Compounded tretinoin formulas: $25-50/month. Topical acne kit (cleanser + tret + niacinamide): $35-75/month. Oral spironolactone via telehealth: $25-40/month. The drugstore equivalent (retinol + niacinamide + SPF) costs $30-50/month but is 10x weaker than the prescription.