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Most of the trouble people have with a prescription skin topical is not the medicine. It is the amount, the wet skin, the six other products already on the face, and a schedule that went from nothing to nightly in a single step. The technique is worth more than the choice of active. The schedule itself — how often, for how long, on which areas — is set by the reviewing doctor. What follows is the method that schedule assumes.

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The four rules that matter most

A pea-sized amount, for the whole face

Roughly half a gram covers an adult face. More does not work faster; it produces irritation, which produces inflammation, which in pigment-prone skin produces more pigment. A tube that runs out in two weeks is a tube being used wrongly.

Completely dry skin

This is the single most effective thing you can change. Damp skin increases penetration and increases irritation, and it is why the same medicine feels different to two people using the same amount. Pat dry and wait until the skin genuinely feels dry, not almost dry.

Retinoids at night

Tretinoin is degraded by light and it increases ultraviolet reactivity, so it goes on in the evening. It is also degraded by oxidising agents, which is why a retinoid and benzoyl peroxide are not layered in the same application unless they came as one product.

Sun protection every morning

Not an optional extra. On all four dermatology pathways, daily broad-spectrum protection is part of the treatment rather than an addition to it — the reasons are set out in the side-effects guide.

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The routine, step by step

1

Cleanse gently

A bland, non-foaming cleanser, lukewarm water, fingertips rather than a cloth or a brush. No scrubs, no exfoliating devices, no astringent toner. Stripping the barrier before applying an active is how a tolerable medicine becomes an intolerable one.
2

Wait until the skin is dry

Pat with a clean towel and then leave it. Several minutes is normal. If you are impatient, this is the step to be patient at — it does more for tolerability than anything else in this list.
3

Apply the pea-sized amount

Dot it across the forehead, both cheeks, nose and chin, then spread it thinly and evenly over the whole affected area. Not spot by spot: acne and rosacea lesions form beneath skin that currently looks fine, and treating only what is visible treats the past.
4

Avoid the edges

Keep the product away from the eyes and eyelids, the corners of the nose and mouth, the lips, and any broken or inflamed skin. These are where irritation starts. For a pigment cream, stay on the patch — spreading it onto normal skin is how halo hypopigmentation happens.
5

Moisturise

A bland moisturiser afterwards, or before as a buffer. Both are used; the doctor may say which they prefer for your case. No fragrance, no essential oils, no active ingredients of its own.
6

Wash your hands

Particularly with hydroquinone and with anything containing benzoyl peroxide, which will bleach whatever the hands touch next.

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Ramping up

Starting nightly on day one is the most common reason a prescription topical gets abandoned in week two. The standard approach is to build tolerance gradually rather than to prove something. The pattern generally used is a low starting frequency for the first week or two, an increase once the skin is settling rather than on a fixed date, and a further increase only if the previous step is comfortable. Irritation is the signal to hold at the current frequency, not to push through. The specific schedule is the reviewing doctor’s decision, and it varies by medicine, by strength and by how reactive your skin has already proved to be.
Buffering means applying a bland moisturiser before the active, so the medicine reaches the skin through a layer that slows its penetration. It reduces irritation at the cost of some potency, which is usually the right trade during the adjustment phase and can be dropped later. It is a legitimate technique, not a way of cheating the treatment.

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What to stop doing while you treat

This list is where most self-inflicted irritation comes from. Pausing these things is part of the treatment.
  • Exfoliating acids — glycolic, salicylic, lactic, mandelic — unless the doctor has specifically included one.
  • Physical scrubs, cleansing brushes and exfoliating cloths. All of them damage the barrier.
  • Vitamin C serums, at least during the adjustment phase, and anything else marketed as an active.
  • Cosmetic retinol, retinaldehyde or retinyl esters while on a prescription retinoid. It is the same pathway, and stacking it only adds irritation.
  • Astringent toners, witch hazel, alcohol-based products, menthol, camphor and fragrance. In rosacea especially, these are among the most commonly reported triggers.
  • At-home peels, microneedling and dermarolling. Any procedure on skin that is already adjusting to an active is asking for a reaction, and in pigment-prone skin it is asking for post-inflammatory hyperpigmentation.
  • Waxing, threading and depilatory creams on treated areas. A retinoid thins the stratum corneum, and hair removal on retinoid-treated skin can lift skin with the hair.
  • Adding several new products at once. If a reaction happens you will have no idea which one caused it.
The questionnaire asks what you are currently using precisely so that conflicts of this kind can be identified before a prescription is issued rather than after.

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Storage and practical details

Keep the tube at room temperature, out of direct light, with the cap closed. Compounded preparations are prepared by a pharmacy for you specifically and carry their own expiry — check the label, and do not keep one past it on the assumption that it is the same product as last time. Do not share a prescription topical. It was issued against your case, your history and your photographs.

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If it is not going well

Stop and message the doctor through the private chat in your account if the irritation is spreading beyond where you applied it, blistering or weeping, or intensely itchy; if the treated area is getting darker rather than lighter; or if a rosacea flare started after the new product and has not settled. Facial swelling or difficulty breathing is emergency care, not a message. Consistent use with no change at all after twelve weeks is a reason to ask for a review rather than to continue indefinitely. The review is asynchronous throughout — no video call, no telephone consultation.

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Start a consultation

Dermatology consultations

Four pathways: acne, rosacea, melasma and anti-ageing. A registered doctor reviews each one and declining is a normal outcome. See what it costs and how the review works.
This page is reference information, not medical advice and not a prescription. Whether a medicine is appropriate for you is decided by a registered doctor after reviewing your consultation.