Which skin-renewal treatments can be prescribed online here?
Tretinoin 0.025% cream for fine lines and texture or melasma, and azelaic acid 15% gel for melasma. A 0.05% tretinoin step-up can be considered at a refill after three or more months of good tolerance. For moderate-to-severe or topical-refractory melasma, oral tranexamic acid 250 mg twice daily for 8-12 weeks may be considered as a physician-initiated escalation — never at first intake — after a strict screen: no personal history of a blood clot, stroke, or heart attack, no clotting disorder or family history of blood clots, not on combined (estrogen-containing) hormonal contraception, not a current smoker, not pregnant or trying to conceive, no kidney disease, and no seizure history. Any one of these rules out the oral option only; topical treatment can continue. Hydroquinone, steroid-containing combination creams like Tri-Luma, and any other oral retinoid are not offered through this lane. Every fill is limited to a 90-day supply with a re-check before each refill.
Will tretinoin erase my wrinkles or remove sun spots?
No — and any service promising that is overpromising. In FDA trials, tretinoin mitigated fine facial wrinkles as an adjunct to sunscreen and moisturizer; it showed no effect on deep wrinkles, sagging, or discrete sun spots. Expect gradual softening of fine lines and smoother texture over 3-6 months of nightly use, with daily sunscreen doing much of the work.
Why are face photos required?
Two reasons. First, the physician confirms the pattern — diffuse fine lines, or classic melasma on both sides of the face — before prescribing. Second, and more important, the photos are a safety check: facial pigment has dangerous mimics, including lentigo maligna, an early melanoma that favors sun-damaged facial skin. Any single, asymmetric, raised, multi-colored, or changing spot in the photos is redirected to an in-person dermatology exam instead of treated.
Why won't this lane lighten one specific dark spot?
Because a single dark spot must be examined in person — with dermoscopy and sometimes a biopsy — to rule out melanoma and other skin cancers before anyone tries to fade it. A lightening cream can disguise a spot that needed a biopsy. That rule protects you, and we always follow it: one-spot requests are always referred to a dermatologist.
Can I use this during pregnancy or while breastfeeding?
No. Tretinoin is a retinoid, and retinoids should not be used in pregnancy — and because this is a cosmetic treatment, there is no benefit that justifies any risk, so the whole lane (including azelaic acid) pauses during pregnancy, while trying to conceive, and while breastfeeding. Melasma that appears in pregnancy often fades after delivery. A tinted SPF 30+ sunscreen with iron oxides is the safe thing to use in the meantime.
What should I expect when starting tretinoin?
Some redness, dryness, and peeling in weeks 2-6 is normal — start 2-3 nights a week, use the moisturizer-sandwich technique, and pause other exfoliants. Deeper skin tones ramp up even more slowly, because irritation itself can darken skin (post-inflammatory hyperpigmentation). Daily broad-spectrum SPF 30+ is required, both because tretinoin makes skin more sun-sensitive and because sun exposure undoes the benefit — for melasma, a tinted sunscreen with iron oxides also blocks the visible light that drives the patches.
When should facial dark patches be seen in person instead?
Any single, one-sided, raised, multi-colored, bleeding, or changing spot; any wish to lighten one specific spot; new pigment at age 55 or older that has never been evaluated; blue-black or gray darkening after past lightening products; patches that began after minocycline, amiodarone, an antimalarial, or chemotherapy; and pigment change with gum or palm-crease darkening, fatigue, weight loss, or dizziness — all of these need an in-person examination rather than online treatment.