Tretinoin, azelaic acid and doxycycline for acne and rosacea
These drugs treat acne, rosacea and sun damage. A licensed clinician reviews your intake and photos and prescribes what fits, following the 2024 AAD acne guideline. A pharmacy ships your regimen with a step-up plan, not just a tube.
Tretinoin has a purge. In the first weeks your skin can break out worse before it gets better, and real improvement takes 8 to 12 weeks. You start every other night and build up, which is how most people get through the early weeks without quitting.
What you get
- Tretinoin for acne and sun damagetopical
- A strength ladder you climb as your skin tolerates it, usually six to eight weeks per step: 0.025% cream to start for most people, then 0.05%, then 0.1%. Oily skin can use a gel at a comparable step. Apply a pea-sized amount at night on dry skin, two to three nights a week to start, building toward nightly over four to six weeks. Buffer with moisturizer. Avoid the eyes, the corners of the nose and the lips. Daily sunscreen is required, because retinoids increase sun sensitivity.
- Azelaic acid 15 to 20%, twice dailytopical
- For inflammatory acne, papulopustular rosacea and melasma or the dark marks breakouts leave, where it lightens excess pigment. Less irritating than tretinoin, and safe in pregnancy, which makes it the route when retinoids are off the table.
- Doxycycline for rosaceaoral
- 40 mg modified-release once daily, an anti-inflammatory dose below the antibiotic threshold, meant for longer use without the resistance pressure of higher doses.
- Doxycycline for acneoral
- 50 to 100 mg once or twice daily for a course of about three months, then reassess. Two rules we hold to: the antibiotic course runs about three months and then stops, and an oral antibiotic is never the only treatment. We pair it with a topical (benzoyl peroxide and/or tretinoin) to limit resistance and aid clearance. Take it with a full glass of water, sitting or standing, and stay upright 30 minutes so it does not burn your throat.
We also offer latanoprost 0.005% for eyelash growth, off-label, with a required consent on permanent iris darkening. See the note in the risks section.
What the evidence says
- [1]
The 2024 AAD acne guideline (J Am Acad Dermatol 2024) strongly recommends topical retinoids as first-line, recommends pairing them with benzoyl peroxide, limits systemic antibiotic courses to the shortest effective duration (typically three to four months), and states oral antibiotics should not be used as monotherapy. Our doxycycline rules come straight from it.
- [2]
Tretinoin mechanism and effect. Topical retinoids normalize how skin cells mature in the follicle, prevent microcomedones, and over time increase dermal collagen, which is the basis for the off-label use against sun damage.
- [3]
Azelaic acid is supported in the 2024 AAD acne guideline and rosacea guidance, and is often chosen for sensitive skin, skin of color and pregnancy.
- [4]
Subantimicrobial doxycycline 40 mg modified-release is supported for papulopustular rosacea, acting through anti-inflammatory rather than antibiotic effect.
- [5]
Latanoprost and iris pigmentation. Prostaglandin analogs reliably grow lashes (the bimatoprost lash indication is FDA-approved), and the class causes permanent iris pigmentation and periocular changes, which is why the consent is mandatory.
Who qualifies
- Age 18 or older.
- Mild to moderate acne, papulopustular rosacea or sun damage, consistent with your photos.
- None of the conditions in the risks section for the drug you want.
Known risks and who should not use this
Known side effects: tretinoin causes dryness, peeling and an early breakout in the first weeks, and it makes your skin more sun-sensitive. Doxycycline makes you sunburn more easily and can burn your throat if a pill lodges there. Azelaic acid irritates less than tretinoin. Latanoprost can permanently darken the iris; the note below covers it.
The conditions below end the intake for the drug in question.
- Tretinoin in pregnancy, breastfeeding, or while trying to conceive. Stop tretinoin before any attempt to conceive. We route you to azelaic acid instead, which is pregnancy-safe and treats both acne and pigment.
- Doxycycline in pregnancy or breastfeeding, at any dose. Tetracyclines harm a developing baby's teeth and bone. Hard stop, with an alternative through a clinician.
- A prior bad reaction to doxycycline, minocycline or another tetracycline. Blocks doxycycline.
- A prior bad reaction to tretinoin or another retinoid. Blocks tretinoin.
- Deep painful nodules or cysts, or acne already scarring. Topicals alone will not fix this. It routes to isotretinoin evaluation or a dermatology partner. Our own isotretinoin program is planned for after August 2026; until then we refer.
- Current isotretinoin use: we will not add doxycycline. The combination raises the risk of intracranial hypertension.
- An eye condition, eye inflammation, or glaucoma treatment blocks the latanoprost lash path; that routes to a clinician or ophthalmology.
Things that flag for clinician review: rosacea with eye symptoms (gritty, burning, red eyes), which routes to ophthalmology for the eye component; reflux or trouble swallowing pills, for doxycycline counseling; a sun-heavy job or sport, for sun-sensitivity counseling; and a widespread facial rash with whole-body symptoms, which a clinician reviews to rule out lupus.
On latanoprost for lashes
Latanoprost can permanently darken the iris, most often in mixed-color or light-brown eyes, and that change does not reverse after you stop. It can also darken the skin around the eye and deepen the eyelid crease. You must read and sign a consent stating this before we dispense it. If you have any eye disease, this routes to a clinician.
How it works here
You answer an intake and upload photos. You tell us your main concern, your skin type and your history, and upload three angles plus a close-up of the area. About ten minutes.
A licensed clinician reviews it. A clinician licensed in your state reviews it. Mild to moderate acne, papulopustular rosacea and sun damage qualify. Nodular, cystic or scarring acne does not get topicals alone; it routes to an isotretinoin or dermatology pathway, because topicals will not fix it.
The pharmacy ships. Your regimen ships to your door with a step-up plan. We reassess at 8 to 12 weeks.
Price
| Clinical visit and prescription | $39 |
|---|---|
| Tretinoin (90-day supply) | $39 |
| Azelaic acid (90-day supply) | $35 |
| Doxycycline, acne or rosacea course | $30 |
| Latanoprost for lashes | $44 |
Commercial generics. Where a pharmacy copay beats our cash price, we will tell you.
FAQ
How long does the tretinoin purge last?
The early breakout typically runs the first few weeks, and overall improvement takes 8 to 12 weeks. If your skin gets raw or peels, drop the frequency rather than stopping entirely. Starting every other night and ramping up is how you get through the purge without quitting.
What strength of tretinoin should I start on?
0.025% cream for most people, especially dry or sensitive skin. We step up to 0.05% and then 0.1% as your skin tolerates it, usually six to eight weeks per step. Oily skin can start on a gel at a comparable strength.
Can I use tretinoin while pregnant?
No. Stop it before trying to conceive and do not use it pregnant or breastfeeding. We route you to azelaic acid, which is pregnancy-safe and works on both acne and pigment.
Why won't you just give me an antibiotic for my acne?
Oral antibiotics should not be used alone for acne, per the 2024 AAD guideline. We pair doxycycline with a topical, run it about three months, then step down to topical maintenance. That limits antibiotic resistance and holds your results.
How long can I stay on doxycycline?
About three months for acne, then we reassess. The course is meant to be limited; the topical is what maintains the result. Rosacea uses a lower 40 mg anti-inflammatory dose that can run longer.
Is azelaic acid as good as tretinoin?
For some people, close, and it is gentler. It treats inflammatory acne, papulopustular rosacea and pigment, with less irritation. It is the first choice when tretinoin is off the table, including pregnancy.
Will doxycycline make me sunburn?
Yes, more easily. Wear sunscreen and cover up, especially with a sun-heavy job or sport. Take each dose with a full glass of water and stay upright 30 minutes so the pill does not irritate your throat.
Does latanoprost really change my eye color permanently?
Yes, it can, most often in mixed-color or light-brown eyes, and it does not reverse after you stop. It can also darken the skin around the eye. We require a signed consent on this before dispensing. If you have eye disease, it routes to a clinician.
I have cystic, scarring acne. Can you treat it?
Not with topicals alone. Nodular, cystic or scarring acne routes to isotretinoin evaluation or a dermatology partner. Our isotretinoin program is planned for after August 2026; until then we refer you.
Do I need bloodwork?
No routine labs to start topicals, and none for a standard short doxycycline course in a healthy adult. We reassess your acne doxycycline at three months.
The rest of the catalog
The same rules apply to every medication we carry: a structured intake, a licensed clinician on every review, flat prices and FDA-approved generics only.
From the catalog · Skin
Start your intake
Answer the intake, upload your photos and get a regimen with a step-up plan, usually within one business day.
Clinical content reviewed by [Reviewer name], MD. Last clinically reviewed 2026-06-10.