Sarah’s Prescription Skincare Experience & 1.5 Year Update

Hi everybody, Sarah here. As you know, I recently incorporated a prescription skincare product into my routine from Apostrophe. Let’s first get into why I decided to make the switch, then I’ll discuss why I picked Apostrophe and what my experience with their service was like.

I’ve had acne for just about twelve years now and over the years, I’ve figured out a lot about how my acne behaves. I’m 99.999% sure it’s hormonally dependent—it comes and goes with my monthly cycle, it massively flares up with stress, and it correlates to my sleep patterns precisely. Because of this, I’ve always known that topical OTC skincare wouldn’t be a cure, but I had always held out that there would some sort of magical recipe routine that would at least keep it at bay until hopefully (eventually?) I would somehow outgrow it.

I tried all the major OTC players—salicylic acid, benzoyl peroxide, retinaldehyde, etc.—and the congestion would initially improve, but it would always, always come back after a while. This was frustrating, but I figured there would be other treatments to try and eventually, I’d find something. I’m now over ten years into it, and sadly, I did not eventually find something. I started retinaldehyde in December of 2020 and although the acne on my face improved for a bit, it eventually returned, bringing a new symptom: acne on my neck. This was the wake-up call. I had to try the prescription skincare route once and for all.

I spoke with a couple of fellow bloggers who had more experience with various services than myself (I had only ever tried Curology, way back when they first launched, and unfortunately, didn’t have the greatest service experience, but they’ve since grown and developed a much more refined system that works for many people!) and followers who gave their input as well. Eventually, I came across Apostrophe, an up-and-coming service that definitely has some pros and cons to it, but ended up being the obvious choice for my personal skincare treatment, which we’ll get into in a moment. For now, let me quickly explain how Apostrophe works in case you’re unaware.

Apostrophe is a fully digital dermatology service provider, allowing you to fill out a questionnaire, upload images of your face and other areas of concern, and within just a few hours (literally, I received a response in eight hours) a licensed dermatologist reviews your medical history and responds with an action plan for your first dose. This is pretty standard procedure for most online providers these days, but I chose to go with Apostrophe mainly because they offer both oral and topical options, as well as a breakthrough version of the infamous hormonal acne medication, Spironolactone, in a topical formula, allowing males to use this treatment safely now as well. As far as I know, Apostrophe is the only online provider to offer this medication at this time. Overall, I went with this service because they have one of the most diverse prescription offerings available for a wide range of people dealing with acne, regardless of age, sex, etc.

Regarding the introductory quiz, I appreciate the level of detail and range of the questions. General questions include those about skin type, environment, and personal concerns, but as you progress, the questions become increasingly specific, asking target questions to determine if your skin concerns are hormonally related, if you’re willing tolerate common side-effects, whether you’re interested in oral medication options or not, and most interestingly, what specific medications from their line you’re interested in trying, if any. For this, I selected Tretinoin, Spironolactone, and Clindamycin, as I suspected Spironolactone would be in my future, and the other two were obvious choices. Lo and behold, my prescription would be composed of all three options: 0.025% Tretinoin, 5% Spironolactone, and 1% Clindamycin.

My dermatologist was very thorough in her response and recommendations as she fully explained what the purpose of each medication was in the blend, laid out a daily application schedule, and listed out important warnings and potential side-effects. In terms of communication, I have absolutely no complaints. What I am a bit concerned about though, is the price of each topical prescription, $90/21 grams or about 0.74 oz. (described as the proper amount for a 90-day supply). 60-day supplies of oral medications are $35, I believe. These prices are a bit steep compared to the amount of product and what competitors are charging, but I have to admit, I’m actually saving money on skin treatments since my Apostrophe prescription is the sole active in my night routine now.

I want to briefly address the texture and scent of my prescription, as I have received questions/comments from interested and previous users. The texture of my prescription is a lightweight gel cream that absorbs quickly, but is not moisturizing to the skin at all, so you need an additional non-active cream for sure. A few previous Apostrophe users mentioned their Spironolactone-containing formulas were gritty in texture when they were on prescription skincare, but my current formula is not. One important thing to note for those sensitive to odors is that my prescription smells quite pungent upon application, similar to…garlic, however, the odor dissipates after a moment.

It is currently July 5th, 2021, and I am just a few days shy of being one month into my prescription. I apply one and half pea-sized amounts onto both my face and neck once every two night. When starting the prescription, I anticipated peeling/flakey skin even though I was previously using OTC retinaldehyde, but I am pleased to report that my skin has maintained its balance so far. At the beginning of my treatment, my neck and forehead were the most active areas, but today, they are almost entirely cleared, with perhaps one or two new pimples a week, if that. My T-zone and jawline are still slightly congested, as they are the most hormonally-affected regions of my face, but I am very, very impressed with the overall smoother texture, decreased hyperpigmentation, and decreased new acne. There is an even-ness to my skin these days that I have not noticed in a long time. As of tonight, I will be increasing product usage to every other night.

To close this off, my expectations are exceeded regarding results and I will be purchasing a second bottle, if not more. If you are unable to be seen by a dermatologist in-person, I recommend conducting a consultation at the very least. If you receive a prescription recommendation that is relatively simple—for example, a niacinamide, tretinoin, and clindamycin blend, I recommend exploring more affordable options, but if you’re prescribed a Spironolactone blend, it will be more difficult to find an alternative. There’s a lot to consider when starting a prescription skincare treatment, so take your time, ask all the questions you have, and do your research.

If you have any questions regarding the information in this blog post, feel free to send me a DM through the @the.top.shelf.edit Instagram account and I’ll be happy to chat or update this post.

*This post is not sponsored by Apostrophe. My initial consultation and first bottle were received free of charge after the brand reach out to us upon hearing about my decision to try them, but The Top Shelf Edit is not affiliated with or sponsored by Apostrophe. Opinions shared in this post are my own. Consult with your healthcare provider regarding any and all matters of your health.

Update: 1.29.2023

Hi friends! It’s been about a year and a half of consistent Apostrophe use and I figured now would be a good time to update you on how everything worked out, if I have any regrets, changes to the formula, etc.

In the last year or so, I’ve figured out my ideal retinoid night routine and what supplemental ingredients pair well with the formula (but I’ll do a separate post on that soon!), so although I only use my formula three to five nights a week, my skin is well maintained. I should also note that my prescription has not changed since that first bottle—my provider doesn’t check in that often (which I like, to be honest), but she’s happy with where my skin is at as well and hasn’t pushed me to increase the tretinoin dose. This allows me to comfortably try other skincare products, namely OTC retinaldehyde treatments, which works out great.

Now, results: my acne has improved beyond expectations. I don’t have diffuse breakouts across the skin at all anymore, but the occasional hormonal pimple will break through every other month or so (or whenever it’s exam season is lol). My skin is still slightly congested around the cheeks, but I incorporate salicylic acid exfoliants at least once a week to keep that under control so there’s no issue there. Beyond that, I have not noticed any additional benefits that I can clearly attribute to the prescription cream—so, if you’re wondering how this works to repair hyperpigmentation, my experience is that it doesn’t do much, so I work on that skin concern in my morning routines. Another thing to note is that my results didn’t really peak until around nine months of use. I certainly began to notice a difference in my skin within the first two months, but the absolute best my skin could look wasn’t achieved until around nine or ten months, and it has since maintained that level of clarity.

About six months into starting Apostrophe, my provider recommended incorporating a benzoyl peroxide 2-5% face wash into my routine to prevent bacterial resistance against the clindamycin in my formula from developing, so I’ve been using a 5% cleanser as a short contact therapy treatment 1-2x/week only and it seems to be working quite well. I actually do notice a slight increase in congestion if I stop using the BPO wash for a week, so I’ve been as consistent with the BPO as I have been with the prescription cream.

One odd negative experience I had that I can sort of contribute to the prescription was the seemingly sudden development of insanely large pores across my entire face, a phenomenon that occurred sometime last summer and lasted a few months. It was strange. I’d take a photo of my face and these deep-appearing holes were present in areas of my face I had never before noticed pores at all, including the highest points of my forehead, chin, temples, and even the jawline. My pores are now back to what they were before (mildly visible in the apples of my cheeks only), and I’m honestly unsure whether their disappearance is attributable to incorporating BHA consistently or if they just went away on their own. Whatever the reason, I found a few people online report similar symptoms and noted they went away on their own after a while, the common denominator cause appearing to be tretinoin.

All in all, would I recommend Apostrophe? Absolutely. I have no plans to change my regimen or switch companies. Apostrophe still appears to be the only online provider offering topical Spironolactone, so although their actual cosmetic formula isn’t the most enjoyable compared to other services (from what I’ve heard), I’ll continue to work with the formula I have. It’s not too big of a deal—slightly smelly, with a somewhat dry/difficult to spread, whipped texture. The price is still quite steep at around $90/bottle, but I don’t mind paying so much for something that consistently works. It’s truly the only constant in my routine—I try tons of different serums, moisturizers, cleansers, etc. throughout the year—so I tend to center my routines around the Apostrophe prescription entirely.

Thanks for reading and keeping up with my Apostrophe experience! I got my sister on her own regimen with them as well so we’re excited to see how her skin’s health improves over the next year or so, too.