Retinoids are a group of medications that normalize the follicle cell lifecycle. There are topical retinoids such as tretinoin (brand name Retin-A), adapalene (brand name Differin) and tazarotene (brand name Tazorac). Like isotretinoin, these medications are similar to vitamin A, but they are topical treatments and generally have much milder side effects. However, they can cause significant irritation of the skin. The retinoids appear to influence the creation and death lifecycle of cells in the follicle lining. This helps prevent the hyper-keratinization of these cells that can create a blockage. Retinol, a form of vitamin A, has similar but milder effects and doctors prescribe because it also contains moisturizers. Doctors have prescribed topical retinoids for over 30 years, but are not available over the counter, so they are not as widely used as other topical treatments. Topical retinoids often cause an initial flare up of acne and facial flushing.

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Some concierge practices do not accept insurance of any kind. These are as cash-only or direct primary care practices. By refusing to deal with insurance companies, these practices can keep overhead and administrative costs low, thereby providing affordable healthcare to patients. They become concierge only if the practice assesses an annual or monthly fee instead of or in addition to a fee for each medical service. Other concierge practices do take insurance, even Medicare, but ask for an annual fee for additional services exclusive of insurance plans. This annual fee is not a substitute for medical insurance, and generally does not cover consultations outside the practice, laboratory procedures, medicines, hospitalizations, or emergency care from other providers. 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