Alternatives to Aklief If You Can't Fill Your Prescription

Your dermatologist prescribed Aklief (Trifarotene) for your acne, but you've hit a roadblock. Maybe your pharmacy doesn't stock it. Maybe your insurance won't cover it. Or maybe the price tag — over $760 per pump without insurance — is simply too much right now.

Whatever the reason, you have options. Several other topical retinoids treat acne effectively, and some are available at a fraction of the cost. Here's what you need to know about each one so you can have an informed conversation with your doctor.

What Is Aklief and How Does It Work?

Aklief is a topical retinoid cream containing Trifarotene at 0.005% concentration. It was approved by the FDA in October 2019 for the treatment of acne vulgaris in patients 9 years and older. It's manufactured by Galderma Laboratories.

What sets Aklief apart from older retinoids is its selectivity. Aklief specifically targets retinoic acid receptor gamma (RAR-γ), the most common retinoid receptor in the skin. This targeted approach is thought to provide effective acne treatment with potentially fewer side effects compared to non-selective retinoids.

Aklief is also the first topical retinoid specifically studied and proven to treat acne on both the face and the trunk (chest, shoulders, and back). For more on this, see our article on how Aklief works.

Why You Might Need an Alternative

There are several common reasons patients look for Aklief alternatives:

• Cost: At $760 to over $1,000 without insurance, Aklief is one of the most expensive topical acne treatments on the market
• Insurance denial: Many insurance plans don't cover Aklief, or require prior authorization and step therapy
• Pharmacy availability: Not all pharmacies stock Aklief routinely (learn why Aklief is hard to find)
• Side effects: Some patients experience irritation that leads them to seek a milder option

Alternative 1: Tretinoin (Retin-A)

Tretinoin is the original topical retinoid and has been used to treat acne for decades. It's available in multiple formulations including creams, gels, and microsphere gels at strengths ranging from 0.01% to 0.1%.

How it works: Tretinoin activates multiple retinoic acid receptors (not just RAR-γ like Aklief), which increases skin cell turnover, unclogs pores, and reduces inflammation.

Pros:

• Widely available as a generic
• Proven track record over 50+ years
• Cash price as low as $15 to $50 for generic versions
• Covered by most insurance plans
• Also used for anti-aging and hyperpigmentation

Cons:

• Can cause more initial irritation, dryness, and peeling than Aklief
• Not specifically studied for trunk acne
• Sun sensitivity is a significant concern

Best for: Patients who need an affordable, well-studied retinoid and can tolerate the adjustment period.

Alternative 2: Adapalene (Differin)

Adapalene is a third-generation retinoid that's unique because it's available over the counter at 0.1% strength (Differin Gel). A stronger 0.3% version (Differin 0.3%) requires a prescription.

How it works: Adapalene selectively targets RAR-β and RAR-γ receptors. It normalizes skin cell differentiation and has anti-inflammatory properties.

Pros:

• OTC version available without a prescription for about $10 to $30
• Generally the best-tolerated topical retinoid
• Less irritating than Tretinoin
• Available as a generic prescription at 0.3%
• Stable in sunlight (can be applied in the morning if needed)

Cons:

• May be less potent than Aklief or Tretinoin for severe acne
• Not specifically studied for trunk acne at the same level as Aklief

Best for: Patients with mild to moderate acne who want an affordable, gentle option they can start without a prescription.

Alternative 3: Tazarotene (Tazorac, Arazlo)

Tazarotene is a potent third-generation retinoid available as a cream, gel, or lotion (Arazlo). It requires a prescription and is only available as a brand-name product.

How it works: Tazarotene selectively targets RAR-β and RAR-γ receptors. It's converted to its active form (tazarotenic acid) in the skin and is considered one of the most potent topical retinoids.

Pros:

• Highly effective for moderate to severe acne
• Also approved for psoriasis treatment
• Arazlo lotion formulation may be better tolerated than older gel/cream

Cons:

• Brand-name cost ranges from $400 to $700
• Can cause significant skin irritation, especially initially
• Not available as a generic in all formulations
• Contraindicated in pregnancy

Best for: Patients with moderate to severe acne who haven't responded well to Tretinoin or Adapalene.

Alternative 4: Benzoyl Peroxide (Over the Counter)

While not a retinoid, Benzoyl Peroxide is one of the most effective over-the-counter acne treatments and is often used alongside retinoids.

How it works: Benzoyl Peroxide kills Cutibacterium acnes bacteria, the primary bacteria that causes inflammatory acne. It also has mild comedolytic (pore-clearing) properties.

Pros:

• Available OTC for about $5 to $20
• Kills acne bacteria — something retinoids don't do
• Available in washes, creams, gels, and spot treatments
• Can be combined with retinoids for better results

Cons:

• Can bleach clothing and fabrics
• May cause dryness and irritation
• Doesn't address skin cell turnover the way retinoids do

Best for: Patients who need an affordable add-on treatment or an alternative when retinoids cause too much irritation.

How to Choose the Right Alternative

The best alternative depends on your specific situation:

• If cost is the main issue: Try Adapalene 0.1% (OTC Differin) or generic Tretinoin
• If you have sensitive skin: Adapalene is typically the gentlest retinoid
• If you have severe acne: Tazarotene or prescription-strength Tretinoin may be more effective
• If you have trunk acne: Talk to your dermatologist — Aklief was specifically studied for this, but other retinoids can be used off-label

Always talk to your dermatologist before switching medications. They can help you choose the right alternative based on your skin type, acne severity, and medical history. Find a prescriber near you with our guide on finding a doctor who prescribes Aklief.

Don't Give Up on Aklief Yet

Before switching to an alternative, consider these options:

• Use Medfinder to find a pharmacy with Aklief in stock
• Apply for the Galderma CareConnect savings card — it can bring the cost down to $20 (insured) or $90 (cash-paying)
• Ask your pharmacy to special-order it — most can get it in 1 to 3 days

For more money-saving strategies, check out our article on how to save money on Aklief.

Final Thoughts

Aklief is an excellent acne treatment, but it's not the only one. If you can't fill your prescription due to cost, availability, or insurance issues, there are proven alternatives that can help clear your skin. Talk to your dermatologist, explore your options, and don't let a pharmacy hurdle keep you from getting the treatment you need.