Bausch Health
Five approved products, and between them the clearest demonstration in this register that the vehicle is the variable — four answers to the same retinoid problem, all with the trials published. The fifth is a chemotherapy agent from an earlier regulatory era whose label publishes no efficacy figure at all.
MODEL
New Drug Applications, manufactured products, retail pharmacy dispensing on a prescriber's script. No subscription, no consultation funnel, no direct sales.
The brand verdict
This is the reference class. Bausch Health's dermatology portfolio — trading in places as Ortho Dermatologics — is where three of the four topical retinoids in this register come from, plus the only product any regulator has approved for facial wrinkles. Every one of them went through a New Drug Application, which means the concentration, the fill weight, the excipient list, the trial design, the endpoint, the vehicle arm and the failures are all public documents.
Read across the four and a thesis emerges that no compounded product page in this register could support. Renova puts tretinoin at 0.02% in an emollient cream for indefinite nightly use on ageing skin. Altreno puts it at 0.05% in a lotion carrying sodium hyaluronate and soluble collagen, and reports dryness in 4% of users. Retin-A Micro puts it inside a porous crosspolymer that meters it out over hours, and measures how much reaches the bloodstream. Arazlo swaps the molecule for tazarotene and gets the largest effect in the register at the worst price. Four vehicles, four trade-offs, all measured.
The disclosure is the reason these score as they do rather than because the drugs are remarkable. Renova prints, in capitals, that it does not reverse photoageing — and publishes a subgroup in Fitzpatrick IV–VI skin where the vehicle outperformed the drug. Retin-A Micro states that three of its four marketed strengths have no pharmacokinetic study, and prints an in vitro genotoxicity signal on one of its own excipients. These are not the disclosures of a company trying to sell you something. They are the disclosures of a company that had to file a dossier.
The weakness is price and scope. Arazlo at around $572 for 45 g has no head-to-head data against the tretinoin sitting next to it at $123. Renova at roughly $319 is the same molecule as a $38 generic, differentiated by a vehicle that has never been compared with the standard one. And three of the four are indicated for acne, so the readers of this site mostly encounter them off-label — which is reasonable, common, and worth naming rather than assuming.
- Every concentration is printed on the carton, in per cent and in milligrams per gram.
- Every fill weight and pack size is published, so cost per gram is computable across the whole range.
- Complete excipient lists on all four products.
- Vehicle arms published for every trial, including the ones where the vehicle did well.
- Renova states in its own indication that it does not reverse photoageing or restore younger skin.
- Renova publishes a subgroup in which its own product underperformed vehicle.
- Retin-A Micro measures and publishes systemic bioavailability at 0.82% and 1.41%.
- Retin-A Micro states which of its strengths have no pharmacokinetic data.
- Arazlo publishes confidence intervals on every treatment difference and its own discontinuation rate.
- Arazlo states its pregnancy contraindication in the highlights, not in a subsection.
- No subscriptions anywhere. A prescription and a tube.
The range
- R-362026-08-02
Altreno
TRETINOIN LOTION 0.05%Tretinoin at a full 0.05% in a lotion carrying sodium hyaluronate, soluble collagen and glycerin — and the trial data show why that matters: dryness in 4% of users, stinging in 3%. This is what happens when a manufacturer treats the vehicle as part of the dose.
RECOMMENDED$123 PER 45 G TUBE
- R-372026-08-02
Arazlo
TAZAROTENE LOTION 0.045%The strongest topical retinoid result in this register — 25.5% and 29.6% success at twelve weeks — attached to the worst price and an absolute contraindication in pregnancy that requires a negative test before you start.
CONDITIONAL$572 PER 45 G TUBE
- R-382026-08-02
Retin-A Micro
TRETINOIN GEL MICROSPHERE 0.04% / 0.06% / 0.08% / 0.1%Four published strengths, a porous polymer reservoir that meters the drug out over hours, and a titration ladder printed on the carton. Two of the four rungs have no efficacy trial and no pharmacokinetic study of their own, and the label says so.
CONDITIONAL$172 PER 50 G PUMP
- R-342026-08-02
Renova
TRETINOIN EMOLLIENT CREAM 0.02%The only prescription anti-ageing product in this register whose own label tells you, in capital letters, that it does not reverse photoageing. It is also the only one that publishes what happened to the people who got the vehicle instead. Both facts are worth more than the drug.
CONDITIONAL$319 PER 40 G TUBE
- R-562026-08-03
Efudex
FLUOROURACIL CREAM 5% / SOLUTION 2% AND 5%The incumbent R-54 is competing with: a chemotherapy agent applied to the face for two to four weeks, stopped when the skin reaches the erosion stage, unsightly for weeks afterwards, and around $36. Its label contains no efficacy figure of any kind.
CONDITIONAL$36 TWICE DAILY
What repeats across the range
These are the findings a single review cannot make. Each one appears in more than one product, and each is drawn from the reviews above rather than from an impression of the brand.
- 01
The vehicle is where the development money went
A hyaluronate-and-collagen lotion, a polymeric emulsion lotion, an emollient oil-in-water cream and a methyl methacrylate crosspolymer microsphere. In every case the molecule is decades old and the innovation is delivery. Altreno's reward is application-site dryness in 4% of users against under 1% on vehicle — a full-strength retinoid that most people can keep using.
- 02
The failures are printed alongside the successes
Renova publishes that only two of five trials demonstrated efficacy for fine wrinkling, that no two demonstrated it for coarse wrinkling, mottled hyperpigmentation, roughness or laxity, and that in darkly pigmented subjects vehicle beat drug 43% to 29%. Retin-A Micro publishes a trial arm where inflammatory lesions fell 29% against 24% on vehicle. Nothing forces a company to make those numbers prominent.
- 03
Every comparator is vehicle, never another drug
Across all four products and eleven trials, not one comparison is against an active alternative. Arazlo's registration programme never tested it against tretinoin; Altreno's never tested it against generic tretinoin cream; Renova's never tested 0.02% against the older 0.05%, and the label says so. So the question a prescriber actually faces — which of these, and is the expensive one worth it — has no answer in any of the dossiers.
- 04
A strength series is not the same as an evidenced ladder
Retin-A Micro markets four concentrations. Efficacy trials exist for two of them. Pharmacokinetic studies exist for one. The label states this plainly, which is to its credit, but a patient stepped down to 0.06% is on a rung with no data of its own.
- 05
One label from before any of this was required
Efudex carries no clinical studies section — no success rate, no comparator, no sample size — because it predates the framework that requires one. It is exemplary about who must not take it and silent about what taking it achieves, which is the mirror image of Renova, and a useful reminder that disclosure is not one thing.
- 06
The prices span a factor of fifteen for the same job
Altreno at about $123 for 45 g, Retin-A Micro at about $172 for 50 g, Renova at about $319 for 40 g, Arazlo at about $572 for 45 g. All four treat the same tissue by the same receptor family. Only Altreno is priced anywhere near the generic alternative, and the differences track brand position rather than any measured advantage.
Disclosure scorecard
Not what is in the product — what the company publishes about it, and where. “Findable” means the concentration exists somewhere, such as a help-centre article, rather than on the page you buy from.
SCROLL THE TABLE SIDEWAYS
| PRODUCT | CONC. ON PAGE | CONC. FINDABLE | CONTRA-INDICATIONS | SIZE | SIDE EFFECTS |
|---|---|---|---|---|---|
| Renova | YES | YES | YES | YES | YES |
| Altreno | YES | YES | YES | YES | YES |
| Arazlo | YES | YES | YES | YES | YES |
| Retin-A Micro | YES | YES | YES | YES | PART |
| Efudex | YES | YES | YES | YES | PART |
If you buy one
Efudex
Worth buying for a specific person with a specific problem. Read who.