What strength tretinoin do you use? Have you compared with topical rapamycin?
I use 0.1% cream. Fortunately, after a battle with my insurance company, they agreed to pay for it, otherwise, it is quite expensive.
Due to frequent and long-term exposure to the sun in my youth, I have been battling actinic keratosis for decades. Originally tretinoin/retinol was used by many dermatologists to treat sun-damaged skin and prevent new actinic keratoses from forming. It is mildly effective in reducing actinic keratoses formation. That is what I have been using it for.
After starting rapamycin, I soon noticed that my sun-damaged skin was improving and new actinic keratoses were not forming. Then, after a few months, actinic keratoses that had already formed disappeared.
Topical rapamycin appears to take longer than oral rapamycin to produce results. Presently I am into a few weeks of self-prepared, topical rapamycin spray. I haven’t noticed anything yet
My take away from personal use:
Tretinoin cream reduces fine wrinkles faster and improves sun-damaged skin in just a month.
Topical rapamycin may produce better results in the long term, but studies that I have looked at indicate it may take a few months.
"Overall, the data indicate that rapamycin is a potent inhibitor of skin tumor promotion and suggest that signaling through mTORC1 contributes significantly to the process of skin tumor promotion.’’
Clinical improvement of skin photoaging in participants receiving topical rapamycin was noted in the majority of subjects and included a decrease in fine wrinkles, an increase in dermal volume (Fig. 3a), a brighter and more even skin tone in treatment areas, and reduced sagging of the skin.
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Thanks. I will add tretinoin to my next overseas order since I have no MD appointments for a while. Although I don’t have any actinic keratosis on my face, I do have on some other areas so I will try the tretinoin there as well.
I’ve seen beneficial effect of topical rapa on my hands compared with adjacent areas on my forearms. My hands show no age spots whereas my forearms do, despite the greater sun exposure. Also, I have no age spot pigmentation on my face either, which I attribute to topical rapa cream.
you can order it from India for $7 to $13 per 20mg tube. Lots of options.
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Good to know in case my insurance company decides to balk about the prescription renewal.
I was using tretinoin before I had heard about rapamycin and buying from India.
Now the first place I go to is India if my doctor won’t prescribe or my insurance won’t pay.
So far, I haven’t received any products that I thought were dodgy.
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The same Indian supplier of Sirolimus has tretinoin cream 0.1 15g for $6.70 each. I just ordered 10.
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Can you quote a source on this?
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Fwiw, glucosamine + chondritin sulfate are probably WAY more effective than collagen is?
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I suggest you prove it with laser confocal microscopy 
FWIW, tretinoin 0.025% works just as well for skin aging as the 0.1% but is also much less irritating to the skin:
Also, adapalene 0.1% aka Differin is also a retinoid that probably works just as well as tretinoin and also causes minimal skin irritation, and is over-the-counter in the USA (used to be Rx-only). I use Effaclar ($30 for 45 gram tube on Amazon).
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Additionally, adapalene is photostable, so you can apply it in the morning (tretinoin is not photostable and has to be applied at night).
Me. N=1 
81 years in the desert.
I’d still only apply a thin film to the skin in the evening before bedtime, you can still have issues applying at morning.
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I’ve never had any patients complain of issues applying adapalene in the morning vs evening, nor have I had any problems myself.
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The last dermatologist with a heavy research background I went to said at evening only - yes, specifically adapalene.
He or she probably didn’t know that it’s photostable (many of my derm colleagues are unaware of this fact and just tell everyone to use any retinoid at night).
I doubt it as he has his own skincare line, knew a lot about it, and had a biochemistry major with published research in photoaging.
I’m not sure why he said it, but my guess is it could still have phototoxicity over long periods of time.
I recall asking to try Differin instead of Retin-A. Ended up doing Retin-A since it works better.
He said I would probably shed like a crocodile with Differin as he’s seen many Asian patients do that. He was right. No offense but this is why I only go to dermatologists and not clinics that farm it out.
I’ve only been practicing dermatology for 15 years, but hey, you do you. 
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How about this - show me the research on adapalene with long-term clinical use and lack of reactions consistent with phototoxicity. I’m quite happy to be proven wrong.
Again no offense, but I’ve seen and heard enough from colleagues saying some midlevel practitioners (out of earshot) are way too overconfident and go past their lane.
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Please show me some research that adapalene specifically shouldn’t be applied in the morning, if that’s what you’re claiming.
(Or just continue trolling, if that’s your thing)
Adapalene - StatPearls - NCBI Bookshelf.
“Adapalene is applied once daily, either in the morning or at bedtime, to a clean face”
I took the liberty to do a simple drug lookup just to make sure.
Every single FDA label with adapalene (topical) only says to apply specifically in the evening/night. Never in the morning.
There is usually a good reason why the FDA labels are such. Either there are not enough studies or there are animal studies showing a negative effect or enough reported adverse reactions post-marketing (even if rare).
https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=BasicSearch.process
Your own cited page says “As there is a risk of photosensitivity with topical retinoids, the clinician should also recommend an oil-free sunscreen and warn the patient against excessive sun exposure.”
Again, no offense, not trolling. Seems consistent with my own experience.
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