Why Apostrophe is ranked first for Black skin
The documented gap in clinical dermatology training for skin of color is real: only 4-10 percent of dermatology textbook images depict skin of color, and most dermatology residents complete training without rotating through a Black-patient-majority practice. This is the structural reason a telehealth-first approach can actually be better than a default in-person dermatologist visit for many Black patients: Apostrophe's intake explicitly captures skin tone (Fitzpatrick IV-VI) and surfaces it to the prescribing dermatologist, who selects actives accordingly.
The custom-compounded formulas include hydroquinone for hyperpigmentation when appropriate (with proper cycling and monitoring) and azelaic acid as a gentler alternative. These are prescription-strength options that you cannot buy over-the-counter, and they are the ingredients most likely to actually treat dark spots and post-inflammatory hyperpigmentation on Black skin.
What the first 2-4 weeks look like
Almost every Black patient using prescription-strength tretinoin for the first time goes through a period of irritation, purging (acne briefly getting worse before getting better), and occasional darkening before the formula starts working. Apostrophe's intake screens for this and starts most patients at a lower tretinoin concentration than competitor services, but the experience is still rough for the first month. Stick with it; most readers who reported their experience said weeks 6-12 were when the formula actually started working.
What it does not cover
Apostrophe is cosmetic-dermatology telehealth. It does not screen for melanoma or other concerning lesions, does not treat keloid scarring (which requires in-office injection or surgery), and does not address conditions like atopic dermatitis or psoriasis. For a suspicious mole or persistent rash, see an in-person dermatologist; for everyday acne, hyperpigmentation, or PFB, Apostrophe is the most evaluated-for-skin-of-color option we found.