OBJECTIVE: Fears of potentially costly use of topical retinoids for cosmetic treatment of photodamaged skin has resulted in many managed care organizations placing prior authorization requirements on this class of medications. The purpose of this investigation was to examine whether prescribing patterns of a nationally representative sample of US physicians shed light on potential inappropriate use of topical retinoids. METHODS: A retrospective, cross-sectional study of data from the National Ambulatory Medical Care Survey (1996 - 2000) was used to determine the impact of patient diagnosis of acne on the probability of retinoid prescription were examined in weighted multivariate logistic regression models. RESULTS: Topical retinoids were prescribed in 0.4% of the 3.67 billion visits for any diagnosis from 1996-2000, and in nearly 31% of the visits for 38.7 million visits for acne. The study found that there was negligible prescription of topical retinoids for non-acne related conditions (Risk Ratio [RR] for topical retinoid prescription with acne diagnosis: 58.8, 95% CI: 33.4, 103.7). This finding held when individual retinoids (tretinoin and adapalene) were examined separately. Clear age-related prescription trends were observed, with significant decrease in prescriptions beyond the teen years. CONCLUSIONS: The data do not support a need for general prior authorization of topical retinoids. Prior authorization requirements for topical retinoids may not be necessary in young patients, given the very small probability of non-acne related use. In older patients, prior authorization, if needed at all, should focus only on those topical retinoids for which there is evidence of efficacy in treatment of cosmetic photoaging.