What recommendations do you provide to patients with sensitive skin that can not tolerate retinoids more than a few times per week?

Our studies showed sensitive skin is mostly the result of a compromised stratum corneum. Microfissures provide channels allowing access to the underlying vulnerable epidermal epithelium. In the past, these patients were very difficult. Low doses of tretinoin partially encapsulated in microsponges were the best option but not very effective and not totally free of irritation. Recently, a combination of benzoyl peroxide(also poorly tolerated by these patients) and tretinoin which are totally encapsulated has been approved. I had the opportunity to evaluate this technology during the development of this product and found it remarkably well-tolerated even by patients with atopic dermatitis and rosacea and highly effective. This product, in comb...

I would suggest short contact exposure with any low-dose retinoid, leaving the topical on for only 30-60 minutes before bedtime. Has worked well for me in most cases.

In my experience, some patients that don't tolerate tretinoin 0.05% do tolerate tazarotene 0.1% cream (or adapalene 0.1% which is available OTC) so switching retinoid classes can help in some cases.

Also 'sandwich' the retinoid with emollient like "Neutrogena hydro-boost" or La Roche Posay hyalu B5 serum. Apply emollient THEN retinoid (make sure patient is just using a pea-sized amount for the entire face) then RE-apply moisturizer.

I would rather the patient use it a few times a week than not at all. Using a barrier moisturizer first (I'm a fan of LRP toleriane ultra) also can help.

Alrtreeno lotion with the HA has been successful for me in those patients that cannot tolerate tretinoin even rosacea-prone patients.