Which medication is better as a treatment for microcomedones: tretinoin or adapalene? — Jayakar Thomas, MD, Chennai, India

There is no clear-cut answer to this question, and results vary from patient to patient. The main difference between adapalene and tretinoin is tolerability. 

In general, adapalene is more tolerable for individuals with very sensitive skin. However, much depends on the strength, formulation, skin type, and other products used. My best advice is to try both therapies and gain real-world clinical experience, because there is no scientific evidence that supports one medication over the other. — Abby A. Jacobson, PA-C (190-1)

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These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.