Balance efficacy, tolerability in ordering retinoids.(Clinical Rounds)

BLAINE, WASH. -- Topical retinoids can be highly effective treatments for acne, but they come in a bewilderingly wide variety of strengths and formulations.

Clinicians should consider effectiveness, tolerability, and the type of vehicle that would be best for an individual patient in making the choice, Robert Sidbury, M.D., said at a conference sponsored by the North Pacific Pediatric Society.

Physicians must choose among adapalene (Differin) 0.1%, which comes formulated as a gel, a cream, a solution, and as pledgets; tretinoin (Retin-A), which comes in four strengths between 0.01% and 0.1% as a cream and 0.01% and 0.025% as a gel; tretinoin micro (Retin-A Micro) gel, which comes in 0.04% and 0.1% strengths; and tazarotene (Tazorac), which comes as a gel and a cream in 0.05% and 0.1% strengths.

Adapalene is at the top of the tolerability list, said Dr. Sidbury of the University of Washington in Seattle. Tretinoin micro comes next, followed by tretinoin. Tazarotene is the least tolerable of the retinoids.

Unfortunately, the least tolerable topical retinoid is the most effective, and the ...