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 we...

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...

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.