The correct answer is A. Start Adapalene 0.1 gel nightly to every other night after wash. 

The patient has comedonal acne. She should wash her face 2 times a day with a gentle cleanser. She should start using Differin 0.1 gel nightly to her face after washing. If too drying, the patient can reduce usgae of Differin to every other night. A topical retinoid treats comedones and assists with the proper keratinization of the hair follicle.

Aggressive exfoliation can damage the skin and make acne worse. Doxycycline is a systemic treatment option in cases of inflammatory acne that has not responded to combined topical treatment with clindamycin/benzoyl peroxide in the AM and a topical retinoid in the PM. Monotherapy with clindamycin is ill advised in cases of inflammatory acne as bacterial resistance becomes a problem; the patient should simultaneously used a benzoyl peroxide product. Isotretinoin is the not the first treatment in cases of comedonal acne.

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