Comedones are part and parcel of life - the accumulation of oil and debris in pores is inevitable. There are ways to reduce them and keep them at the minimum, some of which are harsher with more side effects, and some with a more gradual but safer approach.
The most important step in maintaining relatively oil/comedone free skin is proper skincare. This will do two things
1. Reduce the sebum being produced
2. Exfoliate and prevent clogging up of waste that forms the comedones
This involves the use of:
1. Salicylic acid-based toners: These promote exfoliation and prevent debris accumulation that might contribute to pore congestion. Furthermore, salicylic acid specifically binds to sebaceous glands and reduce sebum secretion.
2. Adapalene/retins: These increase the rate of cell turnover (ie in a sense some form of exfoliation) as well as promote collagen stimulation in the dermis, which can help tighten pores.
Now, the use of the two above are typically sufficient in controlling and maintaining most comedonal issues.That being said, skincare is indeed a routine - it must be maintained. The skin is live organ that will continue to live even after you stop the above skincare, bringing you back to square 1.
Physical extraction (done professionally, preferably) once in a while, or with the use of clay or peel-off masks, help to remove the bulk of gunk that might slowly build up even with the use of the appropriate skincare.
Oral isotretinoin is a very effective option for severe acne and even comedonal issues, but the benefits should always be balanced with the possible risks of liver impairment and teratogenicity. More often than not, there aren't any major issues. In any case, speak properly to your doctor before starting on it.
Even after stopping isotretinoin, as you have experienced, comedonal build-up can and does occur. This again, emphasizes the need for a recurrent, safer method - proper skincare. So, do optimise your skin care routine and you should see satisfactory results in the long run.
Best Regards,
Dr Shane Abucewicz Tan
