How can I get rid of closed comedones that do not respond to topical treatments?

Hello Aaron

Thank you for your question. In addition to what Dr Winston has mentioned, you can consider changing the topical retinol (usually over the counter) to a prescription based retinoid such as retin-A. It can be applied every other night initially and you can gradually increase it to 5 to 6 times per week as tolerated.

You can also consider doing 20-30% salicylic acid (BHA) peels fortnightly. This is a safe chemical peel which is effective in treating oily skin, acne skin and comedones.

Oral antibiotics can also be given if you are not responding to topical treatments. Speak to your doctor to find out more!

Regards,

I would like to ask you to consider stopping benzoyl peroxide. From my experience, it tends to dry the skin and not solve the underlying comedone issue.

I would actually consider adding on oral isotretinoin to work on the pathogenesis of sebum production. And also, to use a keratinolytic such as differin and tretinoin.

Please seek consultation with a doctor to treat it!

Firstly we need to establish that closed comedones is that correct diagnosis as they are some other conditions that may look similar to the layman such as milia and syringomas.

Topical comedolytic treatments such as acid peels and retinoids are generally effective in treatment of comedonal acne. I would suggest switching the retinol to tretinoin. This is a prescription medicine so you will need to see a doctor for this, who will also advise you which concentration to use. Persistent comedonal acne may require physical extraction in addition to the above mentioned treatments.