How can I prevent persistent closed comedones that keep recurring?

Doctor's Answers 3

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Dr Joanna Chan

Aesthetic, General Practitioner

It is great that you are using non-comedogenic products! Do take note, though, that no product is 100% safe, so the key is also not to apply makeup/cosmetics/skin care products excessively.

Comedones form when our skin cells lining the sebaceous ducts proliferate abnormally. Combined with the increased sebum production that is common in acne-prone skin and some skin debris such as cosmetic residue, these debris can block the sebaceous duct and result in a comedo.

In terms of controlling comedones, and acne, in the long-term, I would suggest the use of topical medical-grade creams as a cost-effective way to promote our skin’s normal shedding of dead skin cells so that they do not clog up the pores. In this way, they help to "exfoliate" the skin without excessive mechanical trauma/irritation.

Suitable agents include benzoyl peroxide and topical retinoids 0.025% or 0.05% such as adapalene 0.1% (differin) and treitinoin. Topical chemical peels containing glycolic and salicylic acid of the appropriate concentrations are frequently useful too. In severe cases oral medications such as isotreitinoin may be used.

If your problem is persistent, you could be experiencing a subtype of acne known as acne cosmetica, where multiple small skin-colored bumps and comedones form as a result of unsuitable/excessive use of facial products. As excessive sebum is also a factor in the formation of comedones as it increases the chance our dead skin cells lining the pores "stick" together, your doctor may also consider medications to target excessive sebum production such as spironolactone and oral contraceptive pills for some patients.

Do seek a consult with a trusted doctor for a more in-depth solution to your concerns. Hope this helps!

Best Regards,

Dr. Joanna Chan

Sounds like you've done quite a bit of research, taken some necessary precautions, and yet you are still bothered by this problem.

You are right to use medical grade, non-comedogenic products. Retinoids, chemical peels (e.g. AHAs, salicylic acid) and exfoliation in general should help reduce hypercornification of the pilosebaceous duct unit, which prevent buildup of sebum and cause comedones. Painful extractions work, but like you said, are quite expensive to do regularly.

A good skincare routine would be essential for prevention of comedones. I suggest ensuring that your facial cleansing is done right before you go to sleep at night. Remove your make up with a proper makeup remover, perhaps try a mechanical cleanser, and apply your toner after you wash your face. Also make sure that your makeup is oil free and non-comedogenic. If your condition is severe enough, oral isotretinoin can help to reduce acne and comedones. Q-switch laser and IPL treatment can also help control oil secretion and reduce comedone formation. Lastly, if you find facials too expensive, you can try doing manual extraction yourself at home. Ensure your instruments are sanitized and the extraction is done gently after nicking the tip of the close comedone.

I hope this helps!

Regards,

Dr Harvey Ho

If you are suffering from comedomal form of acne, you should wash your face twice daily with a suitable cleanser and use oil free and non-comedogenic skin-care products especially if you have oily skin. You should avoid using heavy make-up as well as this may cause further congestion of the pores.

Diet wise, it helps to reduce intake of dairy products, carhohydrates especially refined sugars, fatty foods, foods with preservatives. If you smoke and lead a stressful lifestyle, try cutting down on smoking and reducing stress where possible. This will help greatly with whatever form of acne you are facing.

You can also use mild facial scrubs once weekly or once every two weeks to remove the slough and dead skin that’s accumulated on the skin. This will enhance the extrusion of sebum from pores and reduce comedones.

You can also try topical off-the-counter skincare products that contain comedolytic ingredients like salicylic acid, azelaic acid, glycolic acid which will help with reducing comdomes. For persistent cases, topical retinoids like tretinoin, isotretinoin and adapalene which require a doctor’s prescription are useful as they increase cell turnover and prevent buildup of sebum in the skin pores, reducing the formation of comedomes.

For severe cases, there are oral medications which include hormonal therapy and oral isotretinoin which help to reduce the activity of sebaceous glands, and hence reduce the formation of comdomes. However, these come with certain side effects and you should always consult a doctor prior to taking these medications. Procedures like electrocautery and comedome extraction, microdermabrasion and radiofrequency microneedling are useful to treat comdomal acne as well.

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Thanks for the detailed summary. There’s no problem at all with seeing a GP to treat your acne – the treatment algorithm for acne is pretty standard. My pet peeve is only with clinics who overcharge based on having some sort of special super secret ingredient “miracle acne creams”, because the reality is that all effective topical creams contain well-known ingredients, and packaging it under their own brand shouldn’t give them the right to charge more, or “lock-in” patients to only using their creams.

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From your description, the brownish marks are Post-Inflammatory Hyperpigmentation marks which have occurred due to the inflammation from your acne, trauma from squeezing the acne and extraction during facial. As the name suggests, Post-Inflammatory Hyperpigmentation(PIH) may occur whenever there is an insult/inflammation to the skin, and the skin reacts by producing more melanin. It is temporary, but may take some time to heal and resolve without treatment. It also happens more commonly in darker-skinned individuals. Treating PIH takes time and patience.

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