Why do I get recurring whiteheads even after facial extractions?

There are tons of whiteheads on my face, and even with thorough facial extractions, the whiteheads seem to be coming back all the time. I was previously on antibiotics and oral isotretinoin for 2 years, which helped reduce the amount of whiteheads. However, the problem recurred after stopping all medications for 6 months. Why do I get recurring whiteheads even after facial extractions? Should I continue my facial extractions to remove the stubborn whiteheads, or go back to the doctor to get more medications? What other treatment options do I have?

It would appear that you have recurrent comedonal acne. There are 2 types, open or black comedones and closed or white comedones. Acne is basically a chronic recurrent problem hence it tends to recurr even after months or even years of acne free skin.

In your case white comedones are enclosed beneath the skin and formed die to excessive accumulation of sebum/oil , dead skin cells and debris/dirt that completely clogs the hair follicle. 

Therefore despite the extractions which are not normally recommended for white comedones as they are enclosed, and 2 years of antibiotics and oral isotretinion which helped to control the acne, it can relapse.

The relapse can be due to stress, hormonal changes, and in some cases even dietary issues. The main culprit would be the overstimulation and accumulation of excessive sebum and oil leading to clogged follicular ducts and pores. If infection sets in you will get the typical papular pustular acne which looks inflamed and red. 

There are many treatment options including the use of benzoyl peroxide, salicylic acid, azelaic acid, adapalene and retin A . Oral medications include antibiotics like doxycycline, minocycline and isotretinion . 

As you have already tried these treatments you may like to consider Agnes RF treatment for recurrent acne in the same location. This treatment modality uses a fine microneedle that is inserted through the follicle opening and directed at the pile sebaceous gland. The RF energy destroys the gland thus reducing the sebum secretion and treats the source of the problem. A single session can usually target about 8-10 such lesions which leads to the drying up and resolution of the acne.

Hope this helps.

Dr KK Chew

536 views 15 Jan 2019
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