Why do I get recurring whiteheads even after facial extractions?

Doctor's Answer

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

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