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Old 08-12-2007, 06:31 PM   #1
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Idigit HB User
closed comedones/whiteheads and treatment

I've been suffering mild-moderate acne for about four years now. I've tried all sorts of OTC topical products from the drugstore, but because my skin is so sensitive most things would only make me red and blotchy and itchy, or they would make me break out.

However, it has taken all this time for me to realize that the kind of acne I struggle with is different from the type the media fixates on and gives instructions for its control. All of my acne is underneath the surface of the skin - closed comedones that very rarely ever come to a head (I only get about 1-2 actual pustules per month), and their emergence is heavily tied to my menstrual cycle. I believe that treating this kind of acne as you would treat someone mostly suffering pustules is pointless, as the clogged pores aren't receptive to medicines that only serve the purpose of killing bacteria. Because of this, I think the type of acne that consists mostly of closed comedones, while being the mildest type in terms of pain and appearance, is some of the most difficult to treat. All of these years I have been treating my acne as if I was dealing with pustules, but reducing the bacteria on my skin's surface was doing very little or nothing to help unclog my pores.

After doing a little research on prescription acne meds and how they work, particularly Retin-A (which seems to be one of the few meds designed specifically for my variety of acne), I've changed everything I used to believe about acne treatments and how they show their effectiveness.

Now, I think that the years of frustration of using a product and then being discouraged by the subsequent breakout of pustules and stopping the regimen, was the biggest mistake I've made consistently in my struggle with my skin. Acne products generally advertise immediate results - a shrinking in blemish size, a calming of the redness of the skin, an overall smoother appearance, after a few treatments. We expect and hope that a spot will shrink and disappear if we slather some product onto it, not that the skin will erupt in pustules (which my skin has done in response to almost every regimen I've tried). But now that I understand the type of acne I'm dealing with, this process makes perfect sense. Every time I've disregarded an acne product because instead of helping reduce inflammation or shrink my pores, it caused a breakout, I've actually been ceasing treatment at the most crucial point, the point when I should be looking positively upon the treatment. This breakout doesn't signal ineffectiveness, it signals the purging of my pores.

More specifically, I'm talking about salycic acid. Whenever I've used SAcid cleansing pads or a SAcid face wash in the past, I've felt disgusted and ripped off when a couple days later my skin looked ten times worse because the tiny, closed comedones were replaced by "real" pimples. Immediately i assumed that my skin was too sensitive and was reacting poorly to treatment, and I would stop the treatment and go back to simple cleansing and occassional exfoliation, and the comedones would continue to dominate my skin - stubborn and infuriating. But now I realize that perhaps the breakout phase is a necessary part of controlling the type of acne typified by closed comedones. The clogged pores must be forced to bring the clogged material to the surface, form a pustule, then heal. Every time. So, healthboarders, what do you think of this theory? I know it's not a new one, there are some honest acne regimens out there that warn of a breakout preceding improvement. But I think a lot of people face the same self-defeating cycle that I've been involved in throughout my years of acne. Many OTC products and their advertising simply aren't honest enough to admit that your skin will look and feel much worse before it gets to the point where healing can actually take place, and so people continue to go through product after product, feeling discouraged each time when they stop halfway through the purging process.

I'm going to suggest a regimen for people with my kind of acne, 99% closed comedones underneath the skin, with heavy hormonal influence. The regimen is this:

1) Salycic acid, either in cleanser form or in wipe/pad form after gentle cleansing (I'll be using the pads), for as long as it takes for closed comedones/whiteheads to form into pustules.

2) Then limit salycic acid treatment to areas of whitehead persistence, while treating pustules with Benzoyl Peroxide (I happen to have 10% BP available, but 2.5% is probably better, esp if you have sensitive skin like me)

3) SPF oil-free noncomedogenic moisturizer every single day, and a noncomedogenic moisturizer at night if desired (I use Ponds cream at night, and interestingly enough I've never had the problems of irritation or clogged pores that I've had with many other more expensive moisturizers).

I'm going to start this regimen on Monday night (won't have access to all my treatments until then, I'm away from home at the moment), and I'll update on my progress.

Again, I'm not trying to say that this regimen is revolutionary or anything like that, because it definately isn't! But I believe that the idea of purging will be comforting to people like me who have had little luck with drugstore products and are impatient for results.

Any other ideas, suggestions, knowledge to share about the properties of BP or SAcid, closed comedones versus pustules, "pore purging," etc? Please share them!

 
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Old 07-06-2008, 07:57 AM   #2
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extraction706 HB User
Re: closed comedones/whiteheads and treatment

Idigit,
I found your post by searching on google. It is indeed very interesting.

I am convinced that. just like you, don't have the type of acne that is generally being discussed in the media (being a result of oily skin). I am a guy with very sensitive skin, a type of skin that after how you described your acne problems, seems to resemble yours. In the winter it gets awfully dry and in the summer, or rather should I say on hot days, there seems to be a bit of oil showing up. In combination with growing a beard, this leads to breakout.
Other than that, I have closed comedones beneath the skin that seem to be just "waiting". I've tried a couple of times to treat it with BP, and every time has turned out to be a big mess, no matter how much I moisturize.
It is not until recently that I have given Salicyl Acid I try. Just like you described, it seems to be doing stuff worse, actually creating those "real pimples" on my chin. I don't know if this is a necessary evil to get through (and if it is, I don't know if it's worth getting through it...). I feel a little uncomfortable starting a treatment that starts off with bad results; last autumn, after a terrible summer of breakouts (waiting with shaving a few days too long can be devastating) I tried B5 vitamine pills. The company who made them actually warned that it could be a problem in the beginning, pores being "cleaned out" and that. I stuck with it for a few months after which I quit it. It dried out my skin completely and became a disaster. This was at a time where I was still convinced that acne was only the result of oily skin, not even thinking about moisturizing.
So I wanted to hear if you've had any success with the treatment you suggested or if there's something new you've found out to be better.

 
Old 07-14-2008, 06:46 AM   #3
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Micheybell HB User
Re: closed comedones/whiteheads and treatment

I too have been dealing with these same issues. I do feel they are hormone related as well. I do notice more of a flare up around the time i get my period. I've tried Pro-Activ (benzoyl-peroxide) and I definately know that doesn't work for these clogged pores. I started getting facials from a well educated and licensed asthetician. Her facials have helped me greatly. She also gave me a glycolic acid complex that I feel works better than anything else. I try to go for these facials once every 6-8 weeks to keep the problem in check. It has definately helped me.

She also said that a salicylic acid and glycolic acid complex would work well. They work best when used together. I am going to be starting a facial wash containing salicylic acid and I will continue the glycolic complex as well. I will keep you posted on my results.

good luck dealing with this.

 
Old 05-17-2009, 02:08 AM   #4
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Luca22 HB User
Re: closed comedones/whiteheads and treatment

Hello, I was pretty happy when I read your comments and ideas. I have the exact same problem, whiteheads everywhere with only mild acne otherwise, and it gets incredibly bad close to my period. I have been looking online for ages to find someone who experiences the same thing, or some info. on it, and it took awhile but I thought surely someone else out there has this problem! I feel so uncomfotable in my own skin, literally, and hate the look and feel of it. I took accutane awhile ago and I'm wondering if it had some long-term affect on my skin, since my skin is now more oily than ever but it doesn't seem to get flushed away properly or something and everything just gets clogged up. I've NEVER found anything that made it better or affected it besides hormonal factors. I will be interested to hear how your regimen goes, and I will let you know if I find anything thath helps.

 
Old 06-19-2009, 04:02 AM   #5
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Isham HB User
Re: closed comedones/whiteheads and treatment

Nothing topical will work. It could take months to a year for an acid to widdle away at skin just to get a closed comedone to come to the surface. The only way is to extract and here's how I do it.

Get a sewing needle. The sharper the better. Clean the needle with rubbing alcohol. Hold the portion of skin with the comedone taught if its not over a bone or stretch the skin so that its over a bone. Next get your needle ant try to pierce the sub surface comedone at an flat angle. The needle will enter the nearest pore then lift up. What this will do is break the pore and make it real easy to squeeze out. Sometimes that action will cause it to pop out. If its being really stubborn leave it alone and try again in a few days to a week. Closed comedones are like granules depending on how long they have been under which is why an acid isn't going to do anything. After a few months the comedone might reappear, if it does just try again and it will come out even easier if its at the same place. I do this all the time and have found surgery the only way to get them out. Pain level on a scale of 1-10 its a 0.5 you might see a tiny drop of blood but that's all. It's really painless because you no where near the nerves.


I really hate closed comedone because your cant just pop them like a typical zit and if left alone they will get bigger like a mole or a skin tag.

Skin tags I hate also and I get rid of them on my own also but that's another write up. Give a try people and let me know what happens. Make sure your hands are clean and your tools are sterile before you do anything.

 
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