All acne lesions start with what is called the micro-comedome which goes on to be a comedome or clogged pore. Comedomes form from upper skin cell layers sticking together and not sloughing off, thus blocking the pore and causing build up of oil and debris in the pore. These build ups can be “open comedomes” which often have a black surface and are known as blackheads, or they can be “closed comedomes” which look like tiny pimples that do not have a whitehead on them – like tiny, under the skin bumps. Until comedomes are treated and prevented, acne will persist.


Prescription topical medications called retinoids work to loosen comedomes and  to change the upper layer of skin to minimize pore blockage. Topical retinoid medications include Retin-A or tretinoin, Tazorac or tazaratene, Differin or adapalene and over the counter retinol creams. Differin has recently become available over the counter – i.e. you can find it on the drug store shelves and do not need a prersciption. A 45 gram tube is on average $24-27.  Consistent and correct use of these medications is critical to success.

Often– especially when there are a lot of comedomes or clogged pores – these creams are not completely effective by themselves. These clogged pores need physically removal or unclogging. This month’s special “Teen acne facial” does that. First a superficial chemical peel is done – sometimes combined with steam or a treatment mask. Next extractions are done. An extraction is done with lateral pressure around the pore with gauze or a tool to remove the congested material – this is not for the home bathroom!

Home care that complements the prescription creams and acne facials and peels include cleansers, lotions, and masks that contain benzoyl peroxide, glycolic acid or salicylic acid. All of these products exfoliate the upper layer of skin and loosen clogged pores.

Success in your acne treatment is often a matter of combining diligent use of prescription medications with in-office peels and facials and a good, complimentary home care regimen while not losing site of the goal – eliminating the clogged pore culprit for blemish free skin!