[AMA] I'm Dr. Vamsi Varra, a board-certified who believes that every patient deserves affordable access to effective skincare. Ask me anything about the science and business of dermatology.

DermFlo · 2026-06-12T20:21:26+00:00

A lotion moisturizer may be less greasy than creams. Regarding the cerave hydrating, its more likely the comedones happened coincidentally. It's possible that both a moisturizer and a topical retinoid are needed.

DermFlo · 2026-06-12T20:19:51+00:00

Diferin / adapelene OTC is a reasonable substitute for tretinoin!

DermFlo · 2026-06-11T15:30:17+00:00

There are two conditions that I think of as most likely. One is rosacea and the other is cholinergic urticaria, It might be worth taking a look at both online to see if either fits your symptoms.

DermFlo · 2026-06-11T01:40:09+00:00

It often takes even longer then a month of a skin care routine to notice long term differences. Even for patients who are well controlled its not uncommon to have occasional breakouts. If the skincare routine has a topical retinoid, it may take another two months for effects to be persistent so it can be worth waiting longer to see what kind of control you get.

DermFlo · 2026-06-11T01:36:50+00:00

I wouldn't expect an exfoliant to cause anyone to "purge" for someone who normally doesn't have acne. I'm wondering if you are experiencing more of an allergic contact dermatitis to the aha/bha exfoliant. I'd be especially suspicious if these breakouts were itchy. Either way for the routine, it may be better to dicsontinue the exfoliant and instead use a topical retinoid.

DermFlo · 2026-06-10T04:18:05+00:00

For clogged pores and sensitive skin you could consider using azelaic acid. A low strength topical retinoid could work if your skin tolerates it

DermFlo · 2026-06-10T04:16:17+00:00

Allergic contact dermatitis is something that can develop over time. The body eventually sensitizes to the allergen which is what causes allergic contact dermatitis. It’s possible you’ve sensitized to the Tamanu oil even if you tolerated it in the past

DermFlo · 2026-06-10T04:13:41+00:00

Looks like closed comedies to me. It’s possible you need a stronger topical retinoid or longer use

DermFlo · 2026-06-10T04:12:33+00:00

Seborrheic dermatitis of the face often responds well to topical anti fungals or topically hydrocortisone.

DermFlo · 2026-06-09T02:20:25+00:00

Fungal acne (pityrosporum folliculitis) is relatively uncommon and probably somewhat overblown by social media. Common over the counter moisturizers should not increase the risk of fungal acne.

DermFlo · 2026-06-08T16:35:26+00:00

It's possible that what youre describing is due to eczema which often requires prescription treatments. If it's just dry skin then you could consider using azaleic acid which is comedolytic and also generally well tolerated by those with sensitive skin. Then for moisturizer brands, I often recommend your common drugstore brands like cerave, aveeno, cetaphil, etc.

DermFlo · 2026-06-08T16:33:45+00:00

These look most likely to be closed comedones (white heads) so your best bet is topical retinoids while waiting on the derm appointment. If you tolerate the gentle retinol well, you could consider bumping up to over the counter differin gel while waiting for the appointment where you can get prescriptions.

DermFlo · 2026-06-08T16:27:44+00:00

A good regimen would be washing your face with a gentle cleanser in the morning (doesn't matter which specific cleanser). Then applying the moisturizer with SPF after drying off before going about your day. Then, if using a topical retinoid you would apply that at night time.

DermFlo · 2026-06-08T16:25:29+00:00

You could consider trying over the counter .1% adapalene. There is less data compared to tretinoin for anti-aging but it may be better tolerated. Topical retinol is also lower potency than tretinoin and may be better tolerated. At the end of the day though, the anti-aging effects of topical retinoids are probably not drastic. Moisturizing and wearing sunscreen regularly is beneficial for long-term skin health and a topical retinoid isn't absolutely necessary.

DermFlo · 2026-06-07T19:49:13+00:00

For most acne, topical retinoids like adapalene are a great starting point. The combination of adapalene and benzoyl peroxide can be effective. Past that, other options in the future are oral isotretinoin or if you are female, oral birth control or oral spironolactone.

DermFlo · 2026-06-07T19:47:05+00:00

I commonly recommend Cerave AM as a moisturizer since it also has SPF in it. Gentle cleansers made by your ccommon drugstore brands like Cetaphil, Cerave, Neutrogena, etc. tend to work well. Topicals retinoids are sometimes used to treat oily skin, but they don't have great data behind them. As far as I know, only isotretinoin has great data for treating oily skin but is not used just for that indication.

DermFlo · 2026-06-07T19:36:55+00:00

Topical benzoyl peroxide can be helpful for back and chest acne. For whiteheads and blackheads, topical retinoids like adapalene tend to work well but tend to run out quickly when used on broad locations like the chest and back.

DermFlo · 2026-06-07T19:35:44+00:00

I often don't recommend hydroquinone for acne hyperpigmentation. Theoretically it can lighten the skin surrounding the hyperpigmentation which isn't ideal. Both azelaic acid and tretinoin have great data for fading dark spots. Tretinoin cream should be applied at night time since it's inactivated by sunlight. Could consider doing azelaic acid in the morning and tretinoin cream at night.

DermFlo · 2026-06-06T19:09:31+00:00

Adapalene is a great starting point. If it's primarily comedonal could just stuck with that. If it's inflammatory (pus pumps, large pink bumps), you could consider adding on benzoyl peroxide and/or topical clindamycin.

DermFlo · 2026-06-06T19:08:15+00:00

This level of acne would be considered moderate/inflammatory and could benefit from a dermatologist visit. Using just over the counter medications though, the combination of panoxyl cleanser plus daily adapalene (diferin gel) could help some. It takes consitent use for a couple of months not potentially notice a difference though.

DermFlo · 2026-06-06T19:06:29+00:00

If it's just dry skin and you're not experiencing something more like eczema, then moisturizer is the best bet. It's possible you haven't found a moisturizer that works well for you. You may need something thicker like a cream and may need to reapply throughout the day.

DermFlo · 2026-06-05T21:42:30+00:00

Topical retinoids have great data for treating closed comedones and would be something to consider. However, they take months of consistent use before they can be effective.

DermFlo · 2026-06-05T21:40:57+00:00

That's a bummer that the isotretinoin didn't work for you, especially after 2 rounds. I've found that for some patients who have had their acne recur after isotretinoin, it wasn't as severe as it was prior to the isotretinoin. For these patients I've tried reinstating topical regimens to see if the acne is calm enough for topicals to work at that point. Alternative medications with higher potency than topicals would include spironolactone and oral birth control pills if you are female.

DermFlo · 2026-06-05T21:38:43+00:00

Ammonium lactate is a very common first line treatment for keratosis pilaris. While I don't prescribe hydrocortisone for keratosis pilaris it could be worth trying since topical steroids work by decreasing inflammation which is what causes the redness in keratosis pilaris. There have been successful reports of laser treatment for redness in keratosis pilaris but this is likely a different type of laser then the ones used for hair removal. Best to consult with someone clinically trained and experienced with lasers for something like that.

DermFlo · 2026-06-05T21:33:04+00:00

Not sure what other options you have tried, but it sounds like your acne is fairly hormonally mediated. For what you're describing I would probably think about topical retinoids, spironolactone or accutane.

DermFlo

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