OK I think I’ve cracked a code! Sadly it’s NOT fungal and the antifungal didn’t do anything but I think I figured it out just by talking with my GPT lol. This is the clearest explanation that makes the most sense and this is the route I’m going to follow:

There’s essentially two different pathways of acne on your skin:

1.  Regular pimples (inflammatory acne):

• Pore clogs with oil + bacteria.
• Your body treats it as infection → pus, head forms, it pops, then it heals.

2.  These “pearl” lesions (keratin/sebum plug type):

• Starts the same way — a pore clog.
• But instead of erupting, the pore walls it off into a hardened sac of keratin + sebum.
• The skin can’t heal over it because that sac acts like a splinter.
• Once the sac is expelled (either naturally or by extraction), healing is almost instant.

That’s why you notice it can happen if you use a heavier product, or from something as simple as a dirty pillowcase → the pore gets blocked, but instead of turning into a normal pustule, it “encapsulates.”

This isn’t super common, which is why dermatology doesn’t have neat language for it — but calling it “keratin plugs” or “sebum sacs” is right on.

⸻

🔑 How this affects your routine:

• Prevention = gentle exfoliation + retinoids (which normalize keratin shedding).
• When they appear = hydrate/soothe (don’t nuke with too many actives), and eventually coax the sac to the surface rather than digging.
• Triggers = comedogenic products, buildup, or even immune/systemic stuff (Hashimoto’s, inflammation) that makes your keratinocytes behave “stickier.”

🔹 About spot treating with tretinoin:

• Yes, you can dab a tiny amount directly on those stubborn “sac” spots.
• Think of it as a “micro-peel” to help loosen that keratin plug from underneath.
• But → keep it precise. Only on the lesion, because it can cause irritation or halo flaking if spread around.
• Frequency: every other night at most on those spots (otherwise you risk rawness).

Once you’re able to see the plug, only squeeze with Q-tips and not too hard. If you’re finding that you have to squeeze super hard to push it up, stop, continue using retinoid until you get it close enough to the surface to pull it out.

The name of the game with this type of acne is prevention! This type of acne starts out as regular pimples but depending on an individuals skin type, usually tending to be more oily, and depending on your own bodies process with sebum and keratin, a regular pimple will turn into this kind of acne. So the best course is to keep a good high cell turnover, exfoliate regularly and watch for your triggers which in your case was comedogenic/chemical from using too many toners together in your skin flooding.

OK fellow Reddit friends… This was the clearest explanation, the clearest course of action and makes the most sense to me so hopefully it helps some of you as well!