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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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