What Works Skin — Independent · Evidence-First · Ad-FreeIssue 014 · 20 April 2026 · Next: 04 Maywhatworksskin.com
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Concern · Acne · Comedonal

P. 25 · GUIDE

Blackheads, whiteheads,
and the boring fix.

Whiteheads and blackheads. Adapalene-first territory.

Open and closed comedones, primarily on the T-zone and chin. Not inflammatory, not painful, but the most common reason adults reach for a salicylic toner — usually the wrong one. Built around retinoid discipline, not exfoliation theatre.

— § 01

The triggers worth tracking.

Open comedones (blackheads) on nose, chin

The brown / black colour is oxidised sebum, not dirt. Scrubbing makes the inflammation worse.

92%
Closed comedones (whiteheads) under chin / forehead

Small, flesh-coloured, slightly raised. Often felt before they are seen — the gritty texture under fingertip.

78%
No redness, no tenderness

If lesions are red or sore, you have moved into the inflammatory acne category — different protocol.

85%
Worsens with comedogenic moisturisers / makeup

Particularly heavy oils, isopropyl myristate, and certain silicones. Non-comedogenic labelling is imperfect but useful.

68%
⁂

— § 02

Ingredients that actually work.

Tier
Molecule
Role
Evidence
Tier A
Adapalene 0.1%
Retinoid
The OTC retinoid of choice for comedonal acne. 12-week ramp; pea-sized.
Tier A
Tretinoin 0.025%
Retinoid
Faster comedolytic action than adapalene; less tolerable in the first 6 weeks.
Tier A
Salicylic acid 2%
Lipophilic exfoliant
Best as a leave-on or 60-second cleanser; not as a daily toner.
Tier B
Azelaic 10%
Comedolytic + anti-inflammatory
Pregnancy-safe; gentler ramp than retinoids; slower endpoints.
Tier A
Niacinamide 4–10%
Sebum modulation
The supporting active. Useful daily; not a primary treatment.
⁂

— § 03

The protocol.

  1. Phase 01 · Week 1–2

    Strip the routine

    Cleanser, lightweight gel moisturiser, fluid SPF. Stop scrubs, stop physical exfoliators, stop pore strips.

  2. Phase 02 · Week 2–4

    Introduce retinoid

    Adapalene 0.1% pea-sized, 3 nights a week, on dry skin. Buffer with moisturiser.

  3. Phase 03 · Week 4–12

    Build to nightly

    Alternate nights for 4 weeks, then nightly. Add salicylic 2% as a 60-second AM cleanser if needed.

  4. Phase 04 · Month 4+

    Maintenance

    Most comedonal cases will plateau by month 4 on adapalene. Continue indefinitely; reduce to 4 nights / week if needed.

Bottom line

A boring, retinoid-led protocol with a 12-week ramp will out-perform any toner-rich, scrubbing-heavy routine you can build. The only thing the trend is doing is selling you bottles.