Adapalene for blackheads and whiteheads

Blackheads and whiteheads are the form of acne that the American Academy of Dermatology (AAD) ties directly to a retinoid. Comedo is the medical term for a blackhead or a whitehead. The AAD says a retinoid is the treatment to unclog pores, and it names adapalene as the retinoid you can buy without a prescription. This guide sets out what the AAD, MedlinePlus, an NHS hospital leaflet and the Differin label say about using adapalene on them. It is part of Skinli's guide to retinoids for acne.

What blackheads and whiteheads are

The AAD says these appear when pores become clogged with excess oil, bacteria and dead skin cells. If the pore closes up, you see a tiny bump that looks white or flesh colored, and that is a whitehead. If the pore fills with debris but stays open, you see a blackhead. The AAD adds that the black dots are not dirt, so you should resist scrubbing because it will only worsen your acne.

What the AAD recommends

For both types, the AAD's page on types of acne says: "To unclog pores, dermatologists recommend using a retinoid. You can buy one retinoid, adapalene, without a prescription. You'll also want to use a benzoyl peroxide wash." Its page on pimple popping says it can be tempting to pop a large pimple or squeeze out a blackhead, that this can delay clearing, and that touching, picking and popping can worsen acne.

The AAD's acne treatment page describes what the retinoid does: it works to clear your pores, and can treat blackheads, whiteheads and some pimples. A 2012 review in American Family Physician gives the mechanism, saying topical retinoids are effective in treating inflammatory and noninflammatory lesions by preventing comedones, reducing existing comedones and targeting inflammation.

How adapalene works on them

MedlinePlus says adapalene works by stopping pimples from forming under the surface of the skin. An NHS hospital leaflet on adapalene goes further: it says the adapalene in the gel works by increasing the turnover of skin cells, aiding the natural exfoliation of the skin surface layer to unblock the pores and sebaceous glands, thus allowing the natural oils to escape and reducing the formation of blackheads and spots. The leaflet is written for patients in the UK, where adapalene is a prescription medicine, and in the United States adapalene 0.1 percent gel is sold over the counter.

How to use it

The over-the-counter Differin Gel 0.1 percent label gives the directions. Use it once daily and cover the entire affected area with a thin layer. The label leaflet says the gel "is not a spot treatment and should not be used to treat a single pimple," which matters for blackheads, because a blackhead is not the only place a pore can clog. The AAD says dermatologists recommend applying adapalene after you shower or before going to bed, daily. The label says to limit sun exposure, including light from tanning beds, and to use sunscreen when going outdoors.

Avoid the eyes, lips and mucous membranes, which the prescription Differin Gel label names. Skinli's guide to starting adapalene without irritation gives the slow-start schedule, and its guide to Differin gel and adapalene strengths covers the products.

How long it takes

The AAD says to give treatment six to eight weeks to work, and that if you still see blemishes, you may want to see a dermatologist. It says a procedure like comedo extraction, the medical term for removing blackheads and whiteheads, may help, and that prescription-strength acne treatment is another option. The over-the-counter Differin Gel label says it may take up to 3 months of once daily use to see results, and to stop use and ask a doctor if you see no improvement after 3 months of once daily use.

Does it make blackheads worse at first

The label says that in the early weeks of use your acne may appear to worsen before it improves, and MedlinePlus says adapalene may bring previously unseen pimples to the skin surface. A 2012 analysis of clinical trial data on adapalene gel found no evidence of worsening or a flare in the first week. Skinli's guide to whether retinol makes acne worse at first sets out both views.

Other retinoids and combinations

Tretinoin, tazarotene and trifarotene are prescription retinoids. The Retin-A Micro label says tretinoin increases the turnover of the cells that line hair follicles, which pushes the plugs in pores (comedones) out, and reduces the early pore plugs called microcomedones. Skinli's guide to prescription retinoids for acne covers them. On combining a retinoid with a benzoyl peroxide wash, which the AAD recommends, the Differin Gel label says irritation is more likely if you use more than one topical acne medication at a time, and Skinli's guide to using a retinoid with benzoyl peroxide covers how the two are paired.

When to see a dermatologist

The AAD says that if blemishes remain after six to eight weeks of treatment, you may want to see a dermatologist, and that deep, painful acne needs a dermatologist's help. A dermatologist can remove blackheads and whiteheads by extraction, and can prescribe stronger treatment.