Comedonal Acne in a 20-Year-Old Female: A Case from Village Dermatology, Katy & Houston, Texas

by: Ashley Baldree

Case Overview
A 20-year-old female presented to Village Dermatology for evaluation and management of persistent acne located on the face. She reported blackheads, whiteheads, and occasional pimples that had been present for several months. Her only prior and current treatment included benzoyl peroxide lotion.

Clinical Examination
A comprehensive skin examination, including scalp, face, ears, neck, and upper extremities, revealed:

• Primary findings: Open and closed comedones (blackheads and whiteheads)

• Additional findings: Mild inflammatory papules and pustules concentrated on the forehead, cheeks, and chin

• No evidence of cystic or nodular lesions

• Skin otherwise well-nourished, with no signs of infection or scarring

Diagnosis

• Comedonal Acne (L70.0) with mild inflammatory component

• Distribution: Face (forehead, nose, cheeks, and chin)

Treatment Plan
To enhance the patient’s current regimen and improve acne control, the following steps were recommended:

1. Continue benzoyl peroxide lotion for antimicrobial and anti-inflammatory benefits.

2. Add a salicylic acid cleanser to help exfoliate and unclog pores.

3. Initiate topical tretinoin microspheres 0.04% gel – apply a pea-sized amount nightly to the entire face to promote cell turnover and prevent new comedones.

4. Skin care counseling:

   • Use non-comedogenic cleansers and moisturizers.

   • Always apply broad-spectrum sunscreen SPF 30+ during the day.

   • Expect initial irritation and dryness, which can be minimized with moisturizer.

5. Follow-up in 4–5 months to monitor progress and adjust treatment as necessary.

Patient Counseling & Expectations

• Improvement typically occurs gradually, with 60–80% clearance expected within 2–3 months of consistent use.

• Avoid picking or squeezing lesions to prevent scarring.

• Monitor for excessive redness, peeling, or sensitivity and adjust use as needed.

Dermatology Insight – Katy & Houston Focus
Comedonal acne is one of the most common skin conditions we treat at Village Dermatology in Katy and Houston, Texas. Early intervention is key to preventing scarring and hyperpigmentation. Combining benzoyl peroxide, salicylic acid, and tretinoin is a proven regimen that addresses both pore blockage and skin turnover, leading to smoother, clearer skin.