This is a return patient who was stable for the last year but his retinoid was irritating him so he stopped using it correctly and his oil production ramped up and refilled his pores. This is why I recommend regular follow ups to adjust dosage as needed because hormones change and shift and so does acne, it’s not static. Adjusting dosing as needed helps stabilize flares and keep acne controlled. Acne extractions. Nose extractions. Blackheads, whiteheads, milia. Dermatology procedure. Dermatology Physician Assistant. MrPopZit.