Subclinical Acne: What It Is, Treatment Options, Prevention and More

• Subclinical acne refers to tiny bumps that develop beneath the skin and are the first signs of acne
• These bumps are technically referred to as microcomedones, a buildup of trapped sebum, dead skin cells and other debris
• Microcomedones are the first stage of noninflammatory acne and typically develop on the forehead, cheeks and chin
• Subclinical acne can be avoided by following an effective skin care routine that includes active agents to exfoliate and clear pores of buildup

Subclinical acne is a term that refers to the early stages of acne development, and is characterized by small bumps called microcomedones that form beneath the skin. These have not yet broken through the skin’s surface. With time, they increase in size and become comedones.

Microcomedones are a form of noninflammatory acne. If left untreated, symptoms can worsen when acne-causing bacteria becomes trapped and multiplies, leading to inflammation and the development of inflamed papules and pustules. 

Fortunately, there are several effective treatments as well as lifestyle changes that can halt the progression of acne development.

What is Subclinical Acne?

Subclinical acne is the first stage of pimple formation. It presents as small, colorless bumps called microcomedones that are precursors to both comedones (blackheads and whiteheads) and inflammatory lesions. They are so small they may not be visible. 

Where does it appear on the body?

Subclinical acne typically develops on the forehead but also the cheeks and chin; these are the areas with the largest amount of sebaceous glands. These glands secrete sebum (oil) to lubricate and protect the skin.

Causes of Subclinical Acne

All acne begins with the presence of oils. When this oil combines with dead skin cells and grime this matter becomes trapped within follicles (pores) and forms microcomedones. Subclinical acne is the first stage of acne development and is noninflammatory. 

Increases in oil production can occur due to fluctuations in hormones, as is common during puberty and pregnancy. It can also develop due to sweat remaining on skin after exercise, oily hair coming into contact with the face and neck, and headwear that traps moisture and inhibits air circulation.

Evidence also suggests that a diet high in dairy or added sugars can lead to excess sebum production as well as stress.

Treating Subclinical Acne

Over the counter (OTC) treatments can help treat subclinical acne. For treatment-resistant cases, see your dermatologist who can examine your skin and prescribe a prescription-strength solution.

These treatments focus on unclogging pores, exfoliating dead skin cells and decreasing oil production. Importantly, they also work to kill Cutibacterium acnes, the bacteria responsible for inflammation; this will prevent mild acne from progressing to inflammatory acne lesions. 

Over-the-counter products

OTC treatments are usually very effective in treating subclinical acne and include the following:

• Benzoyl peroxide is most effective against inflammatory acne as it is an antibacterial and can kill C. acnes very effectively. However, it has also been shown to be an effective comedolytic and can accelerate skin cell turnover and remove excess oils. Lastly, as an antibacterial, it can prevent comedones from degrading to inflamed lesions.

Benzoyl peroxide cleansers can be used on your entire face or as a spot treatment; for the latter look for a gel or cream as these have a higher concentration and are designed for this purpose.

• Salicylic acid is a chemical exfoliant that is ideal for comedones as it can deeply penetrate to break up hard plugs of sebum and debris; it also breaks apart the bonds that hold dead skin cells together to slough off layers of dead skin cells to keep pores clear.

Depending on your preference and skin type, you can find salicylic acid in multiple products—from face washes, toners, serums and creams—in strengths of 1%–2%.

• Retinol is prized for its ability  to dissolve the outer layer of skin, remove excess oils, exfoliate dead skin cells and debris, and stimulate skin cell turnover. This all contributes to clear skin and prevents acne breakouts.

Retinol can be found in gels, oils, serums and creams which allow you to choose based on your skin type and preference; these can be found in strengths of 0.01% to 2.0%. Retinol can cause redness, irritation and flaking therefore it is advised to use it no more than twice a week, during the evening, to allow your skin to become used to the product. You can then increase usage as instructed on the product label.  

For benzoyl peroxide and salicylic acid, results will vary per person but usually take 4–6 weeks; retinol can take up to 8 weeks to yield significant improvements.

Prescription

If your subclinical acne is not responding to OTC treatments, you can visit a dermatologist who will examine your skin and provide you with a topical prescription-strength treatment, typically a retinoid such as adapalene or tretinoin. Both have been proven effective in treating the microcomedones that are indicative of subclinical acne.

Tretinoin

Tretinoin is a powerful retinoid that can open up and clear debris from clogged follicles by promoting skin cell turnover. This rids pores of grime, dead skin cells, and oil. 

Tretinoin, however, does have some side effects including redness, peeling and dryness. As such, it may not be a suitable treatment for dry or sensitive skin.      

Adapalene

Adapalene is another highly effective retinoid that has been demonstrated to be very well tolerated and cause less skin irritation when compared to other retinoids. One study of adapalene gel 0.1% was found to be superior to other prescribed acne treatments, with a high success rate. 

Prevention

There are several lifestyle changes you can make that can help you achieve and maintain clear skin.

Skin care routine 

The most effective prevention strategy for subclinical acne involves following an effective skin care routine: 

• Wash your face morning and night with a low ph cleanser formulated for your skin type
• Use a glycolic acid toner after cleansing to clear skin or any excess oils and residue;  this agent is safe for all skin types but is best for oily skin
• Include a gentle exfoliation 2–3 times a week to help clear pores and prevent future outbreaks 
• Apply a moisturizer morning and night to counterbalance the drying effects of acne topical medications and to protect the skin barrier function; look for humectants which draw in and retain moisture to skin and emollients, which lock in moisture, prevent moisture loss and form a protective barrier on skin 
• Always apply a sunscreen with an SPF of 30 or greater to protect your skin from the sun’s damaging rays; doing so also protects the skin barrier function and helps prevent acne from developing or worsening

Lifestyle tips

• Shower immediately after exercising to clear skin of oil-clogging perspiration and oils
• Regularly wash your pillowcase to remove accumulated bacteria, dirt and dead skin cells that may transfer to your face while sleeping
• Wash your hair regularly to prevent oil buildup and keep hair away from your face to avoid transferring oils to skin
• If you feel diet is a trigger, reduce your consumption of dairy products and sugar
• If stress is worsening your acne symptoms find a calming activity such as yoga or meditation to help cope 

Takeaway

Subclinical acne is characterized by the formation of small, colorless bumps, called microcomedones that are the first signs of acne and rest just beneath the skin’s surface. These develop when dead skin, excess oil and grime accumulate.

If not addressed, this condition can worsen when bacteria proliferates and causes inflammation and the formation of papules and pus-filled pustules.

Subclinical acne can be treated and prevented with regular cleansing and exfoliation; by using skin care products that are appropriate for your skin type; and that contain active agents such as glycolic acid and salicylic acid to promote skin cell turnover and maintain clear pores. 

Treatment includes OTC topical antibacterial and exfoliating treatments, including salicylic acid, benzoyl peroxide and retinol as well as prescription-strength retinoids.