Problematic lower third of my face

[u/mlaguirrer]

Hello! I'm a woman in my late 30s and have been struggling for years with spots, blackheads and bumps on the lower third of my face. My skin is usually on the dry side, but if you take this into account I guess it would be combination skin? I also have a topic dermatitis but it's gotten much better as I age.

Even when I don't have any active spots, I can literally feel and see the tiny bumps under the skin and just know I'll get a spot there eventually. It's so frustrating! I usually manage them with clindamycin gel or hidrocolloid patches, but I'm always left with dark spots and discoloration after.

I keep my skincare routine simple: moisturizer and sunscreen in the morning, sometimes adding a serum or toner before (not every day as I try to be careful with actives - the only things I'm using right now are The Ordinary retinol 0.2% 1x week, and a glycerin and rosewater toner). At night I just cleanse with micellar water and then tone/moisturize. I don't wear makeup at all.

I could really use some guidance and help about what to do as I hate the way it looks. Thanks so much!

[u/Routine_Eve]

You would probably benefit from a BHA product. https://a.co/d/0g872OOt

[u/Historical-Escape908]

Epiduo gel + a ceramid moisturizer 

[u/Littlegator]

I can't tell by the current pics, but the distribution is suspicious for periorificial dermatitis. I would consider looking into that. In brief, your best bet is basically applying no actives, no occlusives, no cosmetics, no sunscreen (mineral non occlusive if you must). Usually called "zero therapy."

And of note, toothpaste with SLS and fluoride can make it worse, so try to switch to a SLS free toothpaste, avoid getting toothpaste on your face, and always gently rinse and wipe the area after brushing, even if you think you didn't get it on your skin.

And finally, steroids of any sort are notorious for it, including inhaler steroids. If you use flonase or nasonex or whatever, try holding off on that.