Treatment for Pimples on Both Sides of the Nose
Start with adapalene 0.1% gel (available over-the-counter) combined with benzoyl peroxide 2.5-5% as your first-line treatment—apply adapalene once nightly to completely dry skin and benzoyl peroxide once daily in the morning. 1, 2
Foundation of Treatment
The American Academy of Dermatology recommends topical retinoids as the cornerstone of all acne treatment because they target comedones (clogged pores), reduce inflammation, and resolve microcomedones before they become visible pimples 3, 1. Adapalene is specifically preferred as the first-line retinoid due to its superior tolerability, excellent efficacy, and practical advantages—it can be applied with benzoyl peroxide without oxidation concerns and lacks photolability restrictions 1.
Benzoyl peroxide must be added to the regimen because it kills acne-causing bacteria (C. acnes), provides mild comedolytic effects, and critically, no bacterial resistance has ever been reported with its use 3, 1. Lower concentrations (2.5-5%) cause less irritation while maintaining effectiveness 1.
Application Instructions
- Apply adapalene 0.1% gel once nightly to completely dry skin on the entire affected area (not just individual pimples) 1, 2
- Apply benzoyl peroxide 2.5-5% gel once daily in the morning to the same areas 1, 2
- Use daily sunscreen, as retinoids may cause photosensitivity 3, 4
- Start with reduced frequency (every other night for adapalene) and use concurrent moisturizers if irritation occurs 3, 1
If Initial Treatment Is Insufficient
If you still have inflammatory pimples after 4-6 weeks of consistent use, add a topical antibiotic (clindamycin 1% or erythromycin 3%) combined with benzoyl peroxide—never use antibiotics alone, as resistance develops rapidly without concurrent benzoyl peroxide 1, 2. Fixed-combination products (clindamycin 1%/BP 5% or erythromycin 3%/BP 5%) enhance compliance 1.
For adult females with inflammatory pimples, topical dapsone 5% gel is particularly effective and requires no glucose-6-phosphate dehydrogenase testing before starting 3, 1.
Alternative Options for Specific Concerns
- For post-inflammatory dark spots: Add azelaic acid, which is particularly useful for patients with darker skin tones 1
- Over-the-counter alternative: Salicylic acid 0.5-2% is a comedolytic agent available without prescription, though evidence for efficacy is more limited than retinoids 3, 1
Maintenance After Clearing
Continue topical retinoid monotherapy indefinitely after achieving clearance to prevent recurrence—this is essential, as stopping treatment once pimples clear leads to relapse 1, 2. Benzoyl peroxide can also be continued as maintenance 1, 2.
Critical Pitfalls to Avoid
- Never use topical antibiotics without benzoyl peroxide—resistance develops rapidly when antibiotics are used alone 1, 2
- Avoid applying retinoids to broken skin or active wounds 1
- Be aware that benzoyl peroxide can bleach fabrics, towels, and pillowcases 4, 5
- Expect mild irritation (redness, dryness, peeling) during the first 2-4 weeks—this is normal and can be managed by reducing application frequency and using moisturizers 3, 5