Maychiri's Thoughts: September 2024

Belupo Sona Duo Gel Review

September 24, 2024

A special kind of review today – I am reviewing a topical retinoid that is only available with a prescription. This medicine has many different trade names and formulations, but the one I was prescribed is called Belupo Sona Duo Gel, which is a combination of adapalene and benzoyl peroxide.

One thing has been constant my entire life, ever since I entered puberty: acne. But not the type of acne you’d see in teenage flicks, where a girl gets one zit on her forehead before prom... oh no. I suffer from constant and repeating acne on my lower face, particularly my chin. I literally cannot remember a time when my chin was free from acne, I use all the ingredients that should help (salicylic acid, Centella, tea tree/tea plant, niacinamide...), but nothing has, so far, been able to truly rid me of these acne. To be completely honest, I’ve come to terms with it, but one time I was at my GP’s, and she suggested using a stronger medication so that I don’t end up with severe acne scarring. I mean, she is right, the cystic acne that I mostly have are the most likely to cause scarring. So, then, I was given adapalene with benzoyl peroxide; this combination as many names around the world, here, it’s called Sona Duo Gel. Elsewhere, it may have different names, such as Epiduo Gel, or it may simply be called “Adapalene and Benzoyl Peroxide Gel”. It doesn’t matter, it’s all the same thing. However, note that Differin is not the same; Differin contains only adapalene. Now, with the formalities out of the way, let’s see how effective this actually is at clearing acne! I have to admit that I am a bit scared after seeing pictures of Differin purge...

Do note that this particular combination of adapalene and benzoyl peroxide is Rx only. This should tell you that it’s no joke. My doctor wouldn’t have given me the prescription unless she thought it was really necessary.

Packaging: very simple cardboard box as the outer packaging. It’s a medical product, so this is standard. I love the purple text, though. Inside, you’ll find the info leaflet, as all medications have. The gel comes in a thick, wide bottle that looks not special at all in any regard. There’s a sticker with that same purple text. The cap closes extremely tightly, with a loud click once it is closed properly. There’s a pump inside that dispenses the gel. Although it’s pretty simple, everything feels high quality and robust.

Ingredients: only notable ingredients are the active ones, adapalene and benzoyl peroxide. No parabens or anything else harmful. The scent is barely noticeable, it really doesn’t smell like anything. The expiration date is short, which is normal for retinoids, as they are quite sensitive to temperature changes. It lasts only 6 months after opening, and should be kept at or below 25 degrees Celsius.

So, what exactly are the active ingredients here, adapalene and benzoyl peroxide? Just a fair warning, this is going to become very sciencey!

Let’s start with adapalene. Adapalene is a retinoid; you might have heard of retinol; well, retinoids are quite similar, as they are, too, derivatives of vitamin A. And, just like other vitamin A derivatives (retinol, tretinoin, retinoids etc), adapalene has one ability that makes it an invaluable part of an anti-acne routine: it regulates cell turnover, in other words, it helps prevent a build up of sebum because the cells regenerate so quickly, and without excess sebum that gets inflamed, fewer acne form as a result ^{1 2 3}. It penetrates deep into the pores and is rapidly absorbed, which is why it is so effective, because it targets the very source of acne, not the surface^{2 1}. Besides that, it is also anti-inflammatory, as it suppresses inflammatory responses that are caused by Cutibacterium acnes, and it inhibits the production of prostaglandins, which are involved in the process of inflammation ¹. It reduces how much redness and swelling there is with active breakouts ⁴, and it also breaks down oil and dead skin in a process called comedolysis, which further helps it fight off breakouts and helps clear your skin ³. But, you might have heard that everything vitamin A related doesn’t tolerate sunlight very well; this is true of adapalene as well, but it is more stable to light and oxygen than other retinoids, making it less likely it will break down if you accidentally forget to put sunscreen or something like that ². So, as you can see, adpalene is kind of like retinol but on steroids, so to say. It is super powerful, but it has the drawback of causing retinization, like all retinoids ¹. Retinization is, in short, an intense reaction to retinoids, where the skin becomes red, irritated, flaky, and usually, there is a marked increase in the amount of pimples. However, this is transient, so you just gotta tough it out. And, given everything that you now know about adapalene, it is no surprise that it can also be used to target wrinkles and other signs of aging, although this isn’t its primary function ⁵. I am actually worried how my skin is going to react to such a powerful ingredient, it’s already quite sensitive...

Sources: [1] [2] [3] [4] [5]

Now, the second half of the duo, benzoyl peroxide. This is a peroxide, surely you’ve heard of them, they are used to bleach hair, for example. But benzoyl peroxide has found use in the fight against acne because it works in multiple ways to prevent and treat acne lesions. Firstly, it is antiseptic; it inhibits the growth of Cutibacterium acnes, and it can also cause peroxidation in C. acnes, which makes it bactericidal. This is because, as all peroxides, it breaks down into free radicals that cause oxidative damage to bacterial cells ¹ ² ³. Secondly, it is comedolytic, that is, it helps unblock the drainage of sebum, preventing it from clogging up pores. This is also achieved thanks to its conversion into free radicals. And it penetrates deep into the skin, so that it targets the source of acne ¹ ² ³. Thirdly, it is anti-inflammatory. It helps reduce the amount of redness and inflammation that occurs when a new pimple forms, and because it penetrates deep into the skin, it lets the skin rapidly start healing instead of letting the pimple fester for days on end. It dries up pimples, preventing them from becoming cystic and painful ³. Plus, it doesn’t lead to bacterial resistance to it, unlike antibiotics, so you can keep using it continuously! Just note that, like all peroxides, it bleaches fabrics and hair, so try to avoid touching any clothes or hair after applying the gel. So, in short, it’s bactericidal and anti-inflammatory, but it, too, can cause severe reactions in sensitive skin.

Sources: [1] [2] [3]

Now, that’s the general gist of how both of the ingredients work; I am worried that they might be too strong for my skin, but I have to do something because my normal routine of salicylic acid and tea tree isn’t doing enough to prevent pimples. I am mostly afraid of the retinization... here’s hoping my skin can tolerate this incredibly powerful combo!

Now, let’s take a look at the pump! The pump is wide, but it has a tiny little nozzle. The pump feels quite high quality! It dispenses a precise amount of gel every time, so that you get the correct dose. It’s easy to press, although you do need to press it quite a few times the first time you use it. It’s like there’s a lot of air inside, so it takes a long time to get to the gel. Afterwards, it’s super easy to squeeze out a small dollop of gel. Also, the nozzle doesn’t get clogged up.

Colour: white, but it looks thick. It’s opaque, so it looks more like a cream than a gel.

This gel doesn’t have any particularly special instructions when it comes to how you should apply it, at least, it’s basically the same as any other topical retinoid. By that, I mean that it must be used once a day, before bed. All retinoids, including retinol itself, are photosensitive, so, for it to work best, it should be used at night, so that it works overnight, when the skin is regenerating. Benzoyl peroxide isn’t as sensitive to sunlight, so it doesn’t much to it when you apply it, but since it’s combined with adapalene here, then the best time to apply the gel is before bed. Aside from that, it should be applied on dry skin, not moist. Counter to what many other active ingredients require to absorb best, adapalene is best used on dry skin because it can trigger more severe irritations if used on moist or wet skin. So, basically, wash your face with a gentle cleanser, tone it with a gentle face toner and then wait until the skin is dry before applying adapalene/benzoyl peroxide.

It’s also important not to use too many active ingredients together with adapalene/benzoyl peroxide, as this itself is already irritating enough for the skin. Try to avoid products containing salicylic acid or alcohol, or any other AHA, BHA or other retinoids (like retinol, tretinoin etc..). To me, this is the biggest obstacle, because most things that I use contain at least salicylic acid...

One other thing to note with adapalene is to NEVER skip sunscreen! Adapalene is a retinoid, which means that it, itself, is photosensitive, and it makes the skin much more photosensitive. If you don’t apply sunscreen, you might get painful red blisters or any other kind of severe irritation. That is also why it should be applied before bed, not in the morning. This is a serious matter, don’t play around with skipping SPF!

Final note: since my acne tend to fluctuate with sex hormone levels, how my skin looks can be drastically different depending on what part of the cycle it currently is. During the first half of the cycle, my skin is typically feeling healthy and strong, but it all crashes down when luteal phase hits. Then, as progesterone rises, my skin erupts in acne, and nasty, cystic acne, at that. That is why I will be noting which part of the cycle it currently is for each week's end results.

Oh... this formula is wonderful! I actually really love it! It feels rich and luxurious, but it’s not at all heavy. It’s actually very lightweight, even though it is slightly thick. The formula is greasy, but it feels more like dry grease; it feels more creamy than anything else. It spreads extremely easily and it absorbs rather quick. I thought it would take much longer for it to absorb, but a mere 2 minutes later and it was already absorbed by my skin. I have to say that this formula is actually better than most other moisturisers that I’ve used! Although, it definitely feels more like a cream than a gel.

So, this gel is so lightweight that I basically don’t even feel it on my skin! It just feels so light and gentle on the skin, and it absorbs rather quickly, which is great because I don’t want to stain my clothes and hair. However, for the first week or so of use, I also feel a prickly, stinging sensation coupled with a warm sensation. This is just how skin that isn’t conditioned to retinoids reacts to them, nothing unusual. The more I use this gel, the less it feels irritating, and by the end of the 10 weeks I generally don’t feel anything after I apply it.

What my skin looks like normally, prior to using this gel
Cycle day: 10

So, first application and... I don’t really feel much. My biggest worry was that it would burn my skin, as my chin and jawline aren’t conditioned to retinoids yet, but it doesn’t... at least, not yet. Perhaps it needs a few applications before it starts to actually burn or irritate the skin? In any case, the only thing I felt was a slight cooling sensation that felt calming. It didn’t feel like that mix of cool and hot that happens when the skin is irritated.

That went away after a few minutes, and then my skin felt okay. Like, I didn’t feel much of anything anymore. It didn’t feel itchy or irritated or like it’s burning... and it looked as calm as before. So I guess my skin is tolerating it well? Still, for at least a few weeks, I will use it 2x a week, to give my skin a chance to get used to it. Of course, it’s way too soon to say anything about any results. And besides, since it’s still the first half of the cycle, my skin is naturally in better condition.

Not a whole lot of change yet...
Cycle day: 17

Week 1 went by and my skin looks almost the same as before. A few new blemishes are starting to appear, but I am pretty sure they would appear anyways. It’s hot and humid here, so it’s hard to avoid having sweaty skin.

I do not see any signs of drying out, and I am not yet starting to purge. However, I have used the gel only two times so far, on Monday and Friday, so it is still too early to see any changes.

Cycle day: 24

2 weeks of use, and my skin does not look much different. There is quite a few new pimples forming, but since I was quite deep into the luteal phase, this is normal. I don’t think they appeared because of adapelene, it looks like my normal hormonal acne. The skin on my lower cheeks on both sides looks quite irritated and in a bad state, but, again, it’s luteal phase.

Oh, also, ignore the yellow bruise on my right cheek, I had wisdom tooth extraction surgery. This is one of many side effects I am dealing with post-surgery. So no, I did not get punched, I am not ill, this is just a side effect of that surgery.

Skin is looking very angry...
Cycle day: 2
Week 3 in, and my skin is starting to show some real displeasure with this gel. I know it’s the very end of the cycle, and that my skin is typically very angry then, but this is a whole new level of angry. Every time I wash my face, my skin starts to burn, and it becomes very red and itchy. Normally, I would say that this is an allergic reaction, but it doesn’t seem to be because: a) it happens after I wash my face and remove all traces of adapalene from it, and b) it only just started now, so it would have to be some freaky very delayed hypersensitivity reaction. This is extremely annoying, and it is making me want to stop using adapalene.

Fortunately, it goes away after a while, and, even if it didn’t, my Eucerin daily moisturiser calms my skin down enough to neutralise this aggressive reaction to... whatever. Oh, also, I have switched to using it 3 times a week this week, on Monday, Wednesday and Friday. Look, I knew my skin would become hypersensitive at some point, I just didn’t think it would be this bad :( ...

Whyyy is it so angry?? :((
Cycle day: 9

Week 4 and things aren’t getting better. I am using Sona Duo every night, before bed, and my skin sure doesn’t like that. It is becoming even more red and itchy and like it’s literally burning. However, it seems like my neck is starting to be affected by this as well, as it, too, feels extremely irritated and itchy. But results? Well, it is the start of a new cycle, the very first week, so there’s still a lot of hormonal acne from that, but it seems like there’s fewer pimples? Of course, hormonal fluctuations etc, but it seems like it’s starting to work? I really hate the burning irritation, though. It’s difficult to endure it before bed... and since I don’t want to mix products, there’s no cream that will help me feel more soothed before bed. Bummer. As if all the discomfort and pain and cramps and general feeling of being unwell from period isn’t enough... this is adding onto that, and it’s hell :`( .

Also, foundations are starting to apply weirdly on my philtrum, they’re patchy and impossible to blend out. I hope this doesn’t dry out my skin too much... in some ways, I kind of regret starting this. I would rather have oily, acne-prone skin than whatever awaits me at the end of this journey...

It's seriously dry...
Cycle day: 17

Almost halfway to 12 weeks! Week 5 has gone by and, let me tell you, this week was not at all fun. I am still using adapalene nightly, but my skin doesn’t seem to be getting used to it. By this time, retinization has started big time. My skin is still extremely angry after I apply the gel (and the morning after); it still burns a lot and becomes extremely red and itchy and just irritated. Now, not even my Eucerin moisturiser can fully soothe the itching and redness. It is bad – real bad. But, not only is my skin itchy and irritated, it also seems to have started to flake off in some parts. I first noticed it on the right side of my chin; I thought that was just my hands being their standard extremely dry selves, but it wasn’t that. That was the skin on my chin actually crusting and peeling! The philtrum had a similar thing happen, but it didn’t quite peel. I really don’t like this... I don’t think that I have to mention how difficult this makes it to apply and blend out foundations. Foundations and concealers look very grainy, textured, and it’s hard to blend them into the skin properly without it looking even more patchy and horrible; I also have to skip applying any products on my philtrum because it will literally be impossible to blend it in.

As for pimples? Well, this week was the best week for my skin as it was ovulation week, which is, typically, when the skin looks and feels the best. There were fewer pimples, but again, I usually don’t have many pimples this time of the month. There are remains of older pimples, though, so it doesn’t seem to be able to heal those blemishes. One other thing I noticed, aside from my skin flaking off, is that my entire jawline and chin feel much drier. It already feels extremely dry while the irritation and burning is there, but my skin still feels taut and dry when I wake up.

Of course, mixing adapalene with night moisturiser would help... but that would also dilute adapalene and benzoyl peroxide. Now, I wake up with seriously dry lower half of my face; it is so dry that it feels almost scaly when I touch it. No wonder it is peeling off, then! Oh man, my skin really is going to change into a dry type, isn’t it... I am really not happy with this. I can only hope that things have to become worse before they become better. Because the way it is, I really think I will have to take a day off just let my skin recover, or I may do permanent, severe damage to it if I continue using it nightly. Fingers crossed next week is better, although... with each week, period is closer, which means progesterone is higher, which in turn means that my skin is naturally going to create a bunch of new pimples, because my acne is, primarily, hormonal in nature. Yaaay.....

Finally some change for the better...
Cycle day: 25

Alright, things are definitely calming down this week, for whatever reason. I took one day off at the start of the week to let my skin grow a tolerance and it seems like it is keeping the skin slightly less irritated. However, it is luteal phase again, which means new acne! This gel doesn’t really prevent them from popping up, although there seems to be less acne during luteal phase than before. And they don’t feel very cystic and painful. But by Friday, my skin had again begun to feel itchy, red and irritated the morning after applying the gel.

But it’s starting to feel better now, and there’s no peeling anymore. Whew! Glad that’s over – now I can apply foundation normally again! But my skin definitely feels much drier, which isn’t really something I like. I just hope it won’t become very dry... that would be horrible. So, things might be improving? I hope?

Notice the scarring on the right photo, on the chin
Cycle day: 30

Week 7 is when things seemed to plateau. My skin doesn’t look as red or irritated anymore, even though I am back to applying it every night. This is the very last week of the cycle, but my skin doesn’t look as acne-ridden as it usually does. I’m sure that this is the adapalene/benzoyl peroxide finally showing real results, but I also reckon that the pure red raspberry leaf tea had something to do with it, as well. PMDD feels noticeably less severe this month, so, naturally, this means less acne. I am happy that there’s less acne, but I still don’t know how I feel about my skin being drier than before. It doesn’t feel as extremely dry as before (it doesn’t peel anymore), but it is still much drier than the rest of my face. Liquid products still apply not quite right, but I think it’s slowly becoming better.

Also, I have noticed that, in some parts, my skin looks like it is scarring, although this is likely just the skin healing from all the acne that keep reappearing on the same spot over and over again. Have I passed the worst period? Because my skin looks like it’s slowly starting to clear up and looks healthier than before, even if there is less sebum than ideal. Time will tell, I guess. I am just happy that the purging seems to be over.

So much clearer...
Cycle day: 6
Week 8 is probably where my skin really plateaued. And this is very surprising as this was at the start of a new menstrual cycle, and my skin tends to always look horrible at the very end (and the beginning) of cycles. But it doesn’t look that bad anymore! I had noticeably fewer pimples come period, and the ones that were there weren’t as inflamed as usual. My skin looks like it is clearing up further, although I am sure it will never be 100% acne-free (because my acne is hormonal, not bacterial, so I am sure that I will continue to have flare ups with every PMDD cycle). What I love is that the scarring that I noticed the previous week seems to be going away this week, as it is noticeably less visible. This is just proof that the skin is finally regenerating deeply, which should lead to less acne in the future. Idk, I am just very happy with how my skin currently looks, even if there still are some pimples. But trust me, this is way better than what my skin used to look like while on period.

Also, liquid products (foundations etc) finally seem to be able to apply more-or-less normally; there is no patchiness and I don’t have as much trouble buffing it into the skin. It’s not perfect just yet, but it is better than the previous week. I will note that I still do get more severe redness and irritation after 5-6 days of consecutive use of adapalene, but it is not as painful or hot to the touch as before. It seems like my skin needs a bit more time still...

Cycle day: 13

Alright, 9 weeks in and there’s honestly not a whole lot different this week. True, period is gone (for now), so hormones are balanced and stable, but it seems like I’ve truly hit a plateau. I still have some pimples from the previous luteal phase, and I doubt I’ll ever get rid of acne breakouts during that phase of the cycle, but they are rarely cystic and painful. And even if they are, they pop on their own in a day or two instead of lasting like 10 days. I am noticing a definite change for the better this week, just in terms of how my skin feels. It may not be quite as visible but I feel like my skin is more balanced and happy.

I am also overjoyed to finally be able to apply foundations and concealers normally, without it all looking like a blotchy mess. Now, my skin type seems to have changed again; a few weeks before, it was definitely dry and, at some points, flaky, but now it is more combination than anything else. It’s definitely not as dry as before, which I am thankful for (that dry skin was extremely annoying to keep looking hydrated and good)!

Now it’s more oily, but it’s still not nearly as oily as before, so it seems like this combination type of skin is what is achievable for me... I’ll take it – gladly! Oh, and, the irritation that formed by the end of the week is mostly gone now; I do get a tiny bit of redness and warmness, but it’s really not as bad as before. Hmm... will I even need to continue for 3 more weeks? I’ll see whether there are any changes during the next week. But so far – so great!

The messy thing on the left photo is an acne patch!
Cycle day: 20

Double digits – we’re on week 10! Already? Gosh, it seems like only just yesterday I started using adapalene... time flies. Anyways, I don’t have much to report on. There really were minimal changes this week, apart from my skin continuing to look balanced and relatively clear. I rarely get new pimples nowadays, which is weird for me. I’ve spent years living with the permanent roommates on my face... to have only a few pimples at any time seems unnatural to me. But this is the new normal, new me. And even though I am slowly inching towards period, my face isn’t showing any signs of imminent breakouts. It’s... odd. Am I happy about this? Yes! But it’s also going to take some time to get used to.

I don’t have anything to complain about. Makeup applies normally (not patchy and messy), and it lasts a normal amount of time. My chin/jaw area still looks less oily than the rest of the face, but there is some sebum still so it doesn’t look or feel dry. It just feels balanced! And it also stopped reacting after 5-6 consecutive days of use altogether; now it is as calm on Saturday as it was on Monday. No negative changes through the week. Hah, it seems like my skin toughened up from all the retinoids!

And there are no scars or any other sign of damage. Yeah... this might well be the perfect place to stop reviewing adapalene in detail, as I am not seeing any real changes anymore. I’ve hit the peak, it seems.

Cycle day: 8

Yeah, no point going until 12 weeks, things aren’t changing much. However, as you can see from the pictures, after more than 10 weeks, there still can be some irritation and redness à la the first few weeks; I have no idea why my skin decided to react badly and dry out again, but I do reckon it’s got something to do with getting extremely poor sleep the night before I took the pictures. Anyways, this aside, I didn’t think that the changes were that impressive, but now that I look back on what my skin looked like before adapalene and after, the results are very visible!

My chin/jaw area has definitely cleared up significantly, although, of course, I will never truly be rid of acne. I never expected this gel to do that, I never even expected it to actually clear up my skin as much as it did... it’s been a long time coming. And now I finally don’t have a mess of pimples on my lower face... I don’t know how to feel. I am definitely happy about that, but it’s a change that I’ll have to get used to. And I guess I’ll have to get used to having slightly drier skin as well...

Visual representation of changes each week on the entire face
View in full size to see the changes clearly

Detail of the changes each week on the chin area, notice how clearer the skin is by week 10+
View in full size to see the changes clearly

Overall, honestly, this has the pretty much the only thing that I ever used for adult acne that I would call a ‘game changer’. Of course, this is prescription-only, so don’t go just buying it willy-nilly, but if you struggle with acne, especially adult acne, do bring it up with your doctor or dermatologist. I myself never would have tried it had my doctor not suggested it to me, and even then, she was apprehensive about it because it does cost a lot. But this is worth its price, and then some! Of course, YMMV, because every skin and body is different and reacts to medications differently, but for me, this was able to significantly reduce how many pimples I have at any given time, and those that pop up are rarely cystic. This is a godsend, and I wasn’t even aware of it before looking through all the pictures I took for this review... it really makes a visible change for the better. This is because it targets the source of acne, and it is both anti-inflammatory and bacteircidal, a duo of effects that makes sure that the skin gets a fighting chance at regenerating. Indeed, pimples are much drier now, thanks to benzoyl peroxide, and they don’t provoke such a harsh inflammatory response thanks to adapalene. Now, this stuff is strong, so you have to treat it like a marathon; you wouldn’t go running the full marathon all of a sudden, you need to start slowly and patiently build up your stamina. The same goes for adapalene: I had to stagger the applications, because it would literally burn my skin if I tried to use it 2-3 days in a row at the start, but this improves with time and now my skin can tolerate up to 6 days of nonstop use. Also, do be aware that adapalene causes retinization, so if you start seeing a bunch of new pimples a few weeks in – that’s normal, and it will clear up! Think of it as adapalene ‘pushing’ the deep pimples towards the surface so that they dry out quicker. It’s a good thing, even if it is miserable to go through. And you do need to keep using the gel for at least 2 full months to see any changes for the better, so just be patient, persevere through the retinization and irritations, and soon your skin will be born anew, clearer than before. At least, that’s what happened to me – and I am very lucky to have had a very mild and short retinization period! Nothing truly helped before, not salicylic acid, not Centella, not tea tree oil... but this gel, as you can see, has helped tremendously. Nothing will truly get rid of my acne, not when they are predominantly hormonal in nature, and as someone who suffers with debilitating PMDD (which just shows how intense the hormones become then), I know they’ll always come back during the luteal phase of the cycle. But to have something that can help me avoid having a bunch of extremely large, angry pimples on my chin and jawline is... I am at a loss for words. 10+ weeks of (sometimes) suffering, 10+ weeks of seeing my skin type change before my eyes. Now, the only thing that remains is to upkeep it with perhaps not daily usage, but every other day. I will highly recommend this to anyone who has issues with extremely stubborn acne, especially if you are female (menstrual cycle ofc) and/or an adult, since there is a difference between adolescent and adult acne. Naturally, since I myself am female I cannot gauge how well male skin would react (especially given that men don’t have as much estrogen and progesterone as we do), but I do believe it is worth a shot if you’ve exhausted all other options! And don’t worry if you cannot find it under this exact name, any combination of adapalene/benzoyl peroxide will do! So yeah, I thought I would regret using this, but two thumbs up for it in the end, haha!

Rating: 7/10

Would use again? YES