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Bumpy skin texture and apparent hypertrophic scars

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Can someone please help me deal with the bumpy texture of my skin. There are many soft white bumps (not milia) and certain bumps which have persisted for over a year or two now. They look really bad in certain camera angles.
I use cetaphil face wash twice daily and a toner and moisturizer before sleep.

Please help. TIA

WhatsApp Image 2019-04-09 at 11.46.11 AM.jpeg

WhatsApp Image 2019-04-09 at 11.46.11 AM(1).jpeg

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These are closed comedones. Please deal with this before any treatment is tried. The large pores they  can do TCA Cross, but I would treat your comedones first which is a forum of acne. 


Closed Comedones
Genetic Barrier Defect
There are open comedones and closed comedones or blackheads
Makeup can cause comedogenic clogging of the pore, impaired skin barrier, hyperirritable to ingredients
Yellow Dyes and Red Dyes can exacerbate it, Isopropyl can also cause it, palmades or serums leaving residuals
It also happens around the time of menses for women
Less is more, with skincare and treatment
Harsh exfoliators and peels can also cause this, through the impaired skin barrier, inflammation and irritation driving in the skin cells to be plugged. Brushes, micro abrasion, 
There are micro comedones you do not see but products bring them out
High sugar diets and high glycemic diets and dairy can exacerbate it
Moisturizer needs to strengthen the moisture barrier
Wear a sunscreen during the day or comedones will get worse driving inflammation into your skin
Creamy wash Benzoyl Peroxide, put on a few minutes and wash off, also salicylic acid wash top be anti-inflammatory and open up pores. Azelaic Acid is safe for those who are pregnant or tolerate it better
Sulfur Soap or Sulfur Masks are another option
Retinoids, tretinoin, differin, etc can help. 

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If this is what I think it is, I have had these small white bumps for 10+ years now, until I had a skin pen/dermapen procedure done. It got rid of about 90% of them. It’s the only thing that has been successful. If you have a lot of them, I would give it a try. My skin is seriously smooth now. Good luck. 

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