What Are Comedones?

Comedones can be managed with over-the-counter or prescription medications, a regular skin-care routine, and healthy lifestyle changes.

As mentioned, comedones fall into two main categories:

• Closed Comedones Closed comedones, more commonly known as whiteheads, are closed bumps on the skin that look white or yellowish.

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   They are small cysts filled with excess oil and dead skin cells that trap hair within the follicle.

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• Open Comedones Also known as blackheads, these are open bumps filled with excess sebum and dead skin cells. It may look like dirt is in the bump, hence their name, but the dark color is caused by oxidized lipids (oily substances) and melanin. Open comedones don’t hurt or feel uncomfortable to touch the way whiteheads can.

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Both types of comedones appear on the face — especially the forehead, chin, and nose — and may also be present on the neck, back, or chest. Blackheads typically form on the sides and bridge of the nose.

• Sandpaper Comedones Multiple small, closed bumps on the forehead are called sandpaper comedones. This type of comedone gets its name from the feel and look of the affected skin.
• Microcomedones These are tiny clogged pores and are not visible to the naked eye. This is an early stage before they become visible bumps on the skin.
• Macrocomedones These are the opposite of microcomedones — they’re larger, measuring greater than 1 millimeter (mm) in diameter, and can be easily spotted. If comedones of this size are whiteheads, they may not be easily treated by topical and oral ointments.
• Submarine, or Missed, Comedones These are deep-seated comedones that are greater than 5 mm in size and can lead to inflamed pimples as the clogged pore worsens. They’re often missed because they’re sitting under the skin and are not obvious.
• Secondary Comedones These are clogged pores triggered by hair pomade, oils not from the skin, or chemical exposure such as smoking.
• Solar Comedones Also known as Favre-Racouchot syndrome, solar comedones are blackheads, whiteheads, and skin cysts on the face that have been triggered by sun damage. They tend to appear later in life, and typically affect people who have had prolonged sun exposure over their lifetime. It can also come from heavy cigarette smoking.

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• Small bumps on the face, neck, chest, or back
• Black or white spots, depending on whether the pore is open or closed
• Mild skin texture irregularities

They may not be painful but can become inflamed if bacteria lead to acne breakouts.

• Hormonal Changes In certain life stages, such as puberty, you may see a rise in hormonal changes that trigger excess oil production on the skin, leading to more blackheads or whiteheads.
• Oily Skin People with oily skin may be more likely to have comedonal acne due to excess sebum production.

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• Diet Research has shown a correlation between a diet high in processed carbohydrates like bagels, breads, and chips and worsening acne.
• Medication Certain drugs, such as corticosteroids or testosterone, may cause new or worsening acne.
• Stress While stress doesn’t necessarily cause acne, it can make it worse.

Whiteheads and blackheads can be treated at home or in office with a dermatologist, depending on the severity.

Medication Options

There are plenty of nonprescription medications available at the drugstore that address comedonal acne. They include:

• Salicylic Acid A popular choice for treating comedones, salicylic acid helps to remove the top layer of damaged skin, gets rid of dead skin cells, and prevents clogged pores.

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  Try to find products that contain about 2 percent to 4 percent salicylic acid. If they’re drying your skin out, decrease the dosage.

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• Benzoyl Peroxide Also available in various over-the-counter skin care products, including facial cleansers, leave-on gels and ointments, benzoyl peroxide kills surface bacteria, which can trigger acne and aggravate clogged pores. The concentration of benzoyl peroxide within a product usually begins at 2.5 percent, increasing to up to 5 or 10 percent. It can cause initial dryness and some irritation, though your skin should adjust after a week. In rare cases, it can cause a burning sensation, itching or peeling.

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• Azelaic Acid This natural acid found in ingredients, such as barley, wheat and rye, kills bacteria on the skin and reduces swelling. One study that followed real-world cases of women with acne, including comedones, found that azelaic acid — in a 15 percent gel form applied twice daily — played a key role in managing acne and post-acne hyperpigmentation.

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• Retinoids (Vitamin A Derivatives) The American Academy of Dermatology recommends retinoids for treating comedones.

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  Over-the-counter products with retinoids help to unclog pores.

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  Researchers say they’re effective in exfoliating comedones, increasing skin cell production, and promoting cell turnover on the skin. It’s a potent compound, so be sure to talk to your medical provider about how much to use and when.

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If over-the-counter options aren’t helping, consider seeing a dermatologist who can prescribe medication, such as:

• Prescription-Grade Retinoids These are stronger topical products than their over-the-counter counterparts, and require a prescription to pick up. They include adapalene (Differin, Epiduo), alitretinoin (Penretin), bexarotene (Targretin), tazarotene (Tazorac, Avage), and tretinoin (Atralin, Avita, Retin-A, and Tretin-X). Like all retinoids, the prescription-strength kind also helps to unclog pores, remove dead skin cells, and encourage cell turnover. Your skin may go through a “retinol purge” and look worse in the first couple of months of treatment before it starts to look better.

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• Oral Antibiotics In moderate to severe cases of acne, your dermatologist may prescribe oral antibiotics, such as clindamycin or erythromycin, to reduce bacteria on the skin. They’re often prescribed in combination with other treatments, such as benzoyl peroxide.

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Complementary and Integrative Therapies

Your doctor or dermatologist may recommend complementary and integrative therapies to treat comedones. Note that not all of these in-office procedures are covered by insurance.

• Chemical Peels A chemical peel involves applying a chemical solution to your skin, which causes skin layers to eventually peel off, revealing more youthful skin. It’s used to treat acne and smoothen the texture of the skin.

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• Extractions Dermatologists or medical aestheticians can perform a manual extraction of blackheads and whiteheads. For this procedure, your skin will be prepped with a light steam to expand your pores. Then, they’ll use a sterilized metal tool called a comedone extractor to apply pressure until all the contents of the bump have been removed. Don’t try to extract comedones at home because it may lead to scarring.

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   Research suggests extraction is a simple and effective remedy, especially for treating moderate acne, including comedones.

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• Microdermabrasion In this procedure, a professional uses a specialized tool to gently “sand” the top layer of your skin, removing the buildup that causes whiteheads.

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• Laser Skin Resurfacing In this procedure, short, concentrated, pulsating beams of light are aimed at your skin to target comedones, specifically whiteheads. The light beams aid in reducing oil production to prevent clogged pores.

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• Wash your face regularly using warm water and a mild cleanser.
• Use a moisturizer.
• Opt for noncomedogenic makeup products that allow the skin to breathe.
• Remove makeup at the end of each day to help prevent clogged pores.
• Keep your hands away from your face.

• Acne scarring
• Stress
• Anxiety
• Depression

• Comedones — more commonly known as blackheads and whiteheads — are a type of acne that occurs when pores become clogged with oil, dead skin cells, and debris, forming small bumps on the skin.
• Blackheads (open comedones) have a small black tip, while whiteheads (closed comedones) look like small, flesh-colored bumps.
• Comedones can be managed with over-the-counter or prescription products, in-office procedures, and lifestyle changes.