Comedonal Acne

Comedonal acne looks like many small bumps on your skin — often on your face — that aren’t inflamed. The bumps are pores or follicles that are clogged with sebum (an oily substance) and skin cells.

This type of acne is different from pimples, or inflammatory acne. Pimples are discolored (red, purple, brown, black) — usually darker than your normal skin tone — and filled with pus. Comedonal acne bumps are mostly the same color as the surrounding skin and not tender or swollen.

Comedonal acne (pronounced “KO-meh-DOH-nul” “AK-nee”) is very common. It most often affects preteens and teenagers. But many adults have it as well. It can occur in combination with other types of acne, like inflammatory papules and pustules.

Types

There are two types of comedones:

• Closed (whitehead): These are small, plugged follicles that are covered with skin. The contents of them aren’t exposed at the surface of your skin.
• Open (blackhead): These are small, plugged follicles with widened openings. Exposure to air at the surface of your skin causes the tip of the content to turn black in color (it oxidizes).

Symptoms of comedonal acne

Signs of comedonal acne on your skin include:

• Bumpy skin texture: The bumps can vary in size. Your skin may feel rough. The bumps appear to have a solid core.
• Flesh-colored bumps: The bumps mostly match the color of your skin — they’re not discolored or inflamed.
• Small dark spots: Open comedones (blackheads) look like specks of black or dirt on your skin.
• White or yellowish bumps: Closed comedones (whiteheads) may have a slight white or yellow color.

This type of acne usually appears on your forehead and chin. But it can affect other areas, like your nose, cheeks and back.

Comedonal acne causes

Comedones form when pores or hair follicles become clogged with dead skin cells and sebum. Sebum is a natural oily substance your pores release.

This can happen if you have:

• Increased sebum production
• Abnormal formation of keratin (the protein that helps make your hair, skin and nails)
• Increased hormones (androgens)
• Increased amounts of a skin bacterium that causes acne

Risk factors

Several factors may increase your risk of developing comedonal acne, like:

• A biological family history of acne
• Damaged pores or follicles (from popping comedones or pimples, for example)
• Excess or fluctuating hormones (like during puberty or pregnancy)
• Living in areas with high humidity
• Using oily or greasy personal care products
• Consuming a lot of milk products, sugars and fats

Complications of this condition

Without treatment, comedonal acne can turn into inflammatory acne. This type of acne can be painful. It may also be more noticeable.

Comedonal acne can also affect your self-esteem and mental health. Reach out to a healthcare provider if acne is making you feel negatively about yourself. Your mental health matters as much as your physical health.

How doctors diagnose this condition

A healthcare provider can diagnose comedonal acne by looking at your skin. You can visit your primary care physician or a dermatologist (skin specialist) for diagnosis.

How is it treated?

Comedonal acne is typically the mildest form of acne. But it can be difficult to treat because the comedones are “stuck” within the follicles.

Several medical treatments can reduce the number and size of comedones. A healthcare provider can help you find the best treatment plan for your situation.

Topical treatments

Products you put on your skin to treat comedonal acne include:

• Salicylic acid
• Retinoids
• Azelaic acid
• Benzoyl peroxide
• Glycolic acid

Oral medications

If comedonal acne doesn’t respond to topical treatments, your healthcare provider may prescribe oral medicines. They may include:

• Hormonal therapy, like the birth control pill or spironolactone
• Antibiotics
• Isotretinoin (Accutane®)

Procedures

Your provider may recommend certain procedures to remove the clogging material from your skin, like:

• Comedone extraction: A dermatologist or licensed esthetician uses sterile instruments to manually remove clogs.
• Dermabrasion or microdermabrasion: Your provider uses tools to manually resurface the top layer of the skin to remove dead skin and debris.
• Chemical peels: Your provider applies special chemicals to exfoliate your skin and help unclog pores.

Make sure to see a licensed professional for these procedures. Try not to pick, squeeze or pop comedones. Only a professional should do extractions. Doing it yourself can lead to:

• Acne scars
• Damage to the pores or follicles, which can cause more comedones
• Infection
• Inflammatory acne
• More noticeable blemishes

Recovery time

With proper and persistent skin care and treatment, you may start to notice a difference in eight to 12 weeks. But it may take many months for comedonal acne to clear up.

When should I see my healthcare provider?

See your healthcare provider if your treatment plan isn’t giving you the results you want. It can take time — and many tries — to find the right treatment and skin care routine.

If you get side effects from the medications, let your provider know.

What can I expect if I have this condition?

Comedonal acne can be a long-term condition that comes back repeatedly over many years. Things you can’t control — like hormone fluctuations and genetics — play a strong role in it. But taking care of your skin can help minimize future breakouts:

• Avoid touching your face throughout the day, which can cause oil and dirt to build up in your facial pores.
• Choose oil-free, water-based, noncomedogenic (doesn’t clog pores) cleansers, moisturizers and makeup.
• Wash and moisturize your skin every morning and night. Do this after you exercise, too.
• Don’t go to bed with makeup on.
• When you wash your face, do it gently. Don’t scrub.
• Wear sunscreen daily to protect your skin from sun damage.