What is comedonal acne?
Comedones are small flesh-colored acne papules. They usually develop on the forehead and chin. You typically see these papules when you’re dealing with acne.
Blackheads and whiteheads are the most common forms of comedonal acne. Blackheads have “open” comedones, while whiteheads have “closed” ones.
Some comedones may be invisible to the eye (microcomedones). On the flipside, it’s also possible to have larger-than-normal blackheads (giant comedo) and whiteheads (macrocomedones).
Keep reading to learn how to recognize comedonal acne, your options for treatment, and more.
Blackheads are open-faced. When the melanin pigment (found in the sebum produced by our oil glands) makes contact with the air at the top of an open comedone, it oxidizes and turns dark. This is why blackheads have a dark appearance. Whiteheads, on the other hand, have closed surfaces. They look like small white or flesh-colored dots.
All types of comedones feel bumpy to the touch. According to DermNet New Zealand, comedonal acne is most common on your chin and forehead.
Typical blackheads and whiteheads are caused by trapped hair follicles.
Your skin cells normally shed at the surface, allowing new skin cells to form. Sometimes, dead skin cells can get trapped within the hair follicles. When combined with the natural oils in your pores (sebum), a plug can form.
This type of acne primarily affects adults with oily skin. It’s also more common in people who smoke.
Other risk factors for comedonal acne include:
- high dairy consumption
- diet that consists of a lot of fats and sugars
- overhydrated skin, usually from using the wrong moisturizer
- high humidity
- laser therapy or chemical peels
- follicle injury from “picking” skin or popping comedones
The key to stopping comedonal acne is to get to the source — excessive sebum production from the sebaceous glands. For this reason, over-the-counter (OTC) medications may not be strong enough to clear up comedonal acne for good.
Talk to your healthcare provider about the following options. In the meantime, avoid picking at the acne. This will make it worse and lead to scarring.
Topical treatments are applied directly onto the face to control excess sebum and unclog existing comedones.
Common options include:
- azelaic acid
- glycolic acid
- salicylic acid
You should wear sunscreen every day when using topicals — especially acids and retinoids. These are powerful treatments that also remove the outer layer of skin, which makes you more vulnerable to sunburn. Make sure you choose a product with an SPF of 30 or higher.
OTC topicals are a good start for acne management, but they don’t always do the trick. You may need to see your healthcare provider for a prescription-strength topical or oral medication.
They may prescribe:
- oral contraceptives
- isotretinoin (Accutane)
- spironolactone (Aldactone), an anti-androgen medication that’s sometimes used along with oral contraceptives in women to control sebum production
As with topicals, prescription medications can put you at risk for sunburn, so it’s important to wear sunscreen daily. Choose a product with an SPF of 30 or higher.
Surgery may be needed if topicals and medications fail to clear up severe comedonal acne outbreaks. These types of treatments may also help with recurring comedones. Acne surgery, for example, uses needles and small blades to open and remove comedonal acne lesions.
Your healthcare provider may also recommend microdermabrasion. To do this, a machine will blow small crystals onto your skin or a diamond-tipped wand will be rubbed on your skin to remove the top surface layer. This helps open and remove comedones. It may also help remove any related scars.
Cryotherapy is another surgical option. During the procedure, your healthcare provider will apply liquid nitrogen to the comedones. This freezes them for removal.
Natural treatments are increasingly being investigated for all types of acne, including comedones. However, these aren’t a replacement for your healthcare provider-approved treatment plan.
Talk with your healthcare provider or dermatologist about your options for natural treatment and how to incorporate these remedies as a complementary therapy.
Tea tree oil
In alternative medicine, tea tree oil is used for a variety of skin ailments. It’s touted for helping with inflammation, as well as infections. Tea tree oil may help comedonal acne by reducing sebum and calming the skin. You’ll likely be able to find moisturizers and spot treatments containing the oil at your local drugstore.
Witch hazel acts as a natural astringent to help balance your skin’s moisture. It has the added benefit of opening closed comedones. This can help remove trapped dirt and other debris.
You can use witch hazel in place of your usual astringent up to twice a day.
Charcoal or clay masks
With comedonal acne, charcoal and clay masks work better than other formulations because they help dry out trapped sebum in your pores. They can even help get rid of trapped dirt and skin cells, making blackhead removal easier.
The best approach to comedonal acne is to try to prevent it altogether. Lifestyle habits can help complement any treatments your healthcare provider recommends.
For acne-prone skin, creamy or gel cleansers work best at removing oil and dirt. An ideal moisturizer is water-based. If you have comedones, look for lotions made for combination-to-oily skin.
If you wear makeup, make sure it’s non-comedogenic; this ensures that the products won’t clog your pores. As a bonus, wear foundation that contains sunscreen, especially if you’re using retinoids or acid-based peels.
General skincare tips
Good skincare practices start with cleansing and moisturizing every morning and night. Here are some other tips you should adopt in your daily routine:
- Wash your face for at least 30 seconds at a time, using gentle circular motions. No harsh scrubbing!
- Follow up with witch hazel or an OTC toner.
- Let your moisturizer dry before applying sunscreen and makeup.
- Wash your face after working out in the middle of the day.
- Never sleep with makeup on, as this can trap more oil in your pores.
- Try out a pre-cleanser to remove sunscreen, makeup, and oil. Dermalogica’s Pre-Cleanse, for example, is used prior to your cleanser for a deeper clean.
Diet and exercise
It’s also helpful to consider how you can control comedonal acne from the inside out. In this case, diet and exercise may offer some benefits.
DermNet New Zealand recommends that you avoid a lot of added sugars, fats, and dairy in your diet. These ingredients are said to worsen inflammation, which is an underlying cause of comedones. The simplest way to go about this is to avoid processed foods and sweets.
For skin health, you can’t go wrong with plant-based foods. These are rich in antioxidants, which can control free radicals and inflammation. Regular exercise can also offer these effects.
Comedonal acne may be difficult to treat on your own, so it’s important to see a healthcare provider for advice.
Patience is also crucial when dealing with any form of inflammatory acne. It may take several months for a new treatment to have a visible effect on your skin.
It’s also important to keep in mind that comedonal acne requires long-term treatment and management. Overactive sebaceous glands never go away, so new comedones are possible.
If you’re concerned about your acne and don’t already have a dermatologist, you can view doctors in your area through the Healthline FindCare tool.