Table of ContentsView AllTable of ContentsWhat Is It?What It Looks LikeTypesCausesDiagnosisTreatmentPrevention
Table of ContentsView All
View All
Table of Contents
What Is It?
What It Looks Like
Types
Causes
Diagnosis
Treatment
Prevention
This article discusses what the different types of comedones look like and what causes them. It also covers how they’re diagnosed and how to treat or prevent them.
Verywell / JR Bee
What Is Comedonal Acne?
Comedonal acne does not have inflamedpimplesandpustuleslike inflammatory acne(the most common form ofacne vulgaris). Instead, comedonal acne causes bumpy skin,blackheads, and non-inflamed blemishes.
However, if they get infected with bacteria, comedonal acne can turn into papules (red bumps) or pustules (pus-filled papules)—more commonly called pimples.
Reproduced with permission from © DermNetdermnetnz.org2023.
What Comedonal Acne Looks Like
Comedonal acne does not look like typical acne. In fact, many people with comedonal acne do not think they have acne.
Comedonal acne—blackheads andwhiteheads—do not have inflammation. They are not painful, red, or filled with pus.
Comedones are not red orinflamedlike a common pimple. Instead, they start as smaller, non-inflamed bumps (papules) that can either be closed or open.
Comedones are most common on the forehead, chin, and jawline. They can also form on the face, neck, shoulders, back, or chest.
Symptoms of comedonal acne range from mild (with just a few odd blemishes) to severe (covering large areas of skin). Comedones can form on their own or along with acne vulgaris.
Comedones can sometimes become acne pimples if you try to pop them, which gives bacteria easy access to broken tissue.
There are several types of comedonal acne blemishes.
Closed Comedones
Closed comedones, or whiteheads, range in color from creamy white to flesh-toned. They happen when an oil plug develops down below the opening (pore) of the hair follicle. They most often show up on the forehead, chin, and cheeks.
Whiteheads are not painful and cannot be “popped” since they do not contain pus or infection.
This photo contains content that some people may find graphic or disturbing.See PhotoDermNet /CC BY-NC-ND
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
DermNet /CC BY-NC-ND
Open Comedones
Open comedones, or blackheads, happen when the oil plug is near the opening of a pore.
If you were toextract a blackhead, you would see the top portion of the plug is dark, but the lower portion is a creamy white to yellow color.
Blackheads usuallyform on the sides and bridge of the noseas well as on the chin, shoulders, and back.
Microcomedones
Microcomedones are the smallest of all acne blemishes. These comedones are invisible to the naked eye and are the “seeds” from which larger comedones form.
Comedones and inflamed pimples start out as microcomedones.
Macrocomedones and Giant Comedones
Macrocomedones are either closed or open comedones that are bigger than usual. They can range from one millimeter (0.04 inches) to three millimeters (0.12 inches) in diameter.
Usually, a macrocomedo will be open since it will be large enough for oil to push to the opening of a pore.
Giant comedones are blackheads that range in size from several millimeters to two centimeters (0.78 inches) in diameter.They are usually just single blackheads and mainly affect older adults.
Solar Comedones
Chronic exposure toultraviolet (UV) radiationfrom the sun can cause the skin to thicken and papules to form in swollen skin pores. This usually happens around the eyes and on the nose, cheeks, or forehead.
Solar comedones most often occur in people over the age of 60. However, they can start to develop as early as your 40s if you’ve had extreme sun exposure.
Favre-Racouchot syndrome is a sun-related disorder that causes clusters of blackheads on sun-damaged skin. This typically happens under the eyes and around the temples.
The Truth About Tanning and Acne
Comedonal Acne Causes
Comedones are associated with thepilosebaceousunit, which includes a hair follicle andsebaceous gland. Sebaceous glands make sebum, the waxy oil that coats, moisturizes, and protects the skin. The pilosebaceous units are densely clustered on the face, neck, upper chest, shoulders, and back.
Too muchkeratin(a protein in skin, nails, and hair) combined with sebum can plug the follicle pore’s opening.
Comedonal Acne Risk Factors
Like most types of acne, comedonal acne is very common during the preteen and teen years. However, it can happen at nearly every age, including adulthood.
Comedonal acne can sometimes be a sign of acne vulgaris to come, especially when it starts during puberty.
However, having comedones does not necessarily mean you’ll get pimples. Other factors (including genetics) also play a role in who gets acne.
Comedonal acne tends to run in families. If your parents or siblings had it, you are more likely to have it as well.
Puberty also can contribute to the increased production of hormones calledandrogensthat can put the sebaceous glands into overdrive. The same can occur before the onset of a menstrual period when hormone levels spike.
Causes and Risk Factors of Acne
How Comedonal Acne Is Diagnosed
If it does not get better with treatments you put on your skin (topicals), your provider may check to see if you have another health condition like:
Treatment for Comedonal Acne
There are over-the-counter (OTC) and prescription medications that can help with acne including:
If your comedonal acne is mild, a topical OTC acne medication might be enough. For more severe or persistent comedonal acne, you might need to see a dermatologist for treatment.
Whether you use an OTC or prescription treatment, it can take up to 12 weeks before you see any improvement in your skin. Stick with it even if there are no immediate changes.
A face wash containing benzoyl peroxide can also help prevent bacteria on the skin from infecting comedones.
It can take six to eight weeks for blackheads or whiteheads to clear up after home treatment. If you do not see results within three to four months, ask your provider about other treatments. They may suggest stronger therapies for acne. If they do not start getting better, a dermatologist or anaestheticianmight be able to do a procedure to extract stubborn comedones and/or prescribe a stronger acne medication than you can get over the counter.
How Acne Is Treated
How to Prevent Comedonal Acne
If you do get a blackhead or whitehead, do not squeeze it. You are more likely to damage your skin and cause a blemish. Adhesivepore stripsand clay masks can help extract tiny blackheads. Whiteheads should be left alone and treated topically.
How to Extract a Blackhead
Summary
Comedonal acne happens when your hair follicle has an oily plug of sebum and dead skin cells. Closed comedones, or whiteheads, form under a pore opening. Open comedones, or blackheads, form near the pore opening.
Comedones are especially common during the teenage years, but they can happen at any age. Hormone changes can be a contributing factor. Oily skin care products and humidity can also make it worse.
Your provider will talk to you about the best way to treat your acne, as overtreatment can be just as ineffective as undertreatment. That said, if left untreated, comedonal acne can develop into a more severe breakout and become harder to manage.
Try to be patient. It can take weeks or even months of consistent treatment and lifestyle habits to clear up your skin.
Coping and Living Well With Acne
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fox L, Csongradi C, Aucamp M, du Plessis J, Gerber M.Treatment modalities for acne.Molecules. 2016;21(8):1063. doi:10.3390/molecules21081063Ogé LK, Broussard A, Marshall MD.Acne vulgaris: diagnosis and treatment.Am Fam Physician. 2019;100(8):475-484.American Academy of Dermatology.How to treat different types of acne.Institute for Quality and Efficiency in Health Care.Acne: overview. In: InformedHealth.org. Updated September 26, 2019.Fontao F, Von engelbrechten M, Seilaz C, Sorg O, Saurat JH.Microcomedones in non-lesional acne prone skin: New orientations on comedogenesis and its prevention.J Eur Acad Dermatol Venereol.2019;2019:15926. doi:10.1111/jdv.15926Wise EM, Graber EM.Clinical pearl: comedone extraction for persistent macrocomedones while on isotretinoin therapy.J Clin Aesthet Dermatol. 2011;4(11):20-1Primary Care Dermatology Society.Giant comedone.Sonthalia S, Arora R, Chhabra N, Khopkar U.Favre-Racouchot syndrome.Indian Dermatol Online J. 2014;5(Suppl 2):S128-S129. doi:10.4103/2229-5178.146192Paganelli A, Mandel VD, Kaleci S, Pellacani G, Rossi E.Favre-Racouchot disease: systematic review and possible therapeutic strategies.J Eur Acad Dermatol Venereol. 2019;33(1):32-41. doi:10.1111/jdv.15184Tan AU, Schlosser BJ, Paller AS.A review of diagnosis and treatment of acne in adult female patients.Int J Womens Dermatol. 2017;4(2):56-71. doi:10.1016/j.ijwd.2017.10.006Geller L, Rosen J, Frankel A, Goldenberg G.Perimenstrual flare of adult acne.J Clin Aesthet Dermatol. 2014;7(8):30-4.Leung AK, Barankin B, Lam JM, Leong KF, Hon KL.Dermatology: how to manage acne vulgaris.Drugs Context. 2021;10:2021-8-6. doi:10.7573/dic.2021-8-6Leyden J, Stein-Gold L, Weiss J.Why topical retinoids are mainstay of therapy for acne.Dermatol Ther (Heidelb). 2017;7(3):293-304. doi:10.1007/s13555-017-0185-2Nasri H, Bahmani M, Shahinfard N, Moradi Nafchi A, Saberianpour S, Rafieian Kopaei M.Medicinal plants for the treatment of acne vulgaris: A review of recent evidences.Jundishapur J Microbiol. 2015;8(11):e25580. doi:10.5812/jjm.25580
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fox L, Csongradi C, Aucamp M, du Plessis J, Gerber M.Treatment modalities for acne.Molecules. 2016;21(8):1063. doi:10.3390/molecules21081063Ogé LK, Broussard A, Marshall MD.Acne vulgaris: diagnosis and treatment.Am Fam Physician. 2019;100(8):475-484.American Academy of Dermatology.How to treat different types of acne.Institute for Quality and Efficiency in Health Care.Acne: overview. In: InformedHealth.org. Updated September 26, 2019.Fontao F, Von engelbrechten M, Seilaz C, Sorg O, Saurat JH.Microcomedones in non-lesional acne prone skin: New orientations on comedogenesis and its prevention.J Eur Acad Dermatol Venereol.2019;2019:15926. doi:10.1111/jdv.15926Wise EM, Graber EM.Clinical pearl: comedone extraction for persistent macrocomedones while on isotretinoin therapy.J Clin Aesthet Dermatol. 2011;4(11):20-1Primary Care Dermatology Society.Giant comedone.Sonthalia S, Arora R, Chhabra N, Khopkar U.Favre-Racouchot syndrome.Indian Dermatol Online J. 2014;5(Suppl 2):S128-S129. doi:10.4103/2229-5178.146192Paganelli A, Mandel VD, Kaleci S, Pellacani G, Rossi E.Favre-Racouchot disease: systematic review and possible therapeutic strategies.J Eur Acad Dermatol Venereol. 2019;33(1):32-41. doi:10.1111/jdv.15184Tan AU, Schlosser BJ, Paller AS.A review of diagnosis and treatment of acne in adult female patients.Int J Womens Dermatol. 2017;4(2):56-71. doi:10.1016/j.ijwd.2017.10.006Geller L, Rosen J, Frankel A, Goldenberg G.Perimenstrual flare of adult acne.J Clin Aesthet Dermatol. 2014;7(8):30-4.Leung AK, Barankin B, Lam JM, Leong KF, Hon KL.Dermatology: how to manage acne vulgaris.Drugs Context. 2021;10:2021-8-6. doi:10.7573/dic.2021-8-6Leyden J, Stein-Gold L, Weiss J.Why topical retinoids are mainstay of therapy for acne.Dermatol Ther (Heidelb). 2017;7(3):293-304. doi:10.1007/s13555-017-0185-2Nasri H, Bahmani M, Shahinfard N, Moradi Nafchi A, Saberianpour S, Rafieian Kopaei M.Medicinal plants for the treatment of acne vulgaris: A review of recent evidences.Jundishapur J Microbiol. 2015;8(11):e25580. doi:10.5812/jjm.25580
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Fox L, Csongradi C, Aucamp M, du Plessis J, Gerber M.Treatment modalities for acne.Molecules. 2016;21(8):1063. doi:10.3390/molecules21081063Ogé LK, Broussard A, Marshall MD.Acne vulgaris: diagnosis and treatment.Am Fam Physician. 2019;100(8):475-484.American Academy of Dermatology.How to treat different types of acne.Institute for Quality and Efficiency in Health Care.Acne: overview. In: InformedHealth.org. Updated September 26, 2019.Fontao F, Von engelbrechten M, Seilaz C, Sorg O, Saurat JH.Microcomedones in non-lesional acne prone skin: New orientations on comedogenesis and its prevention.J Eur Acad Dermatol Venereol.2019;2019:15926. doi:10.1111/jdv.15926Wise EM, Graber EM.Clinical pearl: comedone extraction for persistent macrocomedones while on isotretinoin therapy.J Clin Aesthet Dermatol. 2011;4(11):20-1Primary Care Dermatology Society.Giant comedone.Sonthalia S, Arora R, Chhabra N, Khopkar U.Favre-Racouchot syndrome.Indian Dermatol Online J. 2014;5(Suppl 2):S128-S129. doi:10.4103/2229-5178.146192Paganelli A, Mandel VD, Kaleci S, Pellacani G, Rossi E.Favre-Racouchot disease: systematic review and possible therapeutic strategies.J Eur Acad Dermatol Venereol. 2019;33(1):32-41. doi:10.1111/jdv.15184Tan AU, Schlosser BJ, Paller AS.A review of diagnosis and treatment of acne in adult female patients.Int J Womens Dermatol. 2017;4(2):56-71. doi:10.1016/j.ijwd.2017.10.006Geller L, Rosen J, Frankel A, Goldenberg G.Perimenstrual flare of adult acne.J Clin Aesthet Dermatol. 2014;7(8):30-4.Leung AK, Barankin B, Lam JM, Leong KF, Hon KL.Dermatology: how to manage acne vulgaris.Drugs Context. 2021;10:2021-8-6. doi:10.7573/dic.2021-8-6Leyden J, Stein-Gold L, Weiss J.Why topical retinoids are mainstay of therapy for acne.Dermatol Ther (Heidelb). 2017;7(3):293-304. doi:10.1007/s13555-017-0185-2Nasri H, Bahmani M, Shahinfard N, Moradi Nafchi A, Saberianpour S, Rafieian Kopaei M.Medicinal plants for the treatment of acne vulgaris: A review of recent evidences.Jundishapur J Microbiol. 2015;8(11):e25580. doi:10.5812/jjm.25580
Fox L, Csongradi C, Aucamp M, du Plessis J, Gerber M.Treatment modalities for acne.Molecules. 2016;21(8):1063. doi:10.3390/molecules21081063
Ogé LK, Broussard A, Marshall MD.Acne vulgaris: diagnosis and treatment.Am Fam Physician. 2019;100(8):475-484.
American Academy of Dermatology.How to treat different types of acne.
Institute for Quality and Efficiency in Health Care.Acne: overview. In: InformedHealth.org. Updated September 26, 2019.
Fontao F, Von engelbrechten M, Seilaz C, Sorg O, Saurat JH.Microcomedones in non-lesional acne prone skin: New orientations on comedogenesis and its prevention.J Eur Acad Dermatol Venereol.2019;2019:15926. doi:10.1111/jdv.15926
Wise EM, Graber EM.Clinical pearl: comedone extraction for persistent macrocomedones while on isotretinoin therapy.J Clin Aesthet Dermatol. 2011;4(11):20-1
Primary Care Dermatology Society.Giant comedone.
Sonthalia S, Arora R, Chhabra N, Khopkar U.Favre-Racouchot syndrome.Indian Dermatol Online J. 2014;5(Suppl 2):S128-S129. doi:10.4103/2229-5178.146192
Paganelli A, Mandel VD, Kaleci S, Pellacani G, Rossi E.Favre-Racouchot disease: systematic review and possible therapeutic strategies.J Eur Acad Dermatol Venereol. 2019;33(1):32-41. doi:10.1111/jdv.15184
Tan AU, Schlosser BJ, Paller AS.A review of diagnosis and treatment of acne in adult female patients.Int J Womens Dermatol. 2017;4(2):56-71. doi:10.1016/j.ijwd.2017.10.006
Geller L, Rosen J, Frankel A, Goldenberg G.Perimenstrual flare of adult acne.J Clin Aesthet Dermatol. 2014;7(8):30-4.
Leung AK, Barankin B, Lam JM, Leong KF, Hon KL.Dermatology: how to manage acne vulgaris.Drugs Context. 2021;10:2021-8-6. doi:10.7573/dic.2021-8-6
Leyden J, Stein-Gold L, Weiss J.Why topical retinoids are mainstay of therapy for acne.Dermatol Ther (Heidelb). 2017;7(3):293-304. doi:10.1007/s13555-017-0185-2
Nasri H, Bahmani M, Shahinfard N, Moradi Nafchi A, Saberianpour S, Rafieian Kopaei M.Medicinal plants for the treatment of acne vulgaris: A review of recent evidences.Jundishapur J Microbiol. 2015;8(11):e25580. doi:10.5812/jjm.25580
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