Table of ContentsView AllTable of ContentsSymptoms of ComedonesTypes of ComedonesWhat Causes Comedones?How to Treat ComedonesPreventionOutlookSummary
Table of ContentsView All
View All
Table of Contents
Symptoms of Comedones
Types of Comedones
What Causes Comedones?
How to Treat Comedones
Prevention
Outlook
Summary
A closed comedo is not open to the skin’s surface and is commonly known as a whitehead. An open comedo typically has a dark appearance where air has oxidized the melanin pigment in it, and it is known as a blackhead.
Comedonal acne is a common type of acne that consists of comedones rather thaninflamed pimples.
This article will discuss types of comedones and the prevention and treatment of comedones and comedonal acne.
Verywell / JR Bee
Comedonal acne doesn’t look like typical acne. Many people with comedonal acne don’t realize those bumps and blemishes are, in fact, a type of acne.
Comedonal acne causes few if any, inflammatory breakouts. Instead, symptoms of acne include:
Comedonal acne can range from mild (with just a few occasional blemishes) to more severe, with many blemishes happening over large areas of skin. It can develop on your face, back, neck, shoulders, and chest.
Comedones can appear on their own or alongside inflamed acne.
Reproduced with permission from © DermNetdermnetnz.org2023.
Open Comedones
An open comedo is what is commonly call a blackhead. It occurs when the plug of oil becomes trapped within the hair follicle near the pore opening. The top of the plug is at the surface of the skin and is exposed to air.
The dark brown top of a blackhead isn’t dirt trapped within the pore, but rather melanin pigment that has oxidized and darkened.
The air oxidizes the oil and darkens it, like when an apple is cut and left exposed to air. The top of the plug takes on the dark brown color typical of blackheads.
If you were to extract the blackhead gently, you could see the dark top portion of the plug is dark while the lower portion not exposed to air is creamy white to yellow.
These blackheads typically form on the sides and bridge of the nose, the chin, shoulders, inside the ear, and back.
Closed Comedones
Closed comedonesdevelop when the pore opening is obstructed, and the plug of oil and skin cells is not exposed to air. The hair follicle is completely blocked.
The plug doesn’t turn black; instead, a whitish or flesh-colored bump appears on the skin. The bump isn’t red or inflamed, and it doesn’t hurt.
These whiteheads most often appear on the forehead, chin, and cheeks.
What Are Closed Comedones?
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1:31
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Microcomedones
Microcomedones are the smallest of all acne blemishes. These comedones, invisible to the naked eye, are the “seeds” of the growth of visible comedones. Every pimple and blackhead begins as a microcomedo.
Macrocomedones
Macrocomedones are open (more common) or closed comedones that are larger than average. They typically range in size from 1 millimeter (0.04 inches) to 3 millimeters (0.12 inches ) in diameter.
Giant Comedones
These are huge blackheads, from several millimeters to 2 centimeters (0.78 inches) in diameter. They typically occur singly and in older adults.
Solar Comedones
All comedones begin as a plug ofsebum, skin oil, and dead skin cells trapped in the follicle. This plug blocks the follicle opening.
Thesebaceousglandscontinue to pump oil into the pore, and as it fills with oil, it pushes up on the skin’s surface. This is what creates the bump that you can feel and see.
Comedones aren’t typically painful, just annoying. Think of them as pre-pimples because all inflamed pimples get their start as a comedo.
Like most types of acne, comedonal acne is especially common during the preteen and teen years. However, it can occur to anyone at nearly any age, adulthood included.
Comedonal acne can be a harbinger of inflammatoryacne vulgaris, especially when it appears during puberty. However, comedones don’t always progress to inflamed pimples and can stay as a non-inflamed blocked pore just under the skin’s surface.
Comedonal acne tends to run in families. If your parents or siblings had it, you’re more likely to have it, too. People with oily skin are more prone to comedonal acne as well.
What Makes Acne Worse?
Many things can make acne progress and worsen. They include:
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Some common treatments for comedonal acne include:
If your acne is mild, you may be able to treat it with over-the-counter (OTC) treatments. For more severe and persistent acne, it’s a good idea to see your healthcare provider to discuss treatment options.
Any treatment can take up to 12 weeks to see an improvement. Stick with it, even if you don’t notice any immediate signs that it’s working. Treatments in the retinoid category might seem to worsen symptoms initially, sometimes referred to as a purge or flare. However, this is a sign that the medication is working, increasing cell turnover, which will lead to clearer skin.
Talk to a dermatologist if you’re not seeing good results after three months of treatment.
Should You Pop Your Comedonal Acne?It can be tempting to apply pressure to the skin surrounding a comedo to extract the contents or pop it. However, doing so can push the contents deeper into your skin, leading to inflammation and making the situation worse.If you have a very painful or bothersome lesion, see a dermatologist for safe treatment.
Should You Pop Your Comedonal Acne?
It can be tempting to apply pressure to the skin surrounding a comedo to extract the contents or pop it. However, doing so can push the contents deeper into your skin, leading to inflammation and making the situation worse.If you have a very painful or bothersome lesion, see a dermatologist for safe treatment.
Prescription Medication
The most common prescription medications for skin conditions involving the sebaceous glands are antibiotics, birth control pills, spironolactone,isotretinoin, and topical retinoids like tretinoin.
Antibiotics: Antibiotics, usually doxycycline, minocycline, azithromycin, and trimethoprim-sulfamethoxazole, are most often prescribed for inflammatory forms of acne, although reduction of open and closed comedones can be seen when used for inflamed acne.
Birth Control Pills: People who menstruate may have skin flare-ups during specific times of the monthly menstrual cycle. Birth control pills can mediate the hormones that lead to these flare-ups.
Spironolactone: This medication is given to females to help prevent severe acne breakouts. It may also be prescribed with birth control pills for increased effectiveness in treating acne. It is also often prescribed with birth control pills because spironolactone can cause severe congenital disabilities.
Isotretinoin: This medication is typically used for severe acne in males and females. People with macrocomedones are more likely to experience a relapse of their symptoms on isotretinoin than those with other types of comedonal acne.
Surgical Procedures
Procedures to extract comedones can be performed in a healthcare provider’s office. However, this is not usually done unless other forms of topical therapy have been tried first. Large comedones are most likely to need surgical removal.
Healthcare providers can use a small blade or needle to make a small hole in the middle of the comedo. A comedone extractor is pressed against the skin, and the material inside the pore is pushed outward.
Some comedones respond to cryotherapy, which involves freezing the lesion with liquid nitrogen, but this is not a common form of treatment. For small lesions, most surgical procedures can be performed with topical lidocaine or even without anesthesia at all.
Preventing Comedones
In many cases, minor comedones can be prevented (or at the least reduced). There are a few steps you can take to keep pore blockages away:
Some people are prone to developing comedones, even with exceptional skincare. In this case, over-the-counter acne products or prescription medications are needed to keep comedones from forming.
Dealing with comedones can be frustrating, but most cases can be managed with a combination of medications and prevention.
How long it takes to see progress depends on the treatment. Surgical treatment is apparent on the same day. Oral treatments can take six weeks to a few months before noticeable clearing.
See a healthcare provider if you are still experiencing troublesome symptoms after trying over-the-counter remedies. Persistent comedones can be treated more aggressively.
As with all types of acne, treating comedonal acne as soon as possible is best. For minor blemishes, OTC products are often enough. More severe, widespread, or long-lasting cases can be effectively treated with prescription medications.
It will take time to notice the benefits of new treatments, so be patient and talk to your healthcare provider if you have any concerns or questions.
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7 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.Branch NSC and O. National Institute of Arthritis and Musculoskeletal and Skin Diseases.Acne.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.2021-8-6Zasada M, Budzisz E.Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments.Postepy Dermatol Alergol.2019;36(4):392-397. doi:10.5114/ada.2019.87443Institute for Quality and Efficiency in Health Care (IQWiG). National institutes of Health.Acne: Learn More – Skin Care for Acne-Prone Skin.American Academy of Dermatology Association.Acne: Diagnosis and treatment.Baldwin H.Oral antibiotic treatment options for acne vulgaris.J Clin Aesthet Dermatol.2020;13(9):26-32.Paichitrojjana A, Paichitrojjana A.Oral isotretinoin and its uses in dermatology: a review.Drug Des Devel Ther. 2023;17:2573-2591. doi:10.2147/DDDT.S427530Additional ReadingOge' LK, Broussard A, Marshall MD.Acne Vulgaris: Diagnosis and Treatment.Am Fam Physician. 2019 Oct 15;100(8):475-484.
7 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.Branch NSC and O. National Institute of Arthritis and Musculoskeletal and Skin Diseases.Acne.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.2021-8-6Zasada M, Budzisz E.Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments.Postepy Dermatol Alergol.2019;36(4):392-397. doi:10.5114/ada.2019.87443Institute for Quality and Efficiency in Health Care (IQWiG). National institutes of Health.Acne: Learn More – Skin Care for Acne-Prone Skin.American Academy of Dermatology Association.Acne: Diagnosis and treatment.Baldwin H.Oral antibiotic treatment options for acne vulgaris.J Clin Aesthet Dermatol.2020;13(9):26-32.Paichitrojjana A, Paichitrojjana A.Oral isotretinoin and its uses in dermatology: a review.Drug Des Devel Ther. 2023;17:2573-2591. doi:10.2147/DDDT.S427530Additional ReadingOge' LK, Broussard A, Marshall MD.Acne Vulgaris: Diagnosis and Treatment.Am Fam Physician. 2019 Oct 15;100(8):475-484.
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.
Branch NSC and O. National Institute of Arthritis and Musculoskeletal and Skin Diseases.Acne.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.2021-8-6Zasada M, Budzisz E.Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments.Postepy Dermatol Alergol.2019;36(4):392-397. doi:10.5114/ada.2019.87443Institute for Quality and Efficiency in Health Care (IQWiG). National institutes of Health.Acne: Learn More – Skin Care for Acne-Prone Skin.American Academy of Dermatology Association.Acne: Diagnosis and treatment.Baldwin H.Oral antibiotic treatment options for acne vulgaris.J Clin Aesthet Dermatol.2020;13(9):26-32.Paichitrojjana A, Paichitrojjana A.Oral isotretinoin and its uses in dermatology: a review.Drug Des Devel Ther. 2023;17:2573-2591. doi:10.2147/DDDT.S427530
Branch NSC and O. National Institute of Arthritis and Musculoskeletal and Skin Diseases.Acne.
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
Zasada M, Budzisz E.Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments.Postepy Dermatol Alergol.2019;36(4):392-397. doi:10.5114/ada.2019.87443
Institute for Quality and Efficiency in Health Care (IQWiG). National institutes of Health.Acne: Learn More – Skin Care for Acne-Prone Skin.
American Academy of Dermatology Association.Acne: Diagnosis and treatment.
Baldwin H.Oral antibiotic treatment options for acne vulgaris.J Clin Aesthet Dermatol.2020;13(9):26-32.
Paichitrojjana A, Paichitrojjana A.Oral isotretinoin and its uses in dermatology: a review.Drug Des Devel Ther. 2023;17:2573-2591. doi:10.2147/DDDT.S427530
Oge' LK, Broussard A, Marshall MD.Acne Vulgaris: Diagnosis and Treatment.Am Fam Physician. 2019 Oct 15;100(8):475-484.
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