Causes and Treatment of Closed Comedones

Closed comedones (whiteheads) are non-inflamed blemishes caused when skin debris and oils block pores in the skin. They can be treated with over-the-counter or prescription creams as well as manual extraction to help clear the plug and improve your appearance.

This article explains the symptoms and causes of closed comedones, including how they are safely and effectively treated.

This photo contains content that some people may find graphic or disturbing.

See Photo

Symptoms of Closed Comedones

Closed comedones look like tiny bumps across the skin's surface. They're not red or inflamed. Instead, they're more often the same color as the surrounding skin. Some whiteheads can develop an actual white head as the overlying skin is stretched by the underlying plug.

Closed comedones can happen anywhere on the skin but most often develop on the face, neck, chest, and back where sebaceous glands (that produce sebum) are densely populated.

By contrast, open comedones (blackheads) develop when the plug pushes through the opening of the follicle. The exposure of the plug to the air causes oxidation (in which oxygen causes the plug to turn black).

Closed and open comedones can (and often do) occur together in the same area of skin.

Causes and Risk Factors

Comedones are caused when dead skin cells (called keratinocytes) mix with natural skin oils (called sebum) and clog pores in the skin known as hair follicles.

Closed comedones develop when the plug is encased by overlying skin, creating non-inflamed whiteheads. If bacteria invade the follicle or the follicle wall ruptures, closed comedones can turn into inflamed, pus-filled pimples (pustules).

Some people are more likely to develop comedones than others. Age, biological sex, lifestyle, and genetics are known to place certain people at greater risk of comedones and acne.

When comedones are persistent, they are referred to as comedonal acne. The term is used because people with persistent comedones are more likely to develop acne vulgaris (the most common form of acne).

This is why comedones are more common in tweens and teenagers when these sex hormones are surging.

At the same time, comedones can develop during menstrual cycles, pregnancy, and menopause due to estrogen fluctuations, or when people use substances like anabolic steroids that suppress testosterone production.

Other factors can increase the risk of comedones and comedonal acne, including:

• Harsh or abrasive soaps and skin care products
• Overhydrated skin from excess moisturizer use or environmental humidity
• Skin care products made with isopropyl myristate or propylene glycol
• Hair gels made with oily pomade
• Diets rich in sugar, saturated fat, and dairy
• Cigarette smoking

Traditional Treatments

Closed comedones can be annoying, but you can treat them. If you have mild bumps and breakouts, you can first try an over-the-counter (OTC) acne remedy before considering prescription drugs.

Over-the-Counter Treatments

Over-the-counter acne creams, gels, and ointments containing benzoyl peroxide, adapalene (0.1 differenc gel) salicylic acid, or glycolic acid can speed up the shedding of dead skin cells and help clear excess sebum from the skin. This can help keep pores from getting clogged.

Over-the-counter products can take time to work. It can take eight weeks before visible improvement is seen.

Prescription Medications

If you have more than just a few closed comedones, or if you've been battling them for a long time, you may want to see a skin specialist called a dermatologist for prescription medications.

Topical retinoids are a great choice and likely the first medication your dermatologist will prescribe. Options include: 

• Retin-A (tretinoin)
• Differin 0.3 (adapalene)
• Tazorac (tazarotene)

These vitamin A-based medications help clear pore blockages and keep new ones from forming. They also have the added benefit of smoothing and softening the skin.

Your dermatologist might also recommend azelaic acid, a topical antiseptic (this can also be gotten OTC depending on the percentage). Birth control pills can also be beneficial for females affected by comedonal acne.

Manual Extractions

Blemish extractions help smooth bumpy skin but should only be done by a dermatologist or esthetician. This is especially true given that whiteheads are buried beneath the skin and can be hard to remove. Squeezing or treating them roughly can cause bleeding and scarring.

Dermatologist and estheticians will use their fingers and a special tool called a comedonal extractor to remove the plug.

While extractions can improve the appearance of your skin, they don't keep closed comedones from forming. You'll still need treatment to prevent them from coming back.

Natural Remedies for Closed Comedones

Instead of applying chemicals to their skin, which can be harsh, some people will turn to natural remedies to prevent or treat comedones.

While the evidence supporting these products is generally weak, people will often swear by such natural topical remedies as:

• Aloe vera
• Green tea extract
• Honey
• Ginseng extract
• Tea tree oil
• Witch hazel
  

Summary

Closed comedones are tiny bumps on your skin, also known as whiteheads. They are caused when dead skin cells and natural oils block skin pores.

Closed comedones can be treated with over-the-counter acne medications. If symptoms are severe, a dermatologist can prescribe topical creams to help get rid of the comedones and keep them from coming back. A dermatologist or esthetician can also manually extract them to help your skin look smoother.