An Overview of Comedonal Acne

Comedones vs. Acne

Updated on May 24, 2023

Medically reviewed by Casey Gallagher, MD

Fact checked by Nick Blackmer

Comedonal acne occurs when a hair follicle is blocked by sebum (a waxy skin oil) and dead skin cells. A single bump is referred to as a comedo, while multiple bumps are called comedones.

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.

Tips for treating comedonal acne — Verywell / JR Bee

What Is Comedonal Acne?

Comedonal acne is when a hair follicle is blocked by skin oil and dead cells. A single bump is referred to as a comedo, and multiple bumps are called comedones.

Comedonal acne does not have inflamed pimples and pustules like inflammatory acne (the most common form of acne 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.

Close up of comedonal acne on a face — Reproduced with permission from Â© DermNet dermnetnz.org 2023.

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 and whiteheads—do not have inflammation. They are not painful, red, or filled with pus.

Comedones are not red or inflamed like 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.

Types

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.

Open Comedones

Open comedones, or blackheads, happen when the oil plug is near the opening of a pore.

The dark color is not caused by dirt; rather, it’s a chemical reaction in the pigment responsible for the color of skin (melanin). When it gets exposed to oxygen, melanin in dead skin cells oxidizes and turns a dark-brown color, which is why a blackhead looks the way it does.

If you were to extract 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 usually form on the sides and bridge of the nose as 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

Solar comedones (senile comedones) are caused by too much sun exposure over a long time. They can be small or large and open or closed.

Chronic exposure to ultraviolet (UV) radiation from 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.

Comedonal Acne Causes

Comedones are associated with the pilosebaceous unit, which includes a hair follicle and sebaceous 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 much keratin (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 called androgens that can put the sebaceous glands into overdrive. The same can occur before the onset of a menstrual period when hormone levels spike.

Comedonal acne can also be caused or made worse by the products you put on your face or skin. This includes oily skin care products or hair pomades. High humidity and air pollution can also contribute to skin problems like comedonal acne.

How Comedonal Acne Is Diagnosed

Comedonal acne can usually be diagnosed just by how it looks.

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:

Keratosis pilaris: a benign condition that causes acne-like bumps
Fibrofolliculoma: a benign (non-cancerous) tumor of a hair follicle
Sebaceous hyperplasia: the benign enlargement of the sebaceous gland
Folliculitis: an infection of the hair follicles

Treatment for Comedonal Acne

As with other forms of acne, comedonal breakouts are not caused by a lack of hygiene. Scrubbing or washing your face more often is not likely to clear up an outbreak. As important as daily skincare is, it cannot cure or prevent comedonal acne on its own.

There are over-the-counter (OTC) and prescription medications that can help with acne including:

Salicylic acid
Benzoyl peroxide
Differin (adapalene)
Topical retinoids
Azelaic acid

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.

The American Academy of Dermatology recommends using a retinoid product to get rid of blackheads and whiteheads. Retinoids are derived from vitamin A and work by decreasing the buildup of dead skin cells and helping prevent inflammation.

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 an aesthetician might 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 to Prevent Comedonal Acne

Minor comedone acne outbreaks can be prevented or reduced by changing the way you care for your skin. Here are a few simple tips that may help prevent pore blockage:

Wash your face twice daily. Cleansing acne-prone skin more often than needed can cause irritation and leave skin dried and inflamed. Inflamed skin is more vulnerable to infection, increasing the risk of acne pimples. You really only need to wash your face twice a day at most, usually in the morning and before you go to bed at night.
Use skin products that will not clog your pores. Use non-oily moisturizers, cleansers, and cosmetics that are designed to prevent pore blockage. Some are labeled non-comedogenic while others advertise themselves as anti-acnegenic.
Keep your makeup brushes and applicators clean. Sebum and dead skin cells can quickly build up on bristles and pads. You can usually remove them with warm, soapy water. Rinse them thoroughly and allow them to air dry.
Take your makeup off before bedtime. Sleeping with makeup on your face can clog pores. Use a fragrance-free, non-alcohol makeup remover to avoid irritation and get cosmetics off your skin. Some products are made with glycerin or aloe vera to help moisturize your skin, too.

Wash up after strenuous activity. Do not let perspiration and oil stay on your skin. Take a shower and immediately rehydrate with a light, oil-free moisturizer.

If you do get a blackhead or whitehead, do not squeeze it. You are more likely to damage your skin and cause a blemish. Adhesive pore strips and clay masks can help extract tiny blackheads. Whiteheads should be left alone and treated topically.

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.

14 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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