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What Are Comedones Exactly?


Ever wondered what those little, skin-coloured bumps sprouting across your forehead or chin are? The strange thing is they don’t hurt or produce any pus – they’re unpoppable! 

If you’ve ever experienced acne (hello adolescence), then you’ve probably experienced different types of acne, like comedones, also known as a single comedo or comedonal acne. 

This is a type of acne you may have seen on the face like your forehead and chin but never knew the name of before and might have just classified it as a big breakout. If you’re lost and confused, no need, as we’re going to explain exactly what this is and how to treat it. 

Types of Comedones

Comedones are characterized by lesions spread across an area, with raised skin-coloured, small bumps, also known as papules. Papules are the small, solid, elevated lesion with no visible fluid which may be up to ½ cm in diameter and the clusters of the papules in one area is a common trait of comedones.

Comedones may range in severity and types with treatment being a little more difficult than treating your average pimple. The key here is to accurately identify what kind of comedones you have and then target treatment efforts.

The undesired skin texture caused by comedones can come in different forms.

Open comedones: Open comedones, also known as blackheads, occur when the oil plug is close to the surface of the skin. When the skin pigment, melanin, oxidizes with air, it forms a “black” head. Melanin is the pigment responsible for tanning of skin when exposed to sunlight.

Closed comedones: closed comedones, or whiteheads or a white comedo, occur when the oil plug is developed beneath the opening of the follicle. They can appear white or colourless and aren’t able to be popped because there isn’t any underlying infection or puss.

Microcomedones: microcomedones are the smallest type of acne and are invisible to the naked eye. These are the starting point by which larger comedones develop from. An inflamed pimple and all other comedones are evolved from microcomedone.

Macrocomedones: Macrocomedones can be closed or open and are typically 2-3mm in diameter.

Giant comedones: giant comedones are closed comedones that are upwards from 3mm in diameter. They are characterized by the large, distinct blackhead on the surface of the skin.

Solar comedones: solar comedones are also known as senile comedones and can be open or closed comedones, and can also range in size. These are caused from chronic exposure to the damaging UV rays of the sun and cause the skin to raise and thicken and cause papules to develop in swollen skin pores.

What Causes Comedones?

Comedones occur in the pilosebaceous unit. This unit is what makes up your pores and includes the hair follicle and sebaceous gland, and are densely clustered on the face, neck, upper chest, shoulders and back. Sebaceous glands are responsible for producing sebum, the natural oil that your skin produces to keep itself hydrated. 

When excess sebum mixes with dead skin cells that are trapped in the follicle, this creates a plug. This type of acne is commonly associated with people that have oilier skin types. Comedonal acne is noninflammatory and the lesions are typically not red or tender to the touch. The lesions do not usually contain puss or the bacteria that causes acne.

Comedones can affect anyone at any age but are commonly found in adolescence during puberty. During puberty, your hyperactive hormones can send those sebaceous glands into overdrive causing acne.

You’re also more likely to experience comedones if it runs in your family. But just because you’re experiencing the symptoms of a comedone, doesn’t mean that it will turn into a pimple. Many comedones just occur as that and nothing more.

Other common causes that can attribute to comedones are:

  • smoking
  • diet that consists of a lot of dairy, fats and sugars
  • products with oil content
  • high humidity, or air pollution

How Do You Get Rid of Comedones?

Now before you look up a blackhead extractor DIY on the internet and treat those suckers yourself, it is important to note that treatment of comedonal acne is not an overnight thing. It is important to note that picking and extracting can lead to more severe acne and infections and can also lead to permanent scarring. Treatment can come in the form of topical product applications, and oral medications, to even surgery for more severe cases.

1.Topical Treatments

You can purchase skincare products to treat your acne that contain any of the following:

  • Azelaic acid: is a comedolytic, antimicrobial, and anti-inflammatory agent that helps unclog pores
  • Benzoyl-peroxide: a common acne treatment that is an anti-inflammatory agent with antimicrobial properties
  • Salicylic acid: is another common acne treatment that cleans out sebum and reduce acne
  • Glycolic acid: is an exfoliant that helps clear away dead skin cells and helps prevent acne
  • Retinoids: are often used as first-line treatment for patients with mild-to-moderate acne, especially when the acne is mainly comedonal. Topical retinoids help to reduce acne by clearing dead skin cells and unclogging pore and the vitamin A derivatives speed up the cell turnover process. 

2. Oral Medication

You can also consider speaking with your doctor or a dermatologist for your persistent comedonal acne. They can prescribe you with a few options best suited for your needs. Common examples include:

  • Antibiotics
  • Homornal therapy: Aldactone is a medication taken by women to block the effect of male sex hormones like testosterone and help reduce sebum production.
  • Isotretinoin (Accutane)

3. Natural Remedies

  • Tea tree oil can be used to treat comedonal acne by reducing sebum and calming the skin. You most likely already have this at home if you deal with acne or can easily find products with tea tree oil spot treatments at your local drugstore.
  • Witch hazel naturally acts like a toner to help balance your skin’s moisture. It can also aid with opening closed comedones and this can help with removing trapped dirt and other build-up. Although, some people react to Witch Hazel so patch test every ingredient just as you would a purchased product. 

4. Surgical Options

If your case of comedonal acne isn’t effectively treated with a topical treatment or oral medication, the your doctor may refer you for surgical options such as:

  • microdermabrasion: is a noninvasive cosmetic procedure where a specialist rubs fine micro crystals onto the skin with a wand that gently exfoliates the surface, removing the top layer. This helps to open closed comedones and remove them while minimizing the chances of scarring
  • cryotherapy: this is when liquid nitrogen is applied to the infected area to freeze the comedones for removal

5. Preventative Measures

Keeping consistent with good skin care hygiene and habits can be the best long-term treatment of comedonal acne.

  • Wash your face your face no more than twice a day as over-washing can leave the skin dried and inflamed
  • Follow up with witch hazel or toner
  • Make sure to wear SPF to prevent sun damage that could ultimately lead to solar comedones.
  • Cleanse after working out to prevent sweat and dirt from clogging pores
  • Sleeping with makeup on is a major thing to avoid as this can trap more oil in your pores
  • Keep a balanced diet, regular exercise, get enough sleep, and manage your stress to maintain a healthy lifestyle

Patience is a virtue when it comes to treating comedonal acne. It’s hard to treat it yourself so it’s best to keep good skin care and hygiene habits and consult help from a professional. We know it’s hard to resist picking but leaving those lesions alone while your treatments take time to work is the best thing you can do! Blackheads and whiteheads happen to anyone and everyone so just remember, you’re not alone.

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