Understanding and Treating Comedonal Acne

If your skin feels bumpy, with small white or dark spots that don’t seem to go away, you may be dealing with comedonal acne a type of acne made up of blackheads, whiteheads, and other clogged pores. Unlike inflamed pimples, comedonal acne isn’t red or painful, which makes it easy to overlook or mistake for rough skin.

But left untreated, comedones can persist for months or lead to more severe breakouts. The good news? With the right skincare approach and targeted treatments, most types of comedonal acne can be managed effectively.

Here’s what to know about comedones, how they form, and what you can do to treat and prevent them.

What Are Comedones?

A comedo is a clogged hair follicle essentially a pore blocked by oil (sebum), dead skin cells, and sometimes bacteria. When many comedones appear, the condition is known as comedonal acne.

There are two main types:

• Open comedones (blackheads): The plug reaches the skin’s surface and oxidizes, turning dark.

• Closed comedones (whiteheads): The plug stays beneath the surface, creating a small, flesh-colored bump.

You’ll often find them on the forehead, nose, cheeks, chin, back, and shoulders.

Types of Comedones

• Microcomedones: Tiny, invisible clogged pores that are the starting point of all acne.

• Macrocomedones: Larger-than-average whiteheads or blackheads (1–3 mm in size).

• Giant comedones: Extra-large blackheads, typically seen in older adults.

• Solar comedones: Caused by long-term sun exposure, more common in adults aged 60–80.

What Causes Comedonal Acne?

Comedones form when oil and dead skin block pores. This can be due to:

• Increased oil production, especially during puberty or hormone shifts

• Genetics (if your family had acne, you’re more likely to develop it too)

• Oily skincare or hair products

• Environmental factors like air pollution and humidity

• Mechanical irritation from tight clothing, helmets, or straps

Interestingly, comedonal acne often precedes more inflamed acne so early treatment can help prevent worsening breakouts.

What Makes It Worse? These habits and triggers can make comedonal acne harder to control:

• Hormonal fluctuations (especially before menstruation)

• Excess sweating left on the skin

• Scrubbing your face too hard

• Picking or squeezing the blemishes

• Using greasy moisturizers or comedogenic makeup

How to Treat Comedonal Acne

While you can’t scrub comedones away, the right topical and prescription treatments can work wonders over time. Here’s what dermatologists often recommend:

Over-the-Counter Treatments:

• Salicylic acid: A beta-hydroxy acid that helps unclog pores

• Benzoyl peroxide: Reduces bacteria and oil

• Adapalene (Differin): A gentle, FDA-approved retinoid available OTC

• Azelaic acid: Reduces keratin production and inflammation

Prescription Treatments:

• Topical retinoids: Such as tretinoin or tazarotene, to boost cell turnover

• Oral antibiotics: Used short-term for moderate to severe acne

• Birth control pills: Help regulate hormones in people who menstruate

• Spironolactone: Prescribed for hormonal acne in females

• Isotretinoin (Accutane): For severe or persistent acne that hasn’t responded to other treatments

Important: Most treatments take 6–12 weeks to show results. A temporary purge (worsening of symptoms) is common with retinoids this means the medication is accelerating cell turnover.

Can You Pop a Comedo?

While tempting, squeezing comedones can cause:

• Inflammation

• Scarring

• Worsening of the blockage

Instead, see a dermatologist or licensed professional for comedone extraction, especially for large or painful lesions.

Are Procedures Necessary?

When topical options aren’t effective, professionals may recommend:

• Manual extraction using a sterile tool

• Cryotherapy, which uses liquid nitrogen to shrink comedones

• Light or laser treatments for severe or recurring cases

Prevention Tips That Actually Work

Good skincare helps prevent future blockages:

• Wash your face twice daily with a gentle cleanser

• Use non-comedogenic products (moisturizers, sunscreen, and makeup)

• Remove makeup before bed

• Shower after workouts to remove sweat and oil

• Clean makeup brushes regularly

• Avoid over-washing or using harsh scrubs

If you’re prone to comedones despite a solid routine, adding a treatment like salicylic acid or a retinoid can help keep pores clear long-term.

When to See a Dermatologist

If your comedonal acne persists after three months of consistent treatment, or worsens into painful or inflamed lesions, it’s time to see a healthcare provider. You may need a prescription or a professional procedure to achieve clear skin.

The Outlook

With time, consistency, and the right combination of treatments, most people see significant improvement in their skin. While comedonal acne can be stubborn, it is very manageable and often preventable with professional guidance and supportive care.

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