Comedonal Acne

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is comedonal acne?

Comedonal acne is a form of acne vulgaris, which is a skin condition. Acne vulgaris (common acne) has two forms—inflammatory and non-inflammatory. Comedonal acne is non-inflammatory. It gets its name from the term comedo, which means pore.

Pores are openings in the skin with a hair follicle and a sebaceous gland. The sebaceous gland secretes sebum, which is an oil that moisturizes the skin. As the oil travels up from the bottom of the pore to the skin surface, it carries dead skin cells with it. Normally, it flows out of the pore without a problem. In comedonal acne, the oil and dead skin get trapped in the pore and form a plug. Bacteria can also become trapped in the clogged pore. In comedonal acne, this can result in two types of acne blemishes:

  • Blackheads. The medical name for a blackhead is an open comedo. Blackheads occur when the plugged pore remains open at the skin surface. It’s a common misconception that the black color is dirt. In reality, the black color comes from oxidation. This chemical reaction is similar to what causes apples, avocados and potatoes to turn brown with exposure to oxygen.
  • Whiteheads. The medical name for a white head is a closed comedo. They occur when the blocked pore is closed at the skin surface. It appears white or flesh-colored because the plug is sealed and can’t react to oxygen.

Comedonal acne is extremely common. In fact, acne is the most common skin problem affecting Americans. Almost everyone will experience an acne breakout at some point during their lifetime. The risk of developing it increases if one or both of your parents have had problems with acne.

In most cases, comedonal acne causes pimples in teenagers and young adults. However, you can get acne at any point during your life, even during the newborn period. Changing hormone levels is a likely factor in the development of acne. This could explain why it’s so common among teenagers. It also explains the breakouts women get near menstruation and during pregnancy. Excess oil production may also play a role.

Comedonal acne on cheeks or the face is most common, but it can also appear on the neck, chest, back and shoulders. The pimples usually heal slowly and go away. In a breakout, other pimples may appear as older ones disappear. Self-care at home can help pimples heal more quickly and prevent new ones. Over-the-counter (OTC) acne medicines containing benzoyl peroxide or salicylic acid can be effective for mild breakouts. If acne persists after eight weeks of OTC medicines, see your doctor. Severe or persistent acne may require stronger prescription medications to clear it.

Acne is more than a cosmetic concern. It can cause scarring, emotional problems, and even contribute to mood disorders.

What are the symptoms of comedonal acne?

Comedonal acne can affect any area of the body, but it most often occurs on skin with a high concentration of oil glands. Common sites include the face, neck, chest, upper back, and shoulders. There are two types of pimples that occur in comedonal acne:

  • Blackheads, which look like dark or dirt-filled pores (the black tint is not actual dirt, but due to oxidation of the contents within the pore)
  • Whiteheads, which are small, white bumps (these pimples are closed and not open to the air for oxidation)

With either of these blemishes, the skin around them can be red or inflamed. This is the result of irritation. Acne can look like other skin conditions, so it’s important to see your doctor if it persists despite home treatment. Getting an accurate diagnosis is key to effectively treating acne and other skin problems. This may require seeing a dermatologist, which is a doctor that specializes in the skin and conditions that affect it.

What causes comedonal acne?

Comedonal acne occurs when skin pores become clogged with oil, dead skin, and bacteria. Researchers have not been able to pinpoint exactly why this happens. Several factors likely play a role. Hormonal changes may be the main one. During the teenage years, rising levels of androgens stimulate increased oil production and skin cell turnover. Hormonal changes during menstruation, pregnancy, and menopause can also stimulate acne breakouts in women. Other factors may include heredity, immune system function, excess oil production, and sensitivity to normal skin bacteria.

Myths about the cause of acne include poor hygiene and eating greasy food.

What are the risk factors for comedonal acne?

A number of factors increase the risk of developing comedonal acne or triggering a breakout. Not all people with risk factors will get acne, which leads to some of the uncertainty about its exact cause. Risk factors for comedonal acne include:

  • Age: Acne is most common in teenagers, but anyone can develop it.
  • Certain medications: Examples include corticosteroids, lithium and phenytoin, which is a drug to reduce seizures.
  • Diet: Some research suggests high-carbohydrate or high-glycemic diets may contribute to acne breakouts.
  • Heredity: If you have a parent who has had problems with acne, you are more likely to have problems as well.
  • Skin environment: Using greasy or oily products, such as cleansers, cosmetics or creams, can clog your pores. Tight clothing, especially in humidity or during sweating, can contribute as well. Friction or pressure from equipment, such as phones or helmets, can have the same effect.
  • Stress: People who already have acne may find that stress increases breakouts.

Several studies have also linked smoking to acne breakouts.

Reducing your risk of comedonal acne

It isn’t possible to prevent or avoid comedonal acne altogether, but you may be able to minimize acne triggers. Strategies to lower the severity of an acne breakout include:

  • Avoiding touching your face and squeezing or popping whiteheads and blackheads. Picking at acne can cause more irritation and inflammation, making it harder for your skin to heal. It can also lead to scarring.
  • Shampooing your hair on a regular basis. If you have oily hair, wash your hair every day.
  • Stopping smoking
  • Using gentle, nonabrasive cleansers. Scrubbing your skin or using harsh or alcohol-based cleansers or products can actually make acne worse by causing more irritation.
  • Washing your face twice daily and after sweating using lukewarm water. Hot water can contribute to skin irritation.

If you have concerns about diet or other factors related to your breakouts, talk with your dermatologist. It may help to keep a breakout diary to record potential acne triggers.

How is comedonal acne treated?

For mild cases, over-the-counter (OTC) comedonal acne treatment can be effective. There are two main active ingredients in these OTC products. The most common one is benzoyl peroxide. It works by killing bacteria trapped in the pores and drying up oil from the sebaceous glands. Salicylic acid products are also available over the counter. They work by increasing skin cell turnover, which helps unclog pores.

OTC products come in a variety of formulations. If you use these products for several weeks with no results, see your doctor.

When you need more than OTC products to treat acne, doctors may recommend a prescription product. Topical retinoids are a common prescription treatment for comedonal acne. These products work by drying out the skin and promoting cell turnover to unclog pores. There are also prescription-strength benzoyl peroxide and salicylic acid products. Azelaic acid is a similar prescription option. Topical antibiotics may be useful in some cases.

In general, doctors don’t typically use oral medicines for comedonal acne. Oral medicines are usually more effective in treating inflammatory acne, such as nodular acne and cystic acne. However, women with comedonal acne may benefit from taking oral contraceptives. They balance hormone levels, which can help control both inflammatory and noninflammatory acne breakouts.

In some cases, doctors may recommend extruding or draining blackheads or whiteheads. Doctors use special tools to remove these pimples when medications alone aren’t effective. This technique can sometimes lead to scarring. Chemical peels may also be an option, but they usually require repeat treatments to maintain their effects.

What are the potential complications of comedonal acne?

Having comedonal acne can lead to both physical and emotional complications. Physical complications include scarring and changes in skin pigmentation—or color. After acne heals, the spot where the pimple was may look darker or lighter than surrounding skin. Permanent skin changes are more common with inflammatory acne.

The emotional toll acne can take comes in several forms including:

  • Embarrassment
  • Low self-esteem
  • Social isolation

Fortunately, you don’t have to live with acne. Work with a dermatologist who treats people like you to find the best solution to your skin problems.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Oct 15
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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