Acne can be such a nuisance, and if you’re reading this, chances are that you’ve experienced acne at some point in your lifetime. Blackheads? Not fun. Whiteheads? Pass.
But did you know that these two have more in common than you might think? Yep, that’s right—blackheads and whiteheads are both types of comedones common in comedonal acne.
In this article, we’ll explore what comedonal acne is, what causes it and how to get rid of comedonal acne.
What is Comedonal Acne?
Comedonal acne is a pattern of acne in which the majority of lesions are comedones. Comedones are the small bumps frequently found on the skin of those with acne. A single lesion is called a comedone.
Comedonal acne is a form of acne vulgaris and comes in two types — inflammatory and non-inflammatory.
Comedonal acne is non-inflammatory acne. Comedonal acne most often affects the skin on the forehead and chin.
Your skin sheds cells at the surface to allow new skin cells to form. When dead skin cells get trapped in the hair follicles and mixed with sebum, they can block the pore.
Typical blackheads and whiteheads are the result.
Blackheads—also known as open comedones. They appear black due to the oxidization of the plug, not because of dirt or debris.
Whiteheads—also known as closed comedones. When the follicle is completely blocked by sebum and dead skin cells, you get whiteheads.
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What Causes Comedonal Acne?
Comedones begin when the cells lining the sebaceous glands of a hair follicle increase, causing an increase in sebum production.
A comedo is then formed by the blockage in the sebaceous duct and hair follicle.
While there is not a direct cause for comedonal acne, there are several risk factors involved in the development of comedones. These include:
Increased male sex hormone 5-testosterone (DHT) within skin cells
A reduction in linoleate in sebum, which can cause more buildup and reduced barrier function within the pores
Inflammation produced by cells lining the follicle
Free fatty acids made from a combination of acne bacteria and sebum
Overhydrated skin, from moisturizers or humidity
Rupture of the follicle by injury caused by squeezing open or closed comedones, abrasive scrubs, chemical peels or laser treatments
Smoking—research shows higher instances of comedonal acne in smokers than non-smokers
Certain dietary factors may contribute to the development of comedones, particularly milk products and high glycemic-index foods ,
Comedonal acne is different from other forms of acne, such as cystic acne and nodular acne, because it is non-inflammatory.
This means that it doesn’t have predominantly inflammatory lesions, such as pustules and papules.
Treatment for Comedonal Acne
Regardless of whether your acne is inflammatory or non-inflammatory, treatment is similar across most types of acne .
If you’re dealing with comedonal acne, oil-free cosmetics are your best bet. Also, wash your face twice daily with a mild soap and water.
It’s also best to quit smoking and eat a healthy diet that’s low in sugar, fat and dairy products.
For topical treatments, patients with acne should choose "comedolytic" topical medications. These medications are available over-the-counter and include:
Salicylic acid—these treatments can also include sulfur and resorcinol
Adapalene (Differin® Gel 0.1%)
These topical treatments should be applied once or twice per day in thin layers to the affected area.
Be patient, because it may take several weeks to months before you see improvement. In order to keep comedones at bay, the treatment also needs to be continued long-term—sometimes for many years.
If your comedones are not responding well to these over-the-counter treatments, you can speak with a healthcare provider or dermatologist about prescription options.
Prescription topical and oral medications for patients with acne include:
Retinoids like isotretinoin, adapalene (in concentrations higher than 0.1%) and tretinoin
Hormonal therapy, such as birth control
Finally, surgical treatments are sometimes recommended or necessary to remove persistent comedones. Surgical treatments for patients with acne include:
Electrosurgery (cautery or diathermy)
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“Comedonal acne” is simply another term for acne made up mostly of comedones. Although there aren’t any direct causes for comedonal acne, risk factors can include an increased level of DHT, overhydrated skin, smoking and certain dietary factors. There are many over-the-counter treatments available for comedonal acne. However, if your skin isn’t responding to these acne treatments , talk with your healthcare provider or dermatologist to discuss prescription or surgical treatment options that may be right for you.