Comedonal Acne: Treatment & Causes

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. Pimples? Hate them.

But did you know that these two have more in common than you might think? Yep, that’s right—breakouts like blackheads and whiteheads are 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 or cysts are comedones. Comedones are the small bumps frequently found on the skin of those with acne. A single cyst lesion is called a comedone.

Comedonal acne is a form of acne vulgaris, which has two types — inflammatory acne and non-inflammatory acne. 

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. 

Your skin sheds cells at the surface to allow new skin cells to form. Sometimes, dead skin cells can get trapped within the hair follicles. When combined with sebum, a plug can form. Typical blackheads and whiteheads are caused by trapped hair follicles.

The two most common types of comedones include:

• 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. Whiteheads occur when the follicle is completely blocked.

Other types of comedones include:  

• Microcomedones, which are closed and invisible to the eye. These have the ability to grow into larger comedones.

• Macrocomedones and giant comedones, which are located on the face and larger than normal. They range from one to three millimeters. Typically, they are open. 

Learn about the difference between comedonal acne and fungal acne.

Comedonal Acne Causes

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, according to the Journal of Clinical and Aesthetic Dermatology

• A reduction in linoleic acid in sebum, according to , which can cause more buildup and reduced barrier function within the pores

• Inflammation produced by cells lining the follicle, according to the Journal of Clinical and Aesthetic Dermatology

• Certain skin care products, according to Institute for Quality and Efficiency in Health Care

• 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.

Comedonal Acne Treatment

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 marketed as "non-comedogenic" are your best bet. Also, wash your face twice daily with a mild cleanser and water and follow with a non-comedogenic moisturizer. 

It’s also best to quit smoking and eat a healthy diet that’s low in sugar, fat and dairy products. Be sure to wear sunscreen when you are exposed to the sun for prolonged periods of time.

For topical treatments, patients with acne should choose "comedolytic" topical medications, according to American Family Physician. These medications are available over-the-counter and include:

• Benzoyl peroxide

• Azelaic acid

• Salicylic acid—these treatments can also include sulfur and resorcinol

• Glycolic acid

• Adapalene (Differin® Gel 0.1%)

These topical treatments should be applied once or twice daily as a thin layer to the entire area affected. 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 OTC treatments, you can seek dermatology advice from 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

• Isotretinoin

• Antibiotics

Finally, mechanical procedures are sometimes recommended or necessary to remove persistent comedones. Surgical treatments for patients with acne include:

• Cryotherapy

• Electrocauterization (cautery or diathermy)

• Microdermabrasion

• ​Chemical peels (to relieve clogged pores and encourage cell turnover)

Comedonal Acne: A Final Word

Comedonal acne is another term for acne that is made up of mostly comedones—aka blackheads and whiteheads. 

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 blemishes aren’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.