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. 

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, which has two types — inflammatory acne and non-inflammatory acne. Comedonal acne is non-inflammatory acne.

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.

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 linoleic acid in sebum, which can cause more buildup and reduced barrier function within the pores
• Inflammation produced by cells lining the follicle
• Certain skin care products
• Rupture of the follicle by injury caused by squeezing open or closed comedones.
• Smoking — comedonal acne is more common in smokers than in 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 non-inflammatory or inflammatory, the treatment of acne is fairly 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:

• Benzoyl peroxide
• Azelaic acid
• Salicylic acid
• 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 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 such as tretinoin, isotretinoin and adapalene (in concentrations higher than 0.1%)
• 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

In Conclusion

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 skin isn’t responding to these treatments, talk with your healthcare provider or dermatologist to discuss prescription or surgical treatment options that may be right for you.