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Feb 01, 2021
6 min read

What are closed comedones?

Closed comedones, also known as whiteheads, are basically just clogged pores covered by skin. Each pore on your face is home to a hair follicle and your body naturally produces something called sebum to keep that hair follicle moisturized and healthy. But if the sebum, dead skin cells or bacteria clogs up that pore, the blockage can cause acne. Here’s everything you need to know about closed comedones, open comedones, and everything in between.

yael cooperman

Reviewed by Yael Cooperman, MD

Written by Cale Li, MD

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

How do comedones form? 

Every single pore in your skin is actually home to an individual hair follicle. Normally, our bodies produce a natural moisturizer called sebum to keep the hair follicle healthy. But sometimes, excess sebum, dirt, or dead skin cells can block this opening causing the formation of comedones and acne. 

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Some people enjoy baby-smooth skin from the day they’re born with nothing more than the occasional pimple, while others are plagued with acne from puberty straight through to adulthood and on. So what’s the deal? There are certain things that increase your chance of developing acne (Tanghetti, 2013): 

  • Skin type: Some people naturally produce more sebum, making it more likely for pores to get clogged.
  • Hormones: High levels of certain hormones, like testosterone, can increase the amount of sebum your body produces, making it more likely for you to have a break out. Fluctuations in hormones, which are more common in puberty, pregnancy and when you get your period, can also lead to breakouts.
  • Inflammation: some individuals experience more inflammation from the natural bacteria on their skin, causing acne to form. 

What are the treatment options for comedones?

The best way to treat comedones is with topical treatments (applied directly to the skin) containing benzoyl peroxide or a topical retinoid (Zaenglein, 2016). Opt for a cleanser, moisturizer, and treatment cream for spot treatment.

There are plenty of excellent over-the-counter options that work for mild to moderate acne or occasional outbreaks available at any local drugstore or pharmacy. The most common side effects are skin dryness and irritation, associated often with overuse (Zaenglein, 2016). 

Topical retinoids (adapalene or tretinoin)

Topical retinoids are the recommended first-line treatment for comedones. Derived from vitamin A, these treatments keep the skin clear by promoting natural exfoliation, clearing out dead skin cells, and keeping your pores clean.

They also help fight inflammation and calm the skin. Safe and effective, topical retinoids are the go-to recommendation of dermatologists for whiteheads (Zaenglein, 2016).

When using these treatments, your skin may be more sensitive to sunlight. Consider limiting these products to night-time usage and applying sunscreen during the day (even if you spend most of the day indoors). 

Benzoyl peroxide

Benzoyl peroxide is another effective treatment for whiteheads, blackheads, and full-blown acne alike. It works by breaking down dead skin cells and inhibiting the growth of bacteria. Certain brands have formulas that combine benzoyl peroxide with a topical retinoid or antibiotic, like clindamycin, for more effective results (Zaenglein, 2016). 

Azelaic acid

Azelaic acid is an alternative acne treatment, often used for pimples that have become inflamed and irritated. Azelaic acid may also help treat dark patches known as hyperpigmentation which can appear in people who have regular outbreaks (Davis, 2010). 

Should I pop them?

It’s tempting, but try not to. Squeezing whiteheads can make them worse by causing infection or scarring. Touching your face also increases the chance of developing more outbreaks. 

But if you must squeeze them (and we’ve all been there), here are a few tips to keep in mind:

Color

Mature whiteheads are easier to pop, as they are closer to the skin. You can tell if a whitehead has matured by its white tip. As the whitehead matures, the tip turns white as your body’s immune cells attack and kill the bacteria trapped in the pore. 

If the whitehead looks angry and red, leave it alone. It’s not ready yet to pop. If you try to pop an immature whitehead, you can cause damage to the skin, increasing the chance of developing an infection or scarring (Zaenglein, 2016). 

Hot and cold

Applying warm compresses to the whitehead can help its maturation, as heat improves circulation to the area. Applying cold compresses or ice after squeezing the whitehead can help reduce inflammation and irritation in the area. 

Clean and dry

Maintain proper hand hygiene before touching your face. You might want to use sterile gloves, which can be purchased at pharmacies. After you pop the whitehead, keep the area clean and dry. As best you can, avoid touching the area afterward to help minimize the chances of infection and scarring (Zaenglein, 2016). 

What else can I do to prevent and treat comedones?

Cosmetics

Cosmetics can be a notorious culprit when it comes to clogging pores. When purchasing cosmetics, look for brands that are labeled “non-comedogenic,” meaning they are free of excess oil or pore-clogging ingredients. 

Diet

The relationship between diet and acne has been hotly contested for ages. We’ve probably all heard about fatty foods and chocolate causing breakouts. But the jury is still out. 

The most recent evidence has been for avoiding cow’s milk and sugary foods, which seem to cause breakouts for certain people (Smith, 2007; Adebamawo, 2005). Eating dark chocolate may worsen existing acne (Vongraviopap, 2016).  

What does all this ultimately mean? There isn’t enough research yet to make routine dietary recommendations for everyone. What you might find helpful, however, is keeping a log of your diet and seeing if any foods make your acne worse. 

Prescription treatments

If your acne won’t go away or has gotten worse, prescription-strength acne treatments may help. These can include oral antibiotics, antibiotic ointments, oral contraceptive pills for women, and isotretinoin. 

Topical antibiotics

Topical antibiotics are applied directly to the skin and come in gels, ointments, and creams. The standard topical antibiotic is clindamycin (Zaenglein, 2016). For optimal results, topical clindamycin is commonly combined with benzoyl peroxide. 

Oral antibiotics

Oral antibiotics are stronger than their topical cousins and are effective in the treatment of inflamed acne. Common antibiotics prescribed for acne include doxycycline and azithromycin (Zaenglein, 2016).  

Oral antibiotics are usually given in combination with topical treatments. After starting antibiotics, it’s a good idea to check in with your healthcare provider after about three months. If your acne has improved, they may recommend stopping the antibiotic. 

From then on, topical treatments alone are effective in keeping your skin clear after an initial period of antibiotics (Tan, 2012). Staying on antibiotics for a long time is not a good idea, as bacteria can become resistant to the medication. Antibiotics also have side effects: doxycycline, for example, can make your skin more sensitive to light, cause stomach aches, and more (Del Rosso, 2015).  

Combined oral contraceptives

Combined oral contraceptives, or birth control pills, are an effective acne treatment for some people. These medications contain the hormones estrogen and progesterone and help regulate hormone changes in your body that contribute to breakouts.

Some women should not take combined oral contraceptives, especially women with a history of blood clots, stroke, heart disease, current breast cancer, or women who are pregnant (Arrington, 2012). 

Isotretinoin

Oral isotretinoin is a medication used for the most severe acne cases with painful cysts and scarring. However, it can have some serious side effects, which include dry skin, nosebleeds, muscle pain, and vision changes. Isotretinoin can also cause miscarriage and severe birth defects in pregnant women (Huang, 2017).

For that reason, your healthcare provider will require that you use some form of birth control while taking the medication. Like topical retinoids, isotretinoin can also make your skin more sensitive to sunlight and you should use sunscreen liberally to protect your skin while taking this medication. 

Before prescribing isotretinoin, your healthcare provider will discuss the iPledge risk reduction program with you. They may also recommend routine blood tests like cholesterol testing to monitor for side effects while you are taking isotretinoin (De Marchi, 2006). 

References

  1. Adebamowo CA, Spiegelman D, et al. (2005) High school dietary dairy intake and teenage acne. Journal of the American Academy of Dermatology, 52(2):207-14. doi: 10.1016/j.jaad.2004.08.007. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15692464/
  2. Arrington E.A., Patel N.S., Gerancher K., Feldman S.R. (2012). Combined oral contraceptives for the treatment of acne: a practical guide. Cutis, 90: 83-90. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22988652/
  3. Davis, E. C., & Callender, V. D. (2010). Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. The Journal of Clinical and Aesthetic Dermatology, 3(7), 20–31. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20725554/
  4. De Marchi, M. ., Maranhão, R.C., Brandizzi, L.I.V. et al. (2006). Effects of isotretinoin on the metabolism of triglyceride-rich lipoproteins and on the lipid profile in patients with acne. Archives of Dermatological Research, 297(9), 403–408. doi: 10.1007/s00403-006-0638-4. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16429299/
  5. Del Rosso J. Q. (2015). Oral Doxycycline in the Management of Acne Vulgaris: Current Perspectives on Clinical Use and Recent Findings with a New Double-scored Small Tablet Formulation. The Journal of Clinical and Aesthetic Dermatology, 8(5), 19–26. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26029331/
  6. Huang YC and Chen YC. (2017). “Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis.” Journal of the American Academy of Dermatology, 76:1068-76. doi: 10.1016/j.jaad.2016.12.028. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28291553/
  7. Smith RN, Mann NJ, et al. (2007). The effect of a high-protein, low glycemic–load diet versus a conventional, high glycemic–load diet on biochemical parameters associated with acne vulgaris: A randomized, investigator-masked, controlled trial. Journal of the American Academy of Dermatology, 57(2):247-56. doi: 10.1016/j.jaad.2007.01.046. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17448569/
  8. Tan, J., Stein Gold, L., Schlessinger, J., Brodell, R., Jones, T., Cruz, A., Kerrouche, N., & Jarratt, M. (2012). Short-term combination therapy and long-term relapse prevention in the treatment of severe acne vulgaris. Journal of Drugs in Dermatology : JDD, 11(2), 174–180. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22270198/
  9. Tanghetti E. A. (2013). The role of inflammation in the pathology of acne. The Journal of Clinical and Aesthetic Dermatology, 6(9), 27–35. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24062871/
  10. Vongraviopap S, Asawanonda P. (2016). Dark chocolate exacerbates acne. International Journal of Dermatology, 55, 587-91. doi: 10.1111/ijd.13188. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26711092/
  11. Zaenglein AL, Pathy AL, Schlosser BJ, et al. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5):945–73.e33. doi: 10.1016/j.jaad.2015.12.037. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26897386/