What is Comedonal Acne?
Comedones are a term used to refer to small skin-colored acne papules that typically develop on the chin and forehead. It is quite common to see such comedone papules when you have acne. Whiteheads and blackheads are usually the most common types of comedonal acne that are observed. While blackheads are known to have open comedones, whiteheads are known to have closed comedones. It is also observed that some comedones are not visible to the eye, known as microcomedones. On the other hand, it is also seen that some people develop bigger than normal blackheads, known as giant comedone, as well as whiteheads, known as macrocomedones.(1, 2, 3, 4)
How to Recognize Comedonal Acne?
Since there are so many different types of acne, it is not always easy to identify if you have comedonal acne. To identify blackheads, the biggest feature is that they are open-faced. This means that when the pigment called melanin, which is typically found in the sebum produced by the oil glands, comes in contact with the air on top of an open comedone, it begins to oxidize and turns darker in color. This is the reason why blackheads are associated with having a darker appearance.(5)
Whiteheads, though, have closed surfaces, and they look often look like small flesh-colored or white-colored dots.(6)
One of the biggest identifying features of comedonal acne is that all comedones feel bumpy when you touch them. According to research by DermNet New Zealand, comedonal acne most commonly appears on the forehead and chin.(7)
What are the Causes of Comedonal Acne?
In most cases, blackheads and whiteheads form due to trapped hair follicles. It has been seen that your skin cells generally shed at the surface, letting new skin cells to appear. Sometimes though, dead skin cells become trapped within the hair follicles, and when they come in contact with the natural oils present in your skin pores (known as sebum), they form a plug.
This creates comedonal acne, and it is known to predominantly affect adults who have oily skin. It is also more commonly observed in those people who smoke.(7) The exact reason behind this, however, remains unknown.
Some of the other risk factors for comedonal acne can include:
- Having a diet that consists primarily of fats and sugars.
- Having a high consumption of dairy.
- High humidity.
- Having overhydrated skin, usually due to using the wrong moisturizer.
- Undergoing laser therapy.
- Using chemical peels.
- Having follicle injury due to popping the comedones or picking at your skin.
Can Comedonal Acne Be Treated?
It is very much possible to treat comedonal acne. The treatment begins by approaching the very source of why this type of acne occurs, that is, to present the excessive production of sebum from the sebaceous glands. For this, most of the time, using over-the-counter (OTC) medications is not sufficient as they are not powerful enough to control and clear up comedonal acne in the long run. You should talk to your doctor or a dermatologist about your options. While you wait to get started on the proper treatment, you must avoid picking at the comedonal acne. This will not only make the acne worse, but it will also lead to scarring.
Some of the treatment options for comedonal acne include:
Topical treatments are those that are applied directly to the face to control the excessive production of sebum and to unclog the existing comedones. Some of the popular, topical treatment options for comedonal acne include:
- Salicylic acid(9, 10)
- Azelaic acid(12, 13)
- Glycolic acid(14)
At the same time, you should make sure to put on sunscreen every day whenever you use topicals, especially if you are getting treated with retinoids and any of the acids.(16) This is because these are potent treatments that can remove the outer layer of the skin, making you more susceptible to sunburn. This is why it is best to select a sunscreen that has an SPF of 30 or higher.
While the first step of acne treatment and management is usually OTC topicals, but for some people, they don’t work. You may need to consult your doctor to get a prescription strength oral medication or topical. Doctors use some of the following prescription drugs for treating comedonal acne:
- Isotretinoin (brand name: Accutane)
- Oral contraceptives
Spironolactone (brand name: Aldactone), which is an anti-androgen medication that is prescribed in some cases together with oral contraceptives in women to regulate the production of sebum.(17)
As it is advised when you are using topicals, even the prescription medications put you at a higher risk for sunburn. This is why it is important to wear sunscreen daily, and that too with an SPF of at least 30 or higher.
In rare cases, surgery might be the only treatment option left if medications and topicals fail to clear up severe instances of comedonal acne outbreaks.(18) Surgery is mainly needed for those people who have recurring comedones. Acne surgery makes use of small blades and needles to open up and remove the comedonal acne lesions.
Sometimes, your doctor may even recommend a procedure known as microdermabrasion.(19, 20) To carry out this procedure, a machine is used to blow small crystals onto the skin. Otherwise, a diamond-tipped wand might also be used to rub onto the skin to remove the top-most surface layer of the skin to help open up and remove the comedones. This procedure may also remove the associated scars of comedonal acne.
Another surgical option is cryotherapy. In cryotherapy, your doctor will make use of liquid nitrogen to the comedones to freeze them and make them easy to remove.(21, 22)
Looking at Natural Remedies for Comedonal Acne
All over the world, experts are looking at natural treatments for all types of acne, including comedonal acne. However, it is essential to realize that natural remedies are not a replacement for a doctor-approved treatment plan for acne. Furthermore, you should always discuss with your dermatologist or doctor first about any natural remedy you are thinking of trying and how to incorporate those into your ongoing treatment plan. Some of the commonly used natural remedies for comedonal acne are given below.
- Tea Tree Oil: Tea tree oil is a popular alternative used for treating a variety of skin problems. In fact, it is even known to help with inflammation and many types of infections. Tea tree oil can help treat comedonal acne as it reduces the production of sebum and also soothes the skin. You can find many spot treatments and moisturizers that contain tea tree oil.(23, 24)
- Clay or Charcoal Masks: If you have comedonal acne, clay and charcoal masks have been shown to work better than other natural remedies as they help in drying out the trapped sebum in the pores of the skin. They also help get rid of the trapped skin cells and dirt in the pores, which makes it easier to remove blackheads.(25, 26)
- Witch Hazel: This natural remedy functions as a natural astringent which helps balance the skin’s moisture naturally. Witch hazel also provides the benefit of opening closed comedones, which helps remove any trapped debris and dirt from them. To incorporate witch hazel for removing comedonal acne, you can swap out your regular astringent and use this in place of it up to two times a day.(27)
It can be difficult to treat comedonal acne on your own. This is why it is important to consult a doctor or dermatologist for advice on the right treatment. You also need a lot of patience when dealing with this type of inflammatory acne. Any new treatment may take several months to start having any visible effect on the skin. At the same time, it is essential to keep in mind that the treatment of comedonal acne requires a lot of time, and they are long-term treatments. Overactive sebaceous glands never really go away, so you will find new comedones making an appearance as soon as the older ones heal. If you are worried about your acne, visiting a dermatologist is a good idea.
- Saurat, J.H., 2015. Strategic targets in acne: the comedone switch in question. Dermatology, 231(2), pp.105-111.
- Katsambas, A.D., Stefanaki, C. and Cunliffe, W.J., 2004. Guidelines for treating acne. Clinics in dermatology, 22(5), pp.439-444.
- Kligman, A.M. and Mills, O.H., 1972. Acne cosmetica. Archives of dermatology, 106(6), pp.843-850.
- Brown, S.K. and Shalita, A.R., 1998. Acne vulgaris. The Lancet, 351(9119), pp.1871-1876.
- Amrutbhai, H.H., Jaykumar, P.A. and Narkhede, S.B., 2019. A review on azelaic acid emulgel for acne and hyperpigmentation. Journal of Innovation in Pharmaceutical Sciences, 3(1), pp.16-21.
- Cunliffe, W.J., Holland, D.B. and Jeremy, A., 2004. Comedone formation: etiology, clinical presentation, and treatment. Clinics in dermatology, 22(5), pp.367-374.
- Comedonal acne (no date) DermNet. Available at: https://dermnetnz.org/topics/comedonal-acne (Accessed: December 4, 2022).
- Thielitz, A., Krautheim, A. and Gollnick, H., 2006. Update in retinoid therapy of acne. Dermatologic therapy, 19(5), pp.272-279.
- Lee, H.S. and Kim, I.H., 2003. Salicylic acid peels for the treatment of acne vulgaris in Asian patients. Dermatologic surgery, 29(12), pp.1196-1199.
- Zander, E. and Weisman, S., 1992. Treatment of acne vulgaris with salicylic acid pads. Clinical therapeutics, 14(2), pp.247-253.
- Pace, W.E., 1965. A benzoyl peroxide-sulfur cream for acne vulgaris. Canadian Medical Association Journal, 93(6), p.252.
- Fitton, A. and Goa, K.L., 1991. Azelaic acid. Drugs, 41(5), pp.780-798.
- Webster, G., 2000. Combination azelaic acid therapy for acne vulgaris. Journal of the american academy of dermatology, 43(2), pp.S47-S50.
- Atzori, L., Brundu, M.A., Orru, A. and Biggio, P., 1999. Glycolic acid peeling in the treatment of acne. Journal of the European Academy of Dermatology and Venereology, 12(2), pp.119-122.
- Sagransky, M., Yentzer, B.A. and Feldman, S.R., 2009. Benzoyl peroxide: a review of its current use in the treatment of acne vulgaris. Expert opinion on pharmacotherapy, 10(15), pp.2555-2562.
- Titus, S. and Hodge, J., 2012. Diagnosis and treatment of acne. American family physician, 86(8), pp.734-740.
- Layton, A.M., Eady, E.A., Whitehouse, H., Del Rosso, J.Q., Fedorowicz, Z. and van Zuuren, E.J., 2017. Oral spironolactone for acne vulgaris in adult females: a hybrid systematic review. American journal of clinical dermatology, 18(2), pp.169-191.
- Shalita, A.R., 1975. Surgical procedures for the treatment of acne vulgaris. The Journal of Dermatologic Surgery and Oncology, 1(3), pp.46-48.
- El‐Domyati, M., Hosam, W., Abdel‐Azim, E., Abdel‐Wahab, H. and Mohamed, E., 2016. Microdermabrasion: a clinical, histometric, and histopathologic study. Journal of cosmetic dermatology, 15(4), pp.503-513.
- Freeman, M.S., 2001. Microdermabrasion. Facial Plastic Surgery Clinics of North America, 9(2), pp.257-66.
- DOBES, W.L. and KEIL, H., 1940. Treatment of acne vulgaris by cryotherapy (slush method). Archives of Dermatology and Syphilology, 42(4), pp.547-558.
- Ihsan, A. and Turfy, A., 2015. Cryotherapy for the treatment of acne keloidalis [a clinical interventional therapeutic trial].
- Bassett, I.B., Barnetson, R.S.C. and Pannowitz, D.L., 1990. A comparative study of tea‐tree oil versus benzoylperoxide in the treatment of acne. Medical Journal of Australia, 153(8), pp.455-458.
- Hammer, K.A., 2015. Treatment of acne with tea tree oil (melaleuca) products: a review of efficacy, tolerability and potential modes of action. International journal of antimicrobial agents, 45(2), pp.106-110.
- Sanchez, N., Fayne, R. and Burroway, B., 2020. Charcoal: An ancient material with a new face. Clinics in Dermatology, 38(2), pp.262-264.
- Kulkarni, S.V., Gupta, A.K. and Bhawsar, S., 2019. Formulation and evaluation of activated charcoal peel off mask. International Journal of Pharmacy Research & Technology, 9(2), pp.44-48.
- Bailey, C., Witch Hazel.