There are several types of acne. Comedonal acne is characterized by many small, flesh-colored papules that make the skin appear bumpy.
The appearance of comedonal acne is different from that of inflammatory acne. Comedonal acne involves blackheads and whiteheads rather than pimples.
While this form can develop in anyone, it is most common in young adolescents. The papules, called comedones, usually occur on the forehead and chin and can prevent the skin from appearing smooth and even.
In this article, we describe how to identify comedones. We also look into their types, causes, and treatment options.
Comedonal acne causes many small bumps to form close to the surface of the skin. Types of these bumps include:
- Whiteheads: Also known as closed comedones, these form because a hair follicle is completely blocked.
- Blackheads: Also called open comedones, these are the result of surface pigments collecting in the pores, forming dark dots on the skin. Some people mistake these dots for dirt.
- Giant comedones: These are a type of cyst. A giant comedone is a large lesion with a blackhead-like opening.
- Macrocomedones: These closed comedones are larger than 2–3 millimeters across.
- Microcomedones: These extremely small comedones are usually not visible.
- Solar comedones: These typically result from sun damage and usually form in older adults, primarily on the cheeks.
Comedonal acne is noninflammatory. The lesions do not usually contain pus or the bacteria that can cause acne. They are also typically neither red nor tender to the touch.
A person with comedonal acne may have more than one type of comedone at a time. Meanwhile, people with inflammatory acne can also have comedones, in addition to larger red and tender blemishes.
Comedonal acne also differs from other types because its lesions tend to be small. Nodular and nodulocystic forms of acne, for example, can cause larger, tender, fluid-filled lesions to form.
Doctors usually consider comedonal acne to be a mild-to-moderate form of the condition, according to an article in the Journal of the European Academy of Dermatology and Venereology.
Comedones form when excess oil and dead skin cells block the oil-producing glands in the skin. This causes the affected pores to bulge outward, creating the bumps.
Several factors can contribute to the development of comedonal acne. They include:
- skin irritation from contact with oils, dyes, and similar products
- excessive testosterone production, which can increase oil production
- harsh contact with the skin, such as from squeezing pimples, having a chemical peel, or exfoliating roughly
People who smoke are more likely to experience comedonal acne. Also, for some people, dietary factors, such as eating too much milk or sugar, can lead to this issue.
Treating comedonal acne involves adjusting skin care habits, using medicated creams or gels, and, sometimes, changing the diet.
A skin care routine designed to reduce comedones may involve:
- washing the face twice daily with a mild soap and lukewarm water to avoid irritation
- refraining from using skin or hair care products, including cosmetics, that contain oil
- applying a prescription or over-the-counter topical medication daily
A person may need to use a medication for at least 8 weeks before they can tell whether it has been effective.
Various medicated creams and gels can help reduce excess oil and promote skin cell turnover. An effective medication may contain:
- azelaic acid
- benzoyl peroxide
- glycolic acid
- salicylic acid
If a comedonal acne does not respond to the above treatments after several months, the person may benefit from seeing a dermatologist, who may prescribe topical medications called retinoids.
These medicines promote skin cell turnover. However, they require a prescription because they can be more abrasive to the skin. Examples of retinoids include tretinoin and isotretinoin.
Unlike inflammatory acne, comedonal acne does not usually respond well to antibiotics, isotretinoin pills, or hormonal medicines that can control breakouts, such as birth control pills.
Rarely, comedonal acne does not respond to topical treatments. In this case, a doctor may recommend an in-office treatment to close off comedones in an effort to keep them from coming back. These treatments include:
There is some evidence that natural remedies can help resolve acne due to their anti-inflammatory, antibacterial, or antioxidant effects.
Popular home remedies for acne involve:
- tea tree oil
- aloe vera gel
However, before using any new skin treatment or remedy, consult a general practitioner or dermatologist. Also, always do a patch test on a small area of skin to be sure that the product or remedy does not cause irritation.
Treating comedonal acne may also help prevent it from returning. Using topical retinoids, for example, can prevent the formation of further comedones, according to an article in the journal American Family Physician.
A person’s skin may respond best to an over-the-counter adapalene gel sold as Differin, the article’s authors conclude, after reviewing tolerance to various retinoids.
Consistently following a skin care routine that involves washing the face and using gentle, oil-free products can also help prevent future comedone breakouts.
Comedonal acne may involve less skin irritation than other forms of acne, but it can be uncomfortable.
Most doctors recommend medicated creams or gels and a consistent skin care routine to treat and prevent this type of acne.
If acne becomes difficult to treat, especially if an increasing number of papules appear, consult a dermatologist.