Comedonal Acne: Causes, Treatments, Extraction and More

• Comedonal acne is a mild form of acne including blackheads and whiteheads that is caused by oily matter clogging the skin’s pores.
• Comedones can be treated with a variety of topical and oral medications. Commonly treated by retinoids, but some home remedies, such as tea tree oil, have been shown to have some effectiveness against the affliction.
• You can prevent comedones by avoiding oil based moisturizers and cosmetic products, avoiding excessive sunlight and by treating any flare ups of the condition.

Comedones, better known as blackheads and whiteheads, are a form of mild acne which can prove difficult to remove and may develop into more severe forms of acne. Around 80% of teenagers and young adults are affected by acne. Acne usually clears up in the early 20s, but it may persist for many years later. This article will address the major causes of comedone formation as well as provide information on comedone treatment and prevention.

What is Comedonal Acne?

Comedonal acne is the noninflammatory form of acne vulgaris. It can be found in the form of open or closed comedones. Open pore comedones, or blackheads, are not clogged with dirt as some people believe. Their dark color is created by skin cells in the pore that have been oxidized after being exposed to the air. Whiteheads, or closed pore comedones, resemble small light colored (white or yellowish) bumps on the surface of the skin, these are not red or inflamed like more severe forms of acne.

Comedones are the result of sebum (an oily substance produced in the hair follicles) clogging the opening of the follicle either on or below the skin’s surface. When the clog forms below the skin, this results in whiteheads, whereas when the follicle is blocked from on top of the skin’s surface (therefore exposing the blockage to air), this results in blackheads. 

Where is it likely to occur?

Comedones are formed when organic materials, such as skin cells, oily matter, and various proteins, gather in follicles with sebaceous glands. These follicles are most highly concentrated in skin of the face, chest, and shoulder regions, and therefore these are the areas of the body where comedonal acne is most likely to develop. 

As material accumulates within the pore, the comedone will grow in size. Inflammation of the comedone may lead to more extreme forms of acne and are caused by infiltration of the follicle by bacteria. 

What Causes It? 

Some behavioral or demographic tendencies can lead to the formation of comedones. 

First, while the connection between diet and acne is still widely contested, some research shows a possible relation between dairy products and acne formation. 

Mechanical irritation, such as rubbing your face too hard or overaggressive physical extraction of comedones leads to a higher prevalence or more severe degree of acne. This is because irritation blocks your pores by forcing dead skin cells and other matter into them through friction. The blocking of pores encourages comedone formation.

The use of heavy moisturizing creams, particularly those with oils present, should be avoided to prevent comedones as these block your pores. Some ingredients to look out for include oleic acid and lanolin. Other triggers to avoid for the prevention of comedonal acne include excessive exposure to sunlight, and psychological stress.

Hormones also play a role in the presence of comedones. For instance, there is a connection between high levels of testosterone and comedonal acne. Testosterone and other androgen steroids increase sebum production in the follicle which leads to the blocking of pores and eventually develop into comedones. 

Who is most likely to get comedonal acne? 

Adolescent boys are particularly likely to suffer from this form of acne due to their high levels of testosterone during puberty. Genetics have been reported to be more than 50% responsible for a person’s predisposition to acne, and therefore some people may be naturally more inclined to develop comedones, however there is not enough data to determine if this leads to higher risk in certain demographics. 

Comedonal Acne Treatments

Comedones can be treated with varying success by over the counter creams and gels, prescription medications, and some natural ingredients; some of the more common therapies are listed below. The success and possibility of side effects of the various treatments may vary from person to person and so a combination of different therapies can sometimes improve the effectiveness of the treatment.

Over the counter topicals 

Some common over the counter medications include non-antibiotic topical treatments such as benzoyl peroxide, salicylic acid, and azelaic acid. 

Benzoyl peroxide is a mild antimicrobial, and is shown to not be affected by mutated strains, no concentration of benzoyl peroxide has been proven the most effective in treating comedonal acne.

Salicylic acid can be used to treat comedonal acne as its mild antimicrobial properties can prevent an increase in the severity of the acne, it also serves as an anti-inflammatory which prevents the development of severe acne from comedones. However, in the treatment of comedones, salicylic acid is most useful in increasing the shedding of dead skin cells, which prevents the clogging of hair follicles.

Azelaic acid should also be considered for over the counter treatments due to its slightly antimicrobial and anti-inflammatory properties as well as it comedone prevention properties (done by limiting skin cell growth in follicles).

Prescription medications

Prescription treatments are usually shown to be the most effective treatments for comedonal acne. Should you visit your doctor or dermatologist for treatment, they may provide oral and/or topical medications in order to combat and prevent the development of comedones. 

Although oral antibiotics, such as doxycycline and erythromycin, can be used to treat acne, they are generally reserved for the treatment of moderate to severe acne, but can be used to prevent comedones from developing into more severe forms of acne such as papules, pustules, and nodules by preventing infection of the area around the comedone. 

For comedonal acne, it is most common for topical retinoids to be prescribed first. Topical retinoids are vitamin-A based medications which prevent the formation of comedones and slow their growth. They do this by inhibiting rapid growth of specialized cells, this prevents growth of certain skin cells near the follicle which may clog pores and produce oily matter. Retinoids also have a small effect on inflammation of acne, they do this by repressing proinflammatory molecules in the skin. Common retinoids include adapalene, isotretinoin, these medications may cause dryness, irritation, and redness of the treated area. 

Should retinoids prove ineffective in treating comedones, treatment may be combined with the use of benzoyl peroxide or topical antibiotics like clindamycin which can reduce inflammation from microbial intervention and reduce oil production in the pores.

Home remedies

The first home remedy considered is the application of tea tree oil, which is a more natural alternative treatment to over the counter topicals. Tea tree oil has been shown to reduce the presence of acne lesions (both inflammatory and comedonal) on the skin’s surface due to its antimicrobial and anti inflammatory properties.

Topical application of green tea has been shown to reduce the presence of open comedones. However, it does not show a significant effect on closed comedones. Oral ingestion of green tea extract has not been shown to affect comedones, yet has an effect on inflamed acne. Green tea is effective topically because of its anti-inflammatory and slight antimicrobial properties. Green tea is also suspected of repressing excessive cell growth in follicles which lead to clogged pores.

Clay masks are another home remedy for comedones, yet they are most effective against blackheads. The minerals in clay masks inhibit bacterial growth in the pores of the skin. Furthermore, the warm temperature of the clay, water mixture as well as the minerals in the mask are shown to promote the clearing of comedones by opening up pores and encouraging the release of the materials that clog the follicle.

How To Extract Comedonal Acne

In persistent cases of comedonal acne, one can consider physical extraction of the comedone. This is best done by first sterilizing the area of skin to be treated, and any equipment to be used. 

Should it be required, a closed comedone can then be pierced with a sharp, sterile needle. A comedone extractor tool can then be used to push any clogging media out of the pore. It is recommended that a light to medium pressure should be applied to the comedone as excessive stress on the treatment area can lead to irritation of the skin. This pressure should be applied until all media is removed from the pore.

Physical extraction of comedones should be followed by topical treatment of the follicle to avoid the recurrence of the acne. Opening of the pores in closed comedones allows for more effective treatment of this form of acne by topical medications.

Tips to Prevent Comedonal Acne

Some methods that can be used to prevent the development of  comedonal acne include the use of a pH balanced face wash over other cleansers. Some cleansers are effective in both prevention and in the mild treatment of comedones, such as cleansers containing salicylic acid.

Avoiding oil-based moisturizers in problemed areas for comedonal acne can aid in the prevention of comedone formation. Choosing alternative moisturizers allows you to avoid clogged pores and comedone formation. Finally, one can prevent the formation of comedones by avoiding causation factors such as stress and excessive sunlight.

Takeaway

Comedonal acne presents itself in the skin of the face, upper back, and chest. Some triggers for comedonal acne include oily moisturizers, stress, and excessive sun exposure. While some home remedies, like clay masks and tea tree oil, can alleviate comedones, but the most effective treatment for this mild form of acne is the use of topical retinoids. Comedones can be prevented by avoiding triggers for the condition and regular maintenance with topical treatments.