How do comedones form

The top of the plug is at the surface of the skin and is exposed to air. The dark brown top of a blackhead isn't dirt trapped within the pore, but rather oil that has oxidized and darkened. The air oxidizes the oil and darkens it, similar to what happens when an apple is cut and left exposed to air. The top of the plug takes on the dark brown color typical of blackheads. If you were to gently extract the blackhead , you can see the dark top portion of the plug is dark while the lower portion that was not exposed to air is creamy white to yellow.

These blackheads typically form on the sides and bridge of the nose, the chin, on the shoulders, and back. Closed comedones develop when the pore opening is obstructed and the plug of oil and skin cells is not exposed to air. The hair follicle is completely blocked. The plug doesn't turn black, instead a whitish or flesh-colored a bump appears on the skin. The bump isn't red, nor inflamed, and it doesn't hurt. These whiteheads most often appear on the forehead, chin, and cheeks.

Microcomedones are the smallest of all acne blemishes. These comedones, invisible to the naked eye, are the "seeds" of the growth of visible comedones. Every inflamed pimple, every blackhead, begins as a microcomedo. Macrocomedones are open more common or closed comedones that are larger than average.

They typically range in size from 1 millimeter 0. These are huge blackheads, from several millimeters to 2 centimeters 0. They typically occur singly and in older adults. Also called senile comedones, these lesions are caused by excessive sun exposure over time. They may be small or large, open or closed. Solar comedones most often occur in people aged 60 to 80 years, but they can occur in people in their 40s with extreme sun exposure.

All comedones begin as a plug of sebum , or skin oil, and dead skin cells that become trapped in the follicle. This plug blocks the follicle opening. The sebaceous glands continue to pump oil into the pore, and as it fills with oil it pushes up on the skin's surface. This is what creates the bump that you can feel and see. Comedones aren't typically painful, just annoying. You can think of them as pre-pimples because all inflamed pimples get their start as a comedo. Like most types of acne, comedonal acne is especially common during the preteen and teen years.

However, it can occur to anyone at nearly any age, adulthood included. Comedonal acne can be a harbinger of inflammatory acne vulgaris to come, especially when it appears during puberty. Comedones don't always progress to inflamed pimples, though, and can stay as a non-inflamed blocked pore just under the skin's surface.

Comedonal acne tends to run in families. If your parents or siblings had it, you're more likely to have it too. People with oily skin are more prone to comedonal acne as well. Many things can make acne progress and worsen. They include:. In many cases, minor comedones can be prevented or at the least reduced. There are a few steps you can take to keep pore blockages away:. Some people are prone to developing comedones, even with exceptional skincare.

In this case, over-the-counter acne products or prescription medications are needed to keep comedones from forming. Treating comedonal acne involves adjusting skin care habits, using medicated creams or gels, and, sometimes, changing the diet. 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:. 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. Read more about natural remedies for acne. 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.

Consistently following a skin care routine that involves washing the face and using gentle, oil-free products can also help prevent future comedone breakouts. Develop and improve products. List of Partners vendors. If you have comedonal acne, there's no need to stress because spoiler: stress can actually just make matters worse. According to board-certified dermatologist Adarsh Vijay Mudgil , MD, comedonal acne is the mildest form of acne , with cystic acne being at the other end of the spectrum.

In other words, as long as you approach your breakouts the right way, you should be able to clear them up—but that might be a little easier said than done. Acne isn't one-size-fits-all, and not all treatments work for all types of acne. Still following? To help break down this specific type of breakout, we turned to the experts.

Mudgil, as well as board-certified dermatologists Rayna Dyck , MD, and Jessie Cheung , MD, lend their expert advice for identifying this type of acne so that you can correctly treat it and prevent it. Ahead, everything you need to know about comedonal acne treatment, according to the skin experts. According to Dyck, comedones occur when cells lining the ducts of the sebaceous gland or oil gland overgrow and lead to increased oil production and debris, which blocks the opening to the surface of the skin.

So what does this type of breakout look like? Simply put, Mudgil says comedonal acne falls into two categories: open comedones blackheads and closed comedones whiteheads. As Cheung explains it, blackheads get their name because the sebum in the open follicle turns black when exposed to air. When the follicle is completely blocked by dead skin, sebum, and bacteria, on the other hand, you're left with a whitehead.

Dyck adds that with inflammatory acne, you tend to see more red, inflamed bumps, pustules, nodules, and cysts, but comedonal acne is typically non-inflamed. Dyck says comedonal acne can pop up in areas of the skin with the greatest number of sebaceous follicles, which is most commonly the face, but also the chest and the back. As far as where it occurs specifically on the face, Cheung notes that comedones are commonly found in the T-zone like your forehead and chin , which is rich in oil glands.

This type is often seen during early puberty with hormone fluctuations, but Cheung notes that it can affect anyone. Mudgil says that generally, comedones are caused by the pores being clogged with dead skin cells and sebum, but Dyck points out that our daily habits can be risk factors for developing comedonal acne as well. Good news: there are many good options both OTC and prescription to treat comedonal acne.

Dyck explains that most are considered comedolytics or keratolytics, since they not only soften and help clear existing comedones but also prevent changes in the pilosebaceous unit that can lead to new ones forming. According to Cheung, topical retinoids will speed up cell turnover and help prevent comedone formation while treating existing comedones.