Comedones: what are they and how do I treat them?

Girl with comedones

Active, inflammatory acne is a skin disorder that involves the oil glands of our skin (sebaceous glands). Normally, the skin oil (sebum) flows out of these gland and spreads evenly over the skin. However, for people with acne, the openings of some of these glands are clogged by “plugs” made of dead skin cell and dirt, creating what we call "comedones". When the plug is deeper in the oil gland, its has a whitish color (i.e. white comedo or whitehead). When this plug is exposed to the air, it oxidizes and generates a darker looking color (i.e. blackheads).

The different types of comedones:

Blackheads (or open comedones) appear as dark brown/black “dots” at the surface of the pore. Blackheads are often found on the nose, but can also appear on other areas of the face and body.

Whiteheads (or closed comedones) are small, 1-2 mm “bumps” in the skin. Whiteheads are located deeper in the pore with only a microscopic opening to the skin surface. Since the air cannot reach the follicle, the material is not oxidized and remains white or has the appearance of being "closed". 

blackheads and whiteheads

What are the best treatments for comedones?

Skincare routine: Treatment of comedones—both whiteheads and blackheads—takes time. Most treatments take several weeks to months before a noticeable change can be seen. The best thing to do is start, and commit, to a good skincare routine with the right, medicated ingredients, in proper doses according to skin type, sensitivity, and acne severity. 

Best cleansers for comedones: Adequate cleansing of the pores is an essential step for the long-term management of all types of acne. In the case of comedones, the best choice is a medicated cleanser that contains salicylic acid. To avoid over-drying of the skin, these cleansers should be personalized to the user's skin type. People with dry or normal skin types should use a cleanser with a lower percentage of salicylic acid (0.5%) whereas people who experience more oil on the skin should use a higher percentage (2%). 

Best treatment creams for comedones: the best topical medications to prevent and treat comedones are salicylic acid, benzoyl peroxide, and retinoids (tretinoin/retinoic acid).

  • Salicylic acid: Originally derived from a tree bark, Salicylic Acid is an FDA cleared anti-acne medical ingredient this is the single best ingredient for the treatment of clogged pores. What makes it so great? Salicylic Acid is “fat-loving” or “lipophilic” beta hydroxyl acid. The ability of Salicylic Acid to penetrate into the oil gland makes it highly effective at bindig to and melting the keratin plugs that clog the skin pores. In addition to this "keratolytic" effect, Salicylic Acid provides additional anti-acne effects:
    • 1) As a key hormone in the plants immune system, Saliciylic Acid destroys the P. acnes bacteria.
    • 2) Salicilic Acid can help reduce redness, acne inflammation, and swelling (*it's one of the key incgredients in aspirin!).
    • 3) It's oil solubility allows Salicylic Acid to easily penetrate and unclog pores.
  • Benzoyl Peroxide: While Salicylic Acid is the best ingredient for comedones, Benzoyl Perozidde Is the single most effective topical anti-acne ingredient. Benzoyl peroxide has an antibacterial effect and may also decrease the chemical reaction that changes the lining of the hair follicle. As with Salicylic Acid, it also has a keratolytic effect, which helps unclog pores and prevent new comedones from forming.
  • Retinoids: Topical retinoids are commonly prescribed medications for the treatment of both blackheads and whiteheads. Types of retinoids include tretinoin (Retin-A, Avita, Renova), Adapalene (Differin), Epiduo (combination of Adapalene and benzoyl peroxide) or tazarotene (Tazorac). Retinoids are derivatives of vitamin A and work by increasing cell turnover and reducing the "stickiness" of the sloughed off (i.e. "dead") skin cells. There are 2 main disadvantages of using retinoids for acne. First, retinoids can be irritating. Second, sunlight exposure deactivate the positive effects of the retinoids. Third: retinoids will make your skin more sensitive to the sun. For these resaons, it's very important to limit sun expsure and wear sunscreen during treatment with retinoids. Fourth; retinoids are not very active on active, inflammatory pimples.

Manual Extraction of comedones

Pores strips: The best and safest way to extract existing black comedones is with blackhead removal strips, also referred to as pores cleansing strips. Be mindful that some of these strips may irritate the skin and should not be used more than once aweek.

Metal comedone extractors: Comedone extractors are most often metal, and one end has a small loop. For blackheads, the opening of the extractor is placed around the blackhead, and pressure is then applied downwards and laterally. Whiteheads often need to be nicked (i.e. penetrated) beforehand. If you decide to extract your blackheads and whiteheads yourself, make sure to do so properly. Instruments should be sanitized, and extraction should be done gently and carefully. If you have any doubts about performing the extraction, find an experienced facialist or aesthetician to do so for you. Extraction should not be done on an inflamed pimple as it can lead to scarring.

Makeup

Always be mindful of what you're putting on your skin. Even with using the right topical skincare treatments, using the wrong makeup can clog pores and may cause more comedones. In these cases, it's important to ensure your makeup is labeled "oil-free" or "non-comedogenic", meaning that it won't clog pores.

A final word

Whiteheads and blackheads are types of acne that affect many people. There are good treatment options available, so there is no need to suffer from this condition in silence. The best way to start treatment is with a personalized cleanser and treatment cream that includes salicylic acid, such as those available from MDacne. For people who also experience inflamed pimples as well as comedones, the best treatment is a cleanser with salicylic acid paired with an acne treatment cream with benzoyl peroxide.

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