Comedonal Acne: Symptoms, Causes & Treatment

Comedonal acne is a type of acne that’s characterised by small, non-inflamed bumps called ‘comedones’. Comedonal acne mostly affects the forehead and the chin but can appear anywhere on the body.

In this guide, we will explore what comedonal acne is, what causes it, and how you can treat and prevent it.

Comedonal acne is a type of acne that’s characterised by small bumps on the skin called comedones. Unlike inflammatory types of acne that have inflamed pimples and pustules, comedonal acne causes whiteheads or blackheads or a combination of both.

Different types of comedonal acne

There are 2 main types of comedonal acne blemishes.

1. Closed comedones

Closed comedones or whiteheads can range in colour from flesh-tones to creamy white. Closed comedones occur when an oil plug develops below the opening of a hair follicle. They cannot be popped because, although they may be white, they do not contain pus. Whiteheads commonly appear on the forehead, chin, and cheeks.

2. Open comedones

Open comedones are also known as blackheads and occur on the skin when an oil plugs the opening of a pore. The dark appearance isn’t caused by dirt but a chemical reaction in melanin, the pigment that’s responsible for skin colour. When melanin is exposed to oxygen, it turns a dark-brown colour, resulting in the distinctive blackhead appearance. Blackheads typically appear around the nose, or the chin, shoulders, and back.

How to identify comedonal acne

Comedonal acne causes small bumps to appear on the surface of the skin, but doesn't cause redness or inflammation. Comedones can be open (blackheads) or closed comedones (whiteheads).

The comedones are non-inflammatory lumps, so they do not contain any pus or acne-causing bacteria. Whereas, inflammatory acne usually appears red and inflamed and can be painful.

Inflammatory acne is caused by inflammation in the clogged hair follicles, signifying the presence of bacteria and an immune response within the skin.

Comedones are formed when excess oil and dead skin cells block the oil-producing glands in the skin, causing the pores to bulge, creating bumps.

Several factors can contribute to the development of comedonal acne, including:

Several treatment options are available for comedonal acne, ranging from over-the-counter products to professional treatments. However, for treating acne in the long-term you may need to try a stronger treatment than those available over the counter. You may need higher-strength, prescription-only medications to treat the root cause of comedonal acne.

If your comedonal acne is mild, an over-the-counter treatment might be enough to improve its appearance, such as:

• salicylic acid cleansers – exfoliates and penetrates pores to reduce blockages
• benzoyl peroxide like Acnecide – targets acne-causing bacteria and clears pores
• topical retinol – promotes cell turnover to stop pores becoming clogged

These treatments are available over-the-counter at most UK pharmacies without a prescription.

Over-the-counter medications can be useful for acne management, but they don’t always work, especially in more severe cases.

At Superdrug Online Doctor, we offer a range of prescription acne treatments that can help with comedonal acne. Although antibiotic treatments like clindamycin can be prescribed, they aren’t the first-line treatment for comedonal acne and are usually more effective for inflammatory acne.

Topical retinoids, like tretinoin or adapalene, are the most effective treatment for comedonal acne. They work by increasing the follicle cell turnover, speeding up the removal of dead skin cells and comedones, and preventing the formation of microcomedones.

Adapalene gel, such as Differin Gel (also available as Differin Cream) has been shown to reduce non-inflammatory acne lesions by 46%.

Other suitable prescription-only treatments include:

• topical benzoyl peroxide, under the brand name Acnecide, is a 5% gel that is applied 1 to 2 times per day to stop the growth of acne-causing bacteria which may infect comedones
• azelaic acid or Finacea gel or Skinoren cream can reduce the number of comedones by about 26% after 4 months of treatment and works by reducing keratin production, exfoliating the skin, and clearing out and preventing new comedones from forming

If your comedonal acne is severe, you may need to consider professional treatment. These are usually performed by a specialist, such as a dermatologist.

Some of the procedures that may benefit comedonal acne are:

• chemical peels – a chemical solution is applied to the skin to remove the top layers, encouraging the skin to grow back smoother and has been shown to reduce comedones
• microdermabrasion – a treatment that physically exfoliates your skin to remove dead skin cells and unclog pores, this helps to open and remove comedones
• cryotherapy – also known as cold therapy, cryotherapy uses extreme cold to treat several conditions, including acne, however, the evidence for its effectiveness for comedonal acne is limited
• comedone extraction – a dermatologist will use a special tool known as a comedone extractor to physically remove blackheads and whiteheads from the skin

Mild comedonal acne outbreaks can be prevented or reduced by making some simple changes to your skincare routine and lifestyle.

Maintain a skincare routine

Some of the ways you can improve your skincare routine and prevent your pores from becoming blocked are:

• washing your face twice a day – washing your face once in the morning and once in the evening is good for acne-prone skin, but washing too often can lead to dryness and irritation
• using non-comedogenic products – use skin and hair care products that will not block your pores
• gently exfoliating your face 2 to 3 times per week – this will help to remove dead skin cells and encourage new, healthy skin growth. Try using a gentle chemical exfoliant like salicylic acid to unclog pores without causing irritation
• always removing make up before going to bed – make up can clog your pores, so always make sure you remove it before going to sleep with fragrance and alcohol free makeup removers
• showering after exercise – after exercising, take a shower to stop sweat and oil remaining on your skin

If you do get blackheads or whiteheads, it’s important that you do not squeeze them as this can cause scarring. Instead, try adhesive pore strips or clay masks for blackheads or topical treatments for whiteheads.

Lifestyle changes

Lifestyle changes may help manage comedonal acne outbreaks. They include:

• limiting your intake of sugary foods and refined carbohydrates
• increasing your intake of fruit and vegetables which are high in antioxidants and essential skin nutrients
• reducing your dairy intake which may increase the risk of acne
• managing stress with relaxation techniques like yoga or meditation
• regularly exercising to help regulate hormone levels and improve skin health
• drinking plenty of water throughout the day to keep your skin hydrated
• applying sunscreen to protect your skin from sun damage which may impact acne
• quitting smoking can help to prevent the formation of comedones
• limiting your alcohol intake to reduce sebum production and stop pores from becoming clogged

Comedonal acne is a type of non-inflammatory acne which causes the formation of open or closed comedones (blackheads or whiteheads). It’s normally caused by an overproduction of the natural oil in the skin called sebum, which clogs pores.

Although some over-the-counter products are available, you may need prescription treatments to help with more severe comedonal acne. At Superdrug Online Doctor, we can provide a range of acne treatments.

If you’re not sure if you have comedonal acne or what treatment might be best, you can use our skin condition diagnosis service for an accurate diagnosis from our doctors using a photo.

Can comedonal acne be hormonal?

Yes, hormonal fluctuations can cause comedonal acne. Comedones, or blackheads and whiteheads, are caused by clogged hair follicles. Hormone fluctuations can cause an overproduction of sebum, clogging hair follicles, and causing acne, including the comedonal type.

Can isotretinoin cure comedonal acne?

Yes, isotretinoin can be an effective treatment for comedonal acne. It is a topical retinoid and some research shows that it can reduce comedones by 30% after 12 weeks of treatment. However, it may be more effective when it is used in combination with other treatments, such as electrodesiccation.

Can comedonal acne be red?

Comedonal acne is not an inflammatory type of acne, so is not usually red. If comedones are red, it is a sign they may have become infected or inflamed.

Can comedonal acne be itchy?

No, comedonal acne is not usually itchy. However, if a comedone becomes inflamed, it may be itchy.

Is comedonal acne fungal?

No, comedonal acne is not fungal. It is usually caused by an overproduction of sebum and dead skin cells clogging pores. Fungal acne is caused by an overgrowth of yeast and looks different to comedonal acne and requires different treatment. If you are not sure which type of acne you have, you can use our skin condition diagnosis service to help you access the right treatment.