Blackheads and whiteheads are a pain. They’re very noticeable, it takes forever to get rid of, and they leave behind scars. >:((

I had one of my best friends request this post. I was really excited to research Comedonal Acne and found out it’s actually more common than you’d think! Hopefully this post is helpful for you guys!

Just saying, you probably shouldn’t self diagnose yourself based on things you’ve read online. But if you have a LOT of blackheads and whiteheads, hopefully this post encourages you to take action! You should check with your dermatologist though if you can. :))

Here’s what I’ll talk about today:

• What is Comedonal Acne (and Comedones)
• The difference between Comedonal and Regular Acne
• What Are The Causes?
• Treatment and Prevention
• Subscribe and Like this Post

What Is Comedonal Acne?

Comedonal acne is a pattern of skin lesions that consists mostly of comedones and is mostly present on the chin and forehead but can be found anywhere on the skin.

Comedones (sigular form is comedo) are skin-colored papules that are easily seen and felt. The papules are palpable.

There are mutiple types of comedones, the most common are blackheads and whiteheads:

• Open Comedones (also known as blackheads) that are full of excess melanin, dirt, and impurities that have oxidized.
• Closed Comedones (also known as whiteheads) where the follicle is completely blocked with impurities that have not oxidized.
• Macrocomedones are closed comedones that are larger than normal and more than 2–3 mm in diameter
• Microcomedones are so small that they are invisible to the naked eye
• A giant comedone is a type of cyst (meaning there’s a thin layer of skin over it, like a sac or skin pouch) in which there is a clear blackhead-like opening in the skin
• Solar comedone is common among older people and is said to be a result of sun exposure

Following images from DermNet Z

Difference Between Comedonal and Regular Acne

The most common type of acne, “regular” acne, is called Acne Vulgaris. Acne Vulgaris causes inflammed and red pimples. On the other hand, Comedonal acne is noninflammatory. The comedones don’t have pus or the same bacteria that causes Acne Vulgaris. Therefore, Comedonal doesn’t cause red and inflammed pimples. Comedones typically aren’t tender if touched.

A person with Comedonal Acne may have more than one type of comedo at a time, while someone that does not may deal with a comedo every once in a while.

Here are two photos of Acne Vulgaris so you can compare them with the images of Comedonal Acne.

As you can see, these images include red and inflammed pimples. The photos above these two are less red (though some are) and are more “bumpy” and “flesh colored” unless it is a blackhead.

What Causes Comedonal Acne?

Comedones result from when cells in the Sebaceous duct (where sebum, the oily substance on your skin, is produced) rapidly multiply, leading to excess sebum production. Along with this, with cornification, built up debris of dead skill cells blocks the Sebaceous glands and follicles.

BTW cornification is when dead skin cells start to build up on your skin and make a whole layer over your skin.

Other factors include:

• Excessive activity of testosterone (male sex hormone) in skin cells
• Not enough linoleate, a salt in linoleic acid, in sebum causing skin to not function as a protective barrier well
• Sebum’s fatty acid
• Overhydrated skin
• Chemicals in cosmetics
• Rupture of the follicle caused by sweezing a pimple, harsh cleansing, harsh exfoliating, and laswer treatments
• Smoking
• Dietary factors: dairy products and those high in fats and sugar
• Chemokines** result in inflammation on your skin

**Chemokines are a type of Cytokine. Cytokines are “messenger” proteins from cell to cell. For example, if there is a virus that has hijacked a cell, the cell will release a certain cytokine so other cells know to protect themselves with extra barriers. Cytokines are also responsible for fevers and imflammation when you’re injured or sick. Chemokines, specifically, call your immune system cells to a site of infection.**

Treatment and Prevention

According to DermNet NZ, you should “choose comedolytic topical medications (meaning they fight comedones). These should be applied once or twice daily as a thin smear to the entire area affected. It may take several weeks to months before worthwhile improvement occurs. Treatment needs to be continued long-term (sometimes for many years).”

Topical medications that can work:

• Benzoyl peroxide
• Azelaic acid
• Salicylic acid (aka BHA)
• Sulfur
• Glycolic acid (aka AHA)
• Retinoids such as tretinoin, isotretinoin, adapalene (these are prescribed medications)

*Some topical medications cause purging before clearing your skin, which is why you need to wait at least a couple of months to know whether or not the medication is actually working*

*I was prescribed trentinoin for my blackheads and whiteheads in 8th grade and it worked for me! It just dries out your skin and also causes peeling so you may have lighter skin in some places than others. But I thought it was worth it.*

Prescription Oral Medications:

• Hormonal therapy
• Isotretinoin

There are also available antibiotics to help reduce inflammation.

There are also surgical procedures to remove resistant comedones. For information on this, consult your dermatologist.

Prevention:

It’s recommended that, if you are prone to comedonal acne and have oily skin, you should use oil-free products. Though some oils, like Rosehip Seed Oil, that contain Linoleic Acid. Lack of Linoleic Acid in your skin is a cause of Comedonal Acne.

You can also prevent Comedonal Acne by changing your diet and create new healthy habits such as exercising and making a healthy skincare routine.

First, you should make sure you are properly cleansing your skin twice daily with a cleanser that is not overly stripping. A brand I recommend is CeraVe because it’s cleansers are cheap and effective for washing your face but doesn’t strip your face’s natural oils.

In your diet, avoiding foods with a high glycemic index (lots of sugar and fats) as well as avoiding dairy products may benefit your skin if you have severe acne of any type. This diet is not conlusive for those who are of a younger age, since those who are still growing require a balanced diet.

Treatment and prevention should be long-term as overactive Sebaceous glands never go away.

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Love, Moe ❤