Comedonal Acne
Understanding Comedonal Acne
Comedonal acne is a form of acne made up mainly of blocked pores, known as comedones, rather than red or swollen spots. It includes blackheads and whiteheads, and may occur on its own or alongside other types of acne.
Because blocked pores can resemble other skin concerns, clinical assessment can help clarify how the condition is presenting before management options are discussed.
What is Comedonal Acne?
A comedone is a hair follicle, or pore, that has become plugged with oil and dead skin cells. Normally these move up and out of the follicle. When they build up instead, a small plug may form.
When comedones make up most of what is present on the skin, with little visible inflammation, the presentation is described as comedonal acne.
Why Comedones Can Seem to Appear Suddenly
Comedones begin as tiny blockages that are not visible to the eye. Some may develop into blackheads or whiteheads over time, which is why blocked pores can seem to appear without warning.
How Comedonal Acne can present?
01
Blackheads
Blackheads are blocked pores that remain open at the skin's surface. The exposed surface of the plug darkens, which is why the colour is not caused by dirt.
02
Whiteheads
Whiteheads are blocked pores covered by a thin layer of skin. They may appear as small white or skin coloured bumps.
03
Small Bumps and Uneven Texture
Closed comedones are not always recognised as acne. They may feel like tiny bumps or rough, uneven skin, particularly across the forehead.
04
Where Comedones Commonly Appear
Comedones commonly appear on the forehead, nose and chin, and may also develop on the cheeks, jawline, chest and back.
Comedonal acne may occur alongside red or inflamed spots, and blocked pores can sometimes become inflamed.
WHAT IT CAN LOOK LIKE
What can look like Blackheads or Whiteheads?
Several common skin concerns can resemble comedones. Telling them apart matters because they are not managed in the same way.
If you are unsure what you are seeing, clinical assessment can help distinguish between these concerns.
Sebaceous Filaments
Sebaceous filaments are normal structures that line the pores and are most visible on the nose. They may appear as small grey or tan dots that sit flat with the skin. They are not acne.
Milia
Milia are small, firm white bumps, often around the eyes and cheeks. They are tiny cysts of trapped skin protein rather than blocked pores.
Fungal Acne
Fungal acne may cause clusters of small, similar looking bumps that are often itchy. Despite the name, it is not true acne and is assessed and managed differently.
WHAT IT CONTRIBUTES
What can contribute to Comedonal Acne?
Comedonal acne usually develops from a combination of factors rather than a single cause.
Oil and Skin Cell Build Up
Blocked pores may form when oil production and the shedding of skin cells inside the follicle fall out of balance.
Skin Care, Cosmetics and Hair Products
Some heavy or occlusive products may contribute to blocked pores in some people. Reviewing what is applied to the skin, hair and scalp is often part of assessment.
Hormonal Influences
Hormones may influence oil production, and some people experience recurring breakouts associated with hormonal changes.
Picking and Squeezing
Picking does not cause comedones to form, but it may irritate the skin, push contents deeper and turn a blocked pore into an inflamed spot.
Clinical Insight from Dr Ramita
What do patients commonly do to blackheads or closed comedones that makes things worse?
One thing patients may try is squeezing blackheads or closed comedones, sometimes using extraction tools or harsh scrubs in an attempt to clear the pores. However, blackheads are not simply dirt trapped in the skin. They form when oil and dead skin cells accumulate within a follicle, with the exposed material darkening through oxidation.
Closed comedones have no visible opening, making them particularly difficult to extract at home. Repeated squeezing or aggressive exfoliation can irritate the surrounding skin, cause inflammation and increase the risk of pigmentation or scarring. Rather than focusing on physically removing every bump, it is more useful to understand why the blockages are forming and how they can be managed without unnecessarily irritating the skin.
HOW IT IS ASSESSSED
How Comedonal Acne is Assessed?
01
Current Presentation
Assessment considers whether blackheads, whiteheads or both are present, the areas affected and whether inflamed lesions are also present.
02
History and Skin Care
The consultation may consider when the comedones began, how they have changed, recurring patterns, current skin care and cosmetics, and previous treatments.
03
Management Discussion
Following assessment, appropriate management options can be discussed according to the patient's clinical needs.
Common Questions about Comedonal Acne
Are blackheads and whiteheads a type of acne?
Yes. Blackheads and whiteheads are both comedones, which are blocked pores. When they make up most of what is present on the skin, the presentation is described as comedonal acne. They may occur on their own or alongside inflamed spots.
Are the dots on my nose blackheads?
Not always. Small grey or tan dots on the nose are often sebaceous filaments, which are normal structures lining the pores. Blackheads are plugs within the pore with a darker surface. Clinical assessment can help tell the difference.
Is it safe to squeeze blackheads or whiteheads?
Squeezing is generally best avoided. It may push contents deeper into the skin, cause irritation and turn a blocked pore into an inflamed spot. Whiteheads are covered by skin, so pressing on them may cause damage without clearing the blockage.
When should comedonal acne be assessed?
Assessment may be helpful if comedones are persistent, widespread or recurring, if they are becoming red or tender, or if you are unsure whether what you are seeing is acne.
Consult
Dr. Ramita Kaur Shahi
Dr Ramita Kaur Shahi leads acne consultations at The Acne Clinic. She assesses the skin and relevant history before discussing management options and follow up.
CONSIDERING CLINICAL ASSESSMENT
Clinical Assessment Can Help Clarify What You Are Seeing
Blocked pores, inflamed spots and conditions that resemble acne can look similar, and more than one may be present at the same time. Clinical assessment can help clarify the current presentation and support a discussion about appropriate management options.