What are closed comedones?
There are two different types of comedones: open and closed. In open comedones, sebum, or oil, gets into an open follicle and combines with skin cells and sweat to form a plug. The plug is exposed to air, which oxidizes the plug and gives it a dark appearance. This is also called a blackhead.
Closed comedones are simply comedones that are not exposed to air. The pore opening is instead obstructed, keeping the clog under the surface of the skin. For this reason, open comedones are often capped with a white head. Also called milia, they can also be yellow in appearance and feel hard to the touch. Regardless of whether a comedone is open or closed, it will be elevated above the surface of the skin, forming at least a little bit of a bump.
The singular form of comedone, comedo, comes from the Latin word comedere, meaning “to eat up.” In today’s medical terminology, it refers to the pus and oil sometimes expressed from an open or closed comedo. However, if this happens, you are technically no longer dealing with a comedone but with a pimple (pustule) instead. Comedones cannot typically be popped.
A comedone begins to form when oil and skin cells become trapped in the hair follicle. When that happens, the follicle becomes swollen, causing a bump on the surface of your skin. That bump is a comedone.
While they can appear anywhere on the body, closed comedones are most common on the face, particularly the nose, cheeks, and forehead. They can also range in size: Although they are typically small (1 to 2 millimeters in diameter), they can also be too small to be seen (microcomedones) or even much larger than normal (giant comedones). They can also become infected and develop into inflamed acne.
Though not usually itchy or painful, their appearance (and their resistance to popping) can still leave you feeling uncomfortable.
What causes closed comedones?
Although most people experience a comedone once in a while, certain conditions and lifestyles make some people more susceptible to them than others. If you are dealing with ongoing, consistent comedone breakouts, you likely have comedonal acne.
While both whiteheads and blackheads are caused by clogged hair follicles, excess oil is the main culprit when it comes to comedone development. For this reason, people with excess sebum are more likely to experience breakouts. The hormonal changes that occur during puberty make teens more likely to have excess oil. Adults with oily skin can also be affected. There are also a number of other factors that can increase the likelihood of developing comedonal acne. These include:
- Smoking: Several studies have shown that smokers are more susceptible to developing closed comedones than nonsmokers.
- Diet: A diet consisting largely of processed foods, including sugars, fats, and fried foods, can have a direct, negative impact on skin health. Dairy has also been shown to create an inflammatory response in some individuals, causing both painful acne and closed comedones.
- Skincare and makeup: Using heavy moisturizers can increase oil levels in skin. For those who already have oily skin, using the wrong moisturizer can be the difference between clear skin and comedone breakouts. Hair products like pomades can also cause these blemishes, especially near the hairline.
- Environment: Living in an area with high humidity can increase acne, as the extra moisture in the air can open pores, making them more susceptible to trapping oil, dirt, and allergens.
- Touching: Picking or popping comedones can further irritate them, resulting in more comedone breakouts.
- Skin treatments: Some research suggests that chemical peels and laser therapies can increase the chances of getting open or closed comedones.
How to get rid of closed comedones
Fortunately, treating comedones is possible. Before seeking medical attention, consider trying natural or over-the-counter treatments at home. While you are in the process of treating your comedones, make sure not to pick at them. Doing so will only lead to further irritation and breakouts.
Several products are thought to help with reducing skin inflammation and oil production. Clay and charcoal masks, for example, are known to draw out excess oil and irritants. In the process, they can also help reduce the amount of trapped skin cells and dirt in the pores. This, in turn, can make removing whiteheads easier. Witch hazel, mixed with tea tree oil, may help calm the skin and balance moisture levels. Tea tree oil, in particular, has a reputation for improving skin infections and lowering skin inflammation.
OTC/Doctor-prescribed topical treatments
Minor breakouts may be helped with over-the-counter (OTC) treatment options like pimple patches or salicylic or glycolic acids. These products can be applied directly to the skin; just make sure to use a sunscreen daily, as they can make your skin more sun-sensitive. In addition to salicylic and glycolic acid, benzoyl peroxide, sulfur, and retinoids are other popular OTC treatment products. These all work to increase your skin’s natural exfoliation process, helping to keep pore-clogging problems at bay.
If OTC treatments aren’t working or you have chronic comedone breakouts, your doctor may prescribe a prescription-strength topical treatment. These typically contain higher concentrations of ingredients like benzoyl peroxide or retinoids. These topical treatments are generally tried before moving to more aggressive methods like medication or surgery.
While natural or chemical ingredients might clear up closed comedones, medication is another available option. Depending on your specific concerns, oral contraceptives, antibiotics, or drugs such as isotretinoin are options your health care provider may prescribe. Remember that sunscreen should also be used when taking these medications, as they can increase your risk for sunburn. Sometimes, medications and topical treatments are used simultaneously to increase chances for successful treatment.
If topical treatment or medications prove inadequate at stopping comedone acne breakouts, or if breakouts are recurring, surgery may also be an option. During this surgery, a dermatologist uses a small blade or needle to create a tiny incision on the comedone and remove the plug.
Microdermabrasion is another option for treating closed comedones. During the procedure, the top surface layer of skin is removed using crystals, which are blown or rubbed onto breakout areas. Doing this helps the comedones to open up, making them easier to clear up. Microdermabrasion can also help treat scars or prevent future ones from forming. The process of cryotherapy, which freezes comedones using liquid nitrogen, is another option. Once frozen, they are more easily removed.
Ways to prevent closed comedones
The best way to treat comedones is to prevent them from happening in the first place. Changes to your lifestyle and diet might stop breakouts from occurring.
Good skincare hygiene
Taking the time to care for your skin on a daily basis is the first step in keeping comedones away. Use a gentle cleanser, in a gel or cream form, specific to acne-prone skin. Moisturizers should be water-based and made specifically for your skin type.
Remember to always remove makeup before going to bed, as makeup, dirt, and oil can all get trapped in pores if skin isn’t washed at night.
When washing your face, use only gentle pressure and make sure to wash for at least 30 seconds to ensure you really clean your skin. Consider adding a facial cleansing brush to help speed the removal of dead skin. Afterward, use a toner or witch hazel, and let it dry before applying moisturizer (and let the moisturizer dry before applying any makeup). Remember to always remove makeup before going to bed, as makeup, dirt, and oil can all get trapped in pores if skin isn’t washed at night. Also, it's a good practice to wash your face after every workout to remove sweat and excess oil.
Experts now agree: Healthy skin begins on the inside. Cutting back or eliminating processed foods, sugary sweets, and fried foods from your diet may prove very helpful. It’s also important to increase the amount of antioxidant- rich foods (like berries, green leafy veggies, and healthy proteins like wild salmon) in your daily diet.
If you find that at-home methods are not working to treat comedones, reach out to a health professional so they can help you find an appropriate treatment option. The process of healing may be slow, and results can take several months to see. Since the excessive oil production that causes comedonal acne can be long-lasting (or even lifelong), any treatment should be approached from a long- term perspective.