How to Treat Closed Comedones, the Acne You Didn’t Know You Had

Sara Coughlin

If an inflamed, angry-red pimple is the skin-care equivalent of a scream, a closed comedone is a threatening whisper. Seemingly headless and unpoppable, closed comedones are white or skin-colored bumps that gradually build beneath the surface of the skin until they’re large enough to be visible in profile.

Closed comedones are commonly called whiteheads which contrary to popular belief aren’t actually those white, pus-filled pimples you’re so often tempted to pop. In fact actual whiteheads aren’t even really poppable. However, if you attempt to pop them or they get irritated by bacteria, they can develop into poppable pimples.

Here’s how to know if your bumps are actually closed comedones—and how to manage them properly.

Surprise! Whiteheads don’t actually have juicy, poppable heads.

Like most types of acne, closed comedones form when some combination of oil, dead skin cells, and bacteria build up and plug a hair follicle. They’re covered by a layer of skin cells, which gives them a slightly white or fleshy color. That’s why they’re colloquially called whiteheads even though they don’t have a head that can be popped, Clarissa Yang, M.D., chief of dermatology at Tufts Medical Center, tells SELF. If your pimple does have a head that’s just staring you down, daring you to pop it, it’s technically a papule or pustule.

Closed comedones are also not to be confused with open comedones, which develop when the stuff inside is exposed to air and oxidizes, which turns it black. That’s why open comedones are also referred to as blackheads, Samantha Conrad, M.D., dermatologist at Northwestern Medicine, tells SELF.

Closed comedones can form as a result of using skin-care or beauty products that are occlusive (meaning they essentially seal off the top layer of skin) or irritating. Closed comedones can appear anywhere on the face if they’re the result of, say, an occlusive moisturizer. But if they’re concentrated around your hairline or forehead, Dr. Yang explains, it’s more likely that an irritating or oil-based hair product is the culprit. Good to know!

So why are some people more prone to closed comedones than others? In addition to the products they’re using, some people experience an excessive “stickiness” in their skin cells, which may be due to changing hormone levels, Dr. Yang says. As your progesterone and testosterone levels change throughout the month your sebaceous glands produce more or less sebum (oil), which makes it more likely for your hair follicles to get plugged up.

If you notice closed comedones primarily along your chin and jawline, this could indicate that they’re hormonally driven, she says. That’s because, as SELF has previously reported, hormonal changes can cause the oil glands in this area of the face to work overtime, leading to—you guessed it—hormonal acne in the form of closed comedones. (For the record hormonal acne can also appear as cystic acne, papules, pustules, or really any type of pimple.)

Unfortunately closed comedones can become more serious.

Occasionally closed comedones go away on their own without much treatment. But generally they don’t, Dr. Yang says. And even if they do, Dr. Conrad says it can take weeks or months. If they don’t go away they can progress in the other direction, becoming red, painful, and more challenging to treat.

In fact, Dr Conrad refers to closed comedones as the “first step” toward inflammatory acne—all it takes is a little additional stress for them to reach that state. That stress may come in the form of a hormonal surge, an increase in oil production, or a buildup of sweat and bacteria around the already clogged hair follicles.

Physically applying stress to closed comedones (i.e. squeezing or trying to pop them) will have the same effect, Dr. Yang adds. They’ll become irritated, then inflamed, and eventually grow into red, tender-to-the-touch papules or pustules, Dr. Conrad says. If your acne starts to develop into cysts, which are set deeper into the skin and tend to be more painful, you should make an appointment with your derm, since cystic acne can easily lead to scarring.

Skipping exfoliation if you’re prone to dead skin buildup or using too many drying products at once can also play a role in exacerbating preexisting closed comedones, Dr. Conrad says. But beyond that, these habits can even cause you to develop more later on.

Here’s how to treat closed comedones—and prevent more in the long run.

Closed comedones may be annoying but there are some relatively simple ways to deal with them. These are the major methods to preventing and managing closed comedones:

Only use noncomedogenic products. Products that are labeled as noncomedogenic are less likely to clog your pores and therefore less likely to lead to breakouts. That said, the labeling system has its drawbacks and you may still have issues with products that claim to be noncomedogenic. Still, this is a good place to start if you’re dealing with closed comedones.

Occasionally use gentle exfoliants. Chemical exfoliants are helpful because they break down the bonds between dead skin cells, oil, and all the other gunk that can clog your pores. That way you can wash them away more easily and keep your pores clear. Look for products containing ingredients like salicylic acid and glycolic acid, Dr. Yang says.

Bring out the benzoyl peroxide. This classic acne-fighting ingredient works by killing the bacteria that often fuels pimples and clogs pores, Dr. Conrad says. Although benzoyl peroxide is often found on its own in acne treatments, it can also be found in combination with chemical exfoliants like salicylic acid to make your regimen a little more efficient.

Consider using an over-the-counter retinoid. These ingredients, which include retinol, retinal, and adapalene (Differin), are all derivatives of vitamin A that are thought to speed up the cell turnover process. That causes your skin cells to shed more quickly, preventing them from clogging up your pores and leaving behind smoother skin. However, retinoids can be irritating, especially when first starting them. So they’re best applied just a few days a week to start with. It’s also important to avoid using other ingredients that can be irritating (like chemical exfoliants) on the same nights that you’re using your retinoid.

After consistently using these strategies for a while, you should start to see a reduction in your closed comedones. However, know that you’ll need to be patient for the full effect—it could take up to three months for a noticeable change. “You want to use them long enough for them to actually do their job—they’re not going to work in five days,” Dr. Conrad says.

But if you’re not seeing an improvement after that time—or if your acne is getting progressively worse—that’s a sign to check in with a dermatologist for some guidance. They may prescribe you a stronger retinoid or may even recommend some gentle extraction procedures, Dr. Conrad says.

At first glance closed comedones are mere skin-care nuisances, but if left untreated they can progress into angry, inflamed pimples. Luckily as long as you’re regularly taking care of your skin, you should be able to keep them under control.

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Originally Appeared on Self