How to Treat Comedonal Acne, According to Dermatologists

Fact checked by Anna HarrisReviewed by Morgan Rabach, MD

It doesn't matter whether you refer to acne as pimples, zits, spots, or breakouts—what matters most is that you don't treat them all the same. Yes, most acne types share one or two similar characteristics, from redness to raised appearances. But in reality, they all have different root causes and, as such, require targeted treatment approaches. Take, for example, comedonal acne.

Born when excessive sebum (the oil your body produces to hydrate and protect skin) is combined with dead skin cells, bacteria, and dirt to clog pores, comedonal acne is one of the most common forms of acne. Luckily, comedonal acne is also considered one of the more mild forms of acne, too, with cystic acne being at the other end of the spectrum. In other words, as long as you approach your breakouts the right way, you should be able to clear them up. However, that might feel a little easier said than done.

So, to help break down this specific type of breakout, we turned to the experts. Board-certified dermatologists Adarsh Vijay Mudgil, MD, Rayna Dyck, MD, and Jessie Cheung, MD, lend their expert advice for identifying this type of acne so that you can correctly treat it and prevent it.

Ahead, everything you need to know about comedonal acne treatment, according to the skin experts.

Meet The Experts

• Adarsh Vijay Mudgil, MD, is a board-certified dermatologist and the founder of Mudgil Dermatology in NYC.

• Rayna Dyck, MD, is a board-certified dermatologist at Skin Wellness Dermatology in Birmingham, Alabama.

• Jessie Cheung, MD, is a board-certified dermatologist and founder of Cheung Aesthetic and Wellness.

What Is Comedonal Acne?

Comedones are a type of acne that occurs when cells lining the ducts of the sebaceous gland (or oil gland) overgrow and lead to increased oil production and debris, which blocks the opening to the surface of the skin.

What Does It Look Like?

Comedonal acne falls into two categories: open comedones, or blackheads, and closed comedones, also known as whiteheads. As Cheung explains it, blackheads get their name because the sebum in the open follicle turns black when exposed to air. When the follicle is completely closed, on the other hand, you're left with a whitehead. Dyck adds that with inflammatory acne, you'll tend to see more red, inflamed bumps, pustules, nodules, and cysts, but comedonal acne is typically non-inflamed.

Where Can It Appear?

Dyck says comedonal acne can pop up in areas of the skin with the greatest number of sebaceous follicles—most commonly the face, but also the chest and the back. As far as where it occurs specifically on the face, Cheung notes that comedones are commonly found in the T-zone, which is rich in oil glands—like your forehead and chin. This type is often seen during early puberty with hormone fluctuations, but Cheung notes that it can affect anyone.

Causes of Comedonal Acne

Mudgil says that comedones are generally caused by pores clogged with dead skin cells and sebum, but Dyck points out that our daily habits can also be risk factors and triggers for developing comedonal acne.

• Hormones: As Cheung explains it, comedones form as hormones trigger sebum production, and the dead skin lining the follicle fails to shed. Mudgil adds that this type of acne is pretty common among teenagers because of the hormonal-mediated excess sebum production, particularly during puberty.

• Oily products: Other causes, Dyck adds, are more external, such as oily, pore-blocking products, like makeup, moisturizers, and sunscreens. "Comedonal acne can be prevented by keeping the face clean (but not cleansing too abrasively) and sticking with products that are oil-free and non-comedogenic," Dyck notes.

• Haircare products: Yes, Dyck says even your hair products could be the source of your whiteheads and blackheads. "Keep the hairline free of heavy oils, gels, and pomades, as this could lead to comedonal breakouts in these areas," Dyck suggests. Washing your pillowcases frequently and avoiding touching your face is also a good idea.

• Hygiene: Mudgil adds that poor hygiene can also allow dead skin cells to clog pores, which is why it's important to wash your face twice daily. To help prevent body comedones, Dyck recommends removing sweaty clothing and cleansing the skin as soon as possible.

• Trauma: Cheung explains that comedonal acne can be the result of using harsh abrasives that traumatize the skin and rupture the follicle. Dyck adds that trauma can also be caused by vigorous washing, chemical peels, and popping pimples.

• Smoking: All three dermatologists highlight the fact that comedonal acne is more common in smokers. Cheung explains that smokers and those who are exposed to the sun more frequently are more prone to comedones due to damage to their dermal elastic tissue.

• Diet: The experts agree that those with a high-glycemic diet are also more prone to comedonal acne. As Cheung explains it, diets high in processed, sugary foods will cause acne flaring because of hormone surges.

• Stress: Cheung points out that stress can also cause hormone surges.

Treatment Options

Good news: there are many good options, both over he counter and prescription, to treat comedonal acne. Dyck explains that most of the treatment options will be products in the form of comedolytics or keratolytics, since they not only soften and help clear existing comedones, but also prevent changes in the pilosebaceous unit—that's a a fancy term for a skin gland—that can lead to new ones forming.

Incorporate retinoids into your routine

According to Cheung, topical retinoids will speed up cell turnover and help prevent comedone formation while treating existing comedones. In other words, retinoids aren't only good for spot treating—they should be applied to all acne-prone areas.

Dyck agrees that the most effective therapies for comedonal acne are retinoids and retinols. "These are vitamin A-derived products that can reduce inflammation, reduce keratin proliferation in the follicle, and reduce scarring," she explains. "Retinoids contain a higher concentration of retinoic acid, which is the active form of the molecule."

Finally, Dyck notes that all of these options can cause some irritation and dryness, so milder forms are typically used, initially. She suggests keeping the skin hydrated with a non-comedogenic moisturizer for increased tolerability.

Apply a benzoyl peroxide spot treatment.

According to Cheung, this ingredient can help suppress acne-causing bacteria from causing more inflammation. Aside from bleaching your towels, benzoyl peroxide is known for potentially causing dry, irritated skin, so we recommend trying this La Roche-Posay Effaclar Duo Acne Treatment ($36) as it's non-drying. Once you use this oil-free and fragrance-free formula on your blackheads and whiteheads, you'll see why it's one of Byrdie's favorite benzoyl peroxide acne treatments.

Try tea tree oil.

Cheung recommends tea tree oil for the same reason as benzoyl peroxide—it has antibacterial properties and calms inflammation. If you're using a formula that's 100% tea tree oil, dilute it first with a carrier oil and apply it to the area as needed.

Cleanse with an AHA/BHA wash.

"Cleansers containing salicylic acid or glycolic acid can help exfoliate dead skin and loosen debris in clogged pores," Mudgil says. Cheung adds that gentle chemical exfoliation is key to treating comedonal acne and recommends washes and topicals with AHAs and BHAs. We're big fans of SkinMedica's AHA/BHA Exfoliating Cleanser ($48), which contains salicylic acid (BHA) and AHAs, like glycolic and lactic acids, meant to gently and chemically exfoliate without the need for any harsh scrubs.

Use a product with azelaic acid.

Dyck also recommends trying azelaic acid as a wash or a leave-on product to treat comedonal acne. With its ability to soothe, exfoliate, even skin, and fight acne, consider azelaic acid the ultimate multitasking ingredient. We recommend picking up a bottle of The Ordinary's Azelaic Acid Suspension 10% ($12) leave-on formula, a cult favorite that contains 10% azelaic acid.

Ask your doctor about oral medication.

For more resistant forms of comedonal acne, Dyck says oral medications might be necessary. "Antibiotics can be used to reduce bacteria and inflammation, but tend to be more effective in inflammatory acne," Dyck explains. For those who are experiencing more hormonally triggered breakouts, Dyck says oral contraceptives and spironolactone can be helpful. And if you are someone who has severe acne, acne that is not responding to therapy, and/or acne leading to scarring, Dyck adds that Isotretinoin (aka Accutane), a vitamin A-derived oral medication, can give significant skin clearance.

When to See a Doctor

According to Dyck, a good baseline skincare regimen is key, but other cosmetic procedures, such as chemical peels and microdermabrasion, can help. In addition to all the above treatments, Mudgil adds that manual extraction by an experienced provider can also help speed things along.

If you've tried over-the-counter medications for several weeks without improvement, Dyck stresses the importance of seeing a dermatologist to assess your situation. "If you are experiencing scarring or significant hyperpigmentation (which can become severe in dark skin tones), you should see a dermatologist sooner rather than later," Dyck says. "Delaying proper diagnosis and treatment can have lasting effects."

The Final Takeaway

Comedonal acne—often referred to by its two types of appearance, whiteheads and blackheads—is a form of acne that occurs when sebaceous glands are overgrown, leading to increased oil production, and that combines with debris and clogs pores. Causes by lifestyle habits, hormone fluctuations, stress, diet, and hygiene, comedones can be treated with both topical products and oral medications. If you've tried over-the-counter medications for several weeks with worsening conditions or without improvement, seek a board-certified dermatologist who can better assess your condition and recommend further treatment.

Frequently Asked Questions

Is it safe to pop comedonal acne?

Picking or popping acne of any type (including comedonal) can make them worse, cause scarring, or even cause additional breakouts, according to Dyck. Frequently touching pimples can also spread bacteria from your fingers to the pimple, leading to infections.

Read the original article on Byrdie.