How to Treat and Prevent Closed Comedones

Closed comedones (whiteheads) are non-inflamed blemishes caused when skin debris and oils block pores in the skin. They can be treated with over-the-counter or prescription creams as well as manual extraction to help clear the plug and improve your appearance.

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Treatment

Closed comedones can be treated effectively. If you have mild bumps and breakouts, you may first want to try an over-the-counter (OTC) acne remedy before considering a prescription or procedure.

OTC acne creams, gels, and ointments: Products containing benzoyl peroxide, adapalene (0.1% Differin gel), salicylic acid, or glycolic acid can speed up shedding of dead skin cells and clear excess sebum from the skin to keep pores from becoming clogged. OTC products can take time to work. It can take eight weeks before visible improvement is seen.

Azelaic acid: This topical antiseptic can be found in OTC products or obtained by prescription, depending on the percentage.

Prescription medications: For serious or long-term cases of closed comedones, consider seeing a skin specialist called a dermatologist for prescription medications. Topical retinoids (vitamin A-based medications) are a great choice and likely the first medication your dermatologist will prescribe. Options include: 

• Retin-A (tretinoin)
• Differin 0.3% (adapalene)
• Tazorac (tazarotene)

These help clear pore blockages and keep new ones from forming. They also have the added benefit of smoothing and softening the skin.

Manual extraction: Blemish extractions should only be done by a dermatologist or esthetician using a comedonal extractor to remove the plug. While extractions can improve the appearance of your skin, they don't keep closed comedones from forming. Additional treatment will be needed to prevent them from coming back.

Microdermabrasion or chemical peels: These in-office treatments can help to smooth skin and reduce the appearance of comedones.

Natural Remedies for Closed Comedones

Instead of applying chemicals to their skin, which can be harsh, some people will turn to natural remedies to prevent or treat comedones.

While the evidence supporting these products is generally weak, some swear by natural topical remedies as:

• Aloe vera
• Green tea extract
• Honey
• Ginseng extract
• Tea tree oil
• Witch hazel
  

Prevention

Minor cases of comedones can often be prevented or reduced. Steps that you can take to help keep your pores clear include the following:

• Wash acne-prone skin twice per day only; additional washing may irritate your skin.
• Exfoliate regularly to remove dead skin cells.
• Use oil-free and non-comedogenic skincare products and makeup.
• Keep all your makeup brushes and applicators clean.
• Avoid touching your face.
• Remove makeup before going to bed.
• Shower immediately after a workout or other strenuous physical activity; don’t let perspiration and oil stay on your skin.

In some cases, people develop comedones even when taking good care of their skin. In this case, OTC acne products or prescription medications are the next steps to prevent closed comedones from forming.

Types of Closed Comedones

Closed comedones types include:

• Microcomedones, too small to be seen with the naked eye, are closed comedones that can develop into blackheads and whiteheads.
• Macrocomedones are a type of large closed comedones (typically greater than 2-3mm in diameter) most commonly found on the face.
• Solar comedones (or senile comedones) are small, skin-colored closed comedones commonly associated with chronic sun exposure. They can develop into larger, open comedones due to skin changes caused by sun damage. 
• Sandpaper comedones are multiple small closed comedones that typically develop on the forehead. They give the skin a gritty, sandpaper-like feel.
  

Causes and Risk Factors

Comedones are caused when dead skin cells (called keratinocytes) mix with natural skin oils (called sebum) and clog pores in the skin known as hair follicles.

Closed comedones develop when the plug is encased by overlying skin, creating non-inflamed whiteheads. If bacteria invade the follicle or the follicle wall ruptures, closed comedones can turn into inflamed, pus-filled pimples (pustules).

Some people are more likely to develop comedones than others. Age, biological sex, lifestyle, and genetics are known to place certain people at greater risk of comedones and acne.

When comedones are persistent, they are referred to as comedonal acne. People with persistent comedones are more likely to develop acne vulgaris (the most common form of acne).

Comedones can develop during menstrual cycles, pregnancy, and menopause due to estrogen fluctuations. Comedones are more common in tweens and teenagers when these sex hormones are surging. They can also develop when people use substances like anabolic steroids that suppress testosterone production.

Other factors can increase the risk of comedones and comedonal acne, including:

• Harsh or abrasive soaps and skin care products and abrasive washing
• Squeezing pimples
• Chemical peels or laser treatments
• Overhydrated skin from over-moisturizing or high environmental humidity (especially premenstrual exposure)
• Skin care products made with isopropyl myristate or propylene glycol
• Hair gels made with oily pomade
• Diets rich in sugar, saturated fat, and dairy
• Cigarette smoking

Closed vs. Open Comedones

Closed comedones look like tiny bumps on the skin's surface, caused when dead skin cells and natural oils plug skin pores. They are not red or inflamed, but often the same color as the surrounding skin.

Closed comedones can happen anywhere, but most often develop on the face, neck, chest, and back—where sebaceous glands are densely populated. Some whiteheads can develop an actual white head as the overlying skin is stretched by the underlying plug.

By contrast, open comedones (blackheads) develop when the plug pushes through the opening of the follicle. The exposure of the plug to the air causes oxidation (in which oxygen causes the plug to turn black).

Closed and open comedones can (and often do) occur together in the same area of the skin.

Summary

Closed comedones are tiny bumps on your skin, also known as whiteheads. They are caused when dead skin cells and natural oils block skin pores. Closed comedones can be treated with OTC acne medications, and some natural remedies may also be effective in certain cases.

If symptoms are severe, prescription topical creams to help get rid of the comedones and keep them from coming back. A dermatologist or esthetician can also manually extract them to help your skin look smoother. Prevention strategies include regular washing and using non-comedogenic products.