Are they whiteheads or a rash?
A closed comedone is also called a whitehead, although the bump can match your skin color. Its surface stays intact, unlike a blackhead's open surface. Comedones give skin a rough texture, and a solid core can sometimes be visible.3
| Clue | Closed comedones | Perioral dermatitis |
|---|---|---|
| Appearance | Small, uninflamed bumps with a closed surface. | Clusters of small bumps that can look like acne. |
| Color | Often skin colored or white. | Red or skin colored. |
| Surrounding skin | The plugged pore is the defining feature. | Often dry, scaly or flaky, with possible itching or burning. |
| Location | Comedones can occur as part of facial acne. | Often around the mouth, sometimes around the nose or eyes; the skin immediately beside the lips is often spared. |
Comedones are not typical of perioral dermatitis. A mouth centered breakout that refuses to improve with acne treatment deserves a dermatologist's assessment, especially if it burns or itches. Perioral dermatitis can persist for months or years without treatment, so repeatedly treating the wrong condition is not a useful plan.45
What causes true closed comedones?
Comedones form when dead skin cells and sebum, the skin's natural oil, clog pores or hair follicles. Oily or greasy personal care products increase the risk, as can hormone changes and a family history of acne. Location alone does not identify the cause.6
How to care for confirmed closed comedones
- 1Wash gently every morning and night, and after exercise. Do not scrub.
- 2Moisturize after washing. Choose oil free, water based cleansers, moisturizers and makeup labeled noncomedogenic, meaning formulated not to clog pores; the jar does not need to look qualified to run a spa.
- 3Wear sunscreen daily.
- 4Remove makeup before bed, because its shift ends when yours does.
Topical treatment options include salicylic acid, retinoids, azelaic acid, benzoyl peroxide and glycolic acid. These are options, not a shopping list to apply together. A clinician can help choose treatment. Do not squeeze or puncture bumps yourself: extraction belongs with a licensed professional because picking can cause infection, scars and more comedones.6
Improvement can begin after eight to 12 weeks of persistent care and treatment, while clearing can take months. Tell your clinician about medication side effects or treatment that is not helping. Comedonal acne can recur, so clearing existing bumps and limiting future breakouts are separate tasks.6
What changes if it is perioral dermatitis?
Perioral dermatitis needs a different routine. Reduce facial cosmetics and unnecessary topical products, and avoid heavy, occlusive creams or ointments that can worsen the rash. Washing with warm water alone is one approach during a flare; a mild, fragrance free cleanser is another. For dryness, a bland moisturizer without additives can be used, and gel or liquid sunscreen is an option.24
If you are using hydrocortisone on the rash without a doctor's direction, stop using it. For a prescribed corticosteroid cream, contact the prescriber before changing treatment: stronger facial steroids can need gradual withdrawal. The rash can flare when a steroid is stopped. Do not restart it for temporary relief without medical direction. Continue medically necessary nasal, inhaled or oral steroids; rinsing your face and mouth after nasal or inhaled medicines can help.24
A dermatologist can confirm the diagnosis and decide whether you need a topical medicine, an oral antibiotic or another approach. Mention pregnancy before treatment is chosen, because antibiotic choices differ. Sensitive facial skin can make topical treatments difficult to tolerate. Expect gradual improvement over weeks to months rather than overnight clearing.24
Where this answer comes from
- 1Comedodermnetnz.org
- 2Red rash around your mouth could be perioral dermatitisaad.org
- 3Comedones: MedlinePlus Medical Encyclopediamedlineplus.gov
- 4Periorificial dermatitis (Perioral Dermatitis): Authoritative guidancedermnetnz.org
- 5Is that stubborn acne really acne?aad.org
- 6Comedonal Acne: Causes & Treatmentmy.clevelandclinic.org
