Closed comedones on cheeks: what helps?

What do closed comedones look like?

Comedones are a type of acne found at pore openings. A closed comedone has an intact skin surface; an open comedone is a blackhead. Both can give skin a rough texture, and a small solid core can sometimes be visible. Closed comedones can be flesh coloured as well as white, so 'whitehead' is not a particularly strict dress code.3

Comedonal acne usually consists of bumps that match the surrounding skin and are not tender or swollen. It most often affects the forehead and chin, but cheeks are another possible location. A pus filled pimple is different from a whitehead: the similar colour does not make them the same type of blemish.14

Not every cluster of cheek bumps is comedonal acne. Folliculitis, a skin infection, and perioral dermatitis can resemble acne. If you are unsure what the bumps are, a dermatologist can examine them and identify the condition before you commit to an acne treatment.5

Why do pores become blocked?

Sebum is the natural oil that helps stop skin drying out. Normally, oil reaches the skin surface and cells lining the hair follicle shed. With acne, oil and cells stick together inside the pore, trapping the mixture instead. Bacteria can grow within the plugged follicle and contribute to inflammation. If the follicle wall breaks down, its contents can spill into nearby skin and produce an inflamed blemish.6

Hormones and family history affect acne risk. Hormonal changes during puberty and pregnancy can increase breakouts, and acne can continue into adulthood. Some medicines, including corticosteroids, lithium and medicines containing hormones, can cause acne. Stress, humidity, pressure against the skin and harsh scrubbing can make existing acne worse. These factors do not all apply to every breakout.6

Oily personal care products and some cosmetic ingredients can contribute to comedones. Humid conditions and squeezing can also play a part. Diet is less settled: some foods may worsen acne, but research into its role continues. Cheek bumps alone are not a reason to assume that one food caused them.67

Which treatments help closed comedones?

For whiteheads and blackheads, dermatologists recommend a retinoid to unclog pores, with a benzoyl peroxide wash to reduce acne bacteria. Adapalene is available without a prescription in the United States. Prescription access varies by location, so check locally rather than assuming every retinoid is sold the same way.457

Treatments applied to the skin come as washes, gels, lotions, creams and pads. Choose a product with clear acne directions rather than treating all formats as interchangeable. The right treatment plan depends on whether you have only clogged pores or also inflamed pimples. A clinician can combine treatments that address different causes of acne.25

How to build a routine for your cheeks

1. 1Wash gently in the morning and evening, and after heavy exercise. Use a mild cleanser and lukewarm water instead of strong soaps, astringents or rough scrub pads.
2. 2Apply your acne treatment as directed. Treatments for comedonal acne are generally spread in a thin layer across the affected area, rather than only onto individual bumps. Topical retinoids are often used in the evening.
3. 3Moisturize morning and night. Look for oil free, water based products labelled noncomedogenic, meaning formulated not to clog pores. Even products with that label can worsen acne in some people.
4. 4Protect exposed skin with a broad spectrum, water resistant sunscreen of SPF 30 or higher. Seek shade and use protective clothing as well.

Choose oil free cosmetics and hair care products, and shampoo regularly if your hair is oily.12

What if treatment irritates your cheeks?

Topical acne medicines can cause irritation, burning and redness. Tell your doctor about these effects rather than pushing through them. Previous retinoid irritation does not automatically mean an allergy. With a dermatologist's help, possible adjustments include using less medication, applying it less often or applying moisturizer first. If you use a prescription, make these changes with the prescriber's guidance.25

How long does clearing take?

Give treatment six to eight weeks before judging whether it is helping. Improvement in comedonal acne can take eight to 12 weeks, and clearing can take several months. Treatment often needs to continue long term because comedones can return.147

When should you see a dermatologist?

Seek help sooner for deep, painful lumps or developing scars. A dermatologist can offer prescription treatment or professional extraction for stubborn comedones. Do not squeeze or attempt extraction yourself: this can damage follicles, cause infection and leave scars. If topical treatments are not enough, a clinician can assess whether oral treatment is appropriate; antibiotics are usually used for inflammatory acne rather than isolated clogged pores.147