How to treat closed comedones

What are closed comedones?

Closed comedones are whiteheads: small follicles plugged with sebum, your skin's natural oil, and dead skin cells. Skin covers the opening, so the contents are not exposed. The bumps can look white, slightly yellow or the same color as surrounding skin, rather than having an obvious white tip. They are usually not swollen or tender. Comedonal acne commonly appears on the forehead and chin, but can also affect the cheeks, nose and back. Closed comedones can occur alongside inflamed pimples.3

Not every small facial bump is acne. A dermatologist can usually diagnose acne by examining the skin, and tests are unnecessary in most cases. If you are unsure what the bumps are, get them identified before adding more acne treatments: conditions such as folliculitis and perioral dermatitis need a different approach.45

What should you use for closed comedones?

A topical retinoid is a direct treatment for blocked pores and whiteheads. Adapalene is available without a prescription in the US; other acne retinoids, including tretinoin, require a prescription. Salicylic acid and azelaic acid also open clogged pores. Treatment can combine ingredients that address different causes of acne, but the choice should reflect the blemishes you have rather than the number of bottles available.15

Topical options used for comedonal acne include benzoyl peroxide at 2.5% to 10%, salicylic acid at 1% to 3%, azelaic acid at 20%, and glycolic acid at 10% to 20%. These are treatment options, not instructions to use every ingredient together. Follow the individual product directions or your prescription rather than choosing a strength in isolation. Comedonal treatments are generally spread thinly over the whole affected area, not dabbed only onto visible bumps.2

How to build the routine

A useful routine covers cleansing, treatment, moisturizer and sunscreen, without appointing a supporting cast of bottles. Wash gently once or twice daily and after exercise. Avoid scrubbing, repeated washing, rubbing alcohol and very drying toners. If oily skin accompanies the bumps, a salicylic acid or benzoyl peroxide wash is an option.6

For an adapalene gel or cream routine:

1. 1Gently cleanse the affected skin in the evening with a mild cleanser, then pat dry with a soft towel.
2. 2Spread a thin film over the entire affected area. Adapalene is usually applied once daily at bedtime; follow your package or prescription directions.
3. 3Use moisturizer to help with treatment related dryness. If irritation requires a change in application order or frequency, ask your clinician.
4. 4In the daytime, use sunscreen and protect your skin with shade and clothing.

Choose a noncomedogenic sunscreen with broad spectrum protection, SPF 30 or higher and water resistance. Retinoid treatment requires sun protection. A dermatologist can sometimes reduce irritation by recommending less medication, less frequent use or moisturizer before the retinoid; make those changes with their guidance.5

What can keep pores blocked?

Oily cosmetics, including hair pomades, can aggravate comedonal acne. Hormonal factors and humid weather can also contribute. Acne can flare with certain medicines, including steroids, hormones and anticonvulsants. If breakouts began alongside a medication change, discuss that timing with the prescriber rather than stopping the medicine yourself.24

Oil free, water based cosmetics are sensible choices, even when the product name sounds like it was approved by a poetry department. Look for noncomedogenic cleansers, moisturizers and makeup. The term means a product is intended not to clog pores, but stop using a product that clearly worsens your acne. Remove makeup before bed. If your hair is oily, shampoo daily and keep it away from your face.36

How long does treatment take?

Six to eight weeks is an early checkpoint, not a deadline for complete clearing. Adapalene can take eight to twelve weeks or longer for its full benefit, and acne can initially worsen as previously unseen pimples surface. Comedonal acne can take many months to clear. Retinoids can also be used as maintenance treatment once acne is controlled.57

Treatment needs weeks to show fewer breakouts, which gives the marketing department considerably less material than an instant transformation. If blemishes persist after six to eight weeks, you can see a dermatologist to review the treatment rather than repeatedly replacing products.1

Who should be careful with adapalene?

Adapalene treats acne in adults and children aged twelve and older. Discuss pregnancy, plans to become pregnant, breastfeeding, eczema, allergies and other medicines or skincare with your doctor before use. Do not apply adapalene to sunburned, broken or eczema affected skin. Avoid eyes, nose and mouth, and do not use hot wax on treated areas. Applying extra medication does not speed results.7

Dryness, redness, scaling and irritation can occur during the first two to four weeks of adapalene treatment. Contact your doctor about burning, stinging or irritation, especially if severe or persistent. Seek immediate medical help for hives, breathing difficulty or swelling of the face, lips, tongue or throat. Do not dismiss those symptoms as an expected early breakout.7

When do you need professional treatment?

Do not squeeze, pick or try to extract closed comedones yourself. Home extraction can damage follicles, cause infection or scars, and create more noticeable or inflamed blemishes. Professional comedone extraction uses sterile instruments to remove plugs. Chemical peels and microdermabrasion are other procedures a qualified professional can consider.3

See a clinician sooner if acne becomes painful, worsens, leaves scars or causes emotional distress. Persistent comedonal acne that does not respond to topical treatment warrants a dermatologist review. Antibiotics are usually not very effective for predominantly comedonal acne; prescription retinoids, hormonal treatment in appropriate patients or oral isotretinoin are possible next steps under medical supervision.26