How to treat open comedones

Which treatment should you choose?

• A topical retinoid is a main treatment for blackheads. Retinoids clear pores and can also treat whiteheads and some pimples. Adapalene is available without a prescription in the US; other options include prescription tretinoin.
• Salicylic acid is another option for blackheads. It opens clogged pores and comes in creams, cleansers and other forms.
• Benzoyl peroxide reduces acne causing bacteria and helps with blocked pores. It is often used alongside a retinoid, but check with a pharmacist or doctor before combining acne medicines.
• Azelaic acid is another treatment for mild acne. It opens clogged pores, reduces inflammation and can also treat dark marks left after acne.

How to apply treatment

Treatments called comedolytic target blocked pores, which is a useful job description hiding inside an unnecessarily long word. Apply treatment across the affected area rather than only to individual blackheads.4

1. 1Wash gently twice a day. Remove makeup at the end of the day, and do not scrub.
2. 2Apply your acne medicine as directed. Pore clearing topical medicines are generally applied as a thin layer over the entire affected area. Follow the specific product or prescription instructions for frequency.
3. 3Use a retinoid at the time directed; evening application is common. If you have sensitive skin or previous retinoid irritation, discuss this before starting. A dermatologist can advise whether to use less, apply less often or put moisturizer on first.
4. 4Use skincare and makeup labelled noncomedogenic, meaning formulated not to clog pores. For sun protection during retinoid treatment, use a noncomedogenic sunscreen with broad spectrum protection, SPF 30 or higher and water resistance, alongside shade and protective clothing.

For benzoyl peroxide, start with the lowest available strength. It is usually used once or twice daily. A gel stays on the skin; a gel wash is rinsed off. Follow the packet instructions, and keep it away from eyes, mouth, cuts and infected skin. Benzoyl peroxide can bleach clothing and hair.6

How long does clearing take?

Expect fewer breakouts after about six to eight weeks, rather than immediate clearing. Worthwhile improvement in comedonal acne can take several weeks to months. Treatment often needs to continue long term, and a retinoid can be used as maintenance once acne is controlled.45

Irritation, pregnancy and when to get help

Retinoids can irritate skin. Benzoyl peroxide can cause dryness, peeling, itching or painful skin; ask a pharmacist or doctor if symptoms bother you or persist. Swelling of the throat or tongue, or difficulty breathing, needs emergency medical help. During pregnancy, benzoyl peroxide can usually be used, but check with your doctor. When breastfeeding, check first and avoid applying it to the breasts.56

See a dermatologist if blackheads remain after six to eight weeks of treatment. Prescription treatment or professional extraction can help persistent plugs. Do not squeeze them yourself: picking can cause scars. Seek medical care sooner for deep painful lumps, scarring, hot swollen skin or acne affecting your mental health. Antibiotics are usually reserved for inflammatory acne rather than predominantly comedonal acne.234