| Feature | Open comedones | Closed comedones |
|---|---|---|
| Common name | Blackheads | Whiteheads |
| Pore opening | Widened and open to the surface | Blocked and covered by skin |
| Appearance | Black or brown dots, usually flat but sometimes raised | Small raised bumps, white or flesh colored |
| Contents | Oil and dead skin cells exposed at the opening | Oil and dead skin cells trapped beneath the surface |
| Treatment approach | Treat the clog rather than squeezing it | Treat the clog rather than picking it |
What is an open comedone?
An open comedone is a plugged hair follicle with a channel to the skin's surface. Oil and dead skin cells collect inside and widen the opening. The exposed buildup reacts with oxygen in the air and turns dark. The black dot is not dirt, so scrubbing harder will not solve it and can worsen acne. A blackhead is still a clogged pore even though its surface is open; open does not mean empty.156
Are whiteheads open or closed comedones?
Whiteheads are closed comedones, with oil and dead skin cells plugging the pore opening. They form small raised bumps rather than exposed dark dots. Whiteheads can be flesh colored, so the name is taking a fairly relaxed approach to description. A white or yellow center does not automatically mean a whitehead: an inflamed pimple containing pus is a pustule. Comedonal bumps are generally not tender or swollen, unlike inflammatory acne. The distinction is the covered clog, not simply the color.245
Why do both types form?
Both start with oil and skin cells blocking a hair follicle. Increased oil production and changes in how cells build up contribute to the clog. Comedonal acne means acne made up mostly of these bumps, commonly on the forehead and chin. Hormone changes and oily skin or hair products can contribute. The surface opening determines whether the visible result is a blackhead or whitehead, rather than a completely different cause.47
How should you care for blackheads and whiteheads?
- 1Wash gently morning and night with a mild cleanser. Do not scrub: irritation can make acne worse.
- 2Use an acne treatment that helps unclog pores. Retinoids are recommended for both blackheads and whiteheads. Other topical options include salicylic acid, azelaic acid, benzoyl peroxide and glycolic acid.
- 3Apply topical comedone treatments as a thin layer across the affected area, rather than only on individual visible bumps. General comedonal acne directions use treatment once or twice daily; the particular medicine determines the schedule.
- 4Moisturize and use sunscreen daily. Choose oil free, noncomedogenic skincare and makeup, meaning products designed not to clog pores. Remove makeup at the end of the day.
How long does treatment take?
Give treatment six to eight weeks before assessing whether it is helping. Noticeable improvement can take eight to twelve weeks, and clearing comedonal acne can take many months. Continued treatment is often needed because comedones can return. If bumps persist, a dermatologist can consider prescription treatment or professional extraction.267
When should you get medical help?
Do not pick, squeeze or attempt extraction yourself: this can cause scars, infection and further damage to follicles. See a doctor if treatment is not helping, spots become deep or painful, or acne is causing scars or affecting your mental health. Hot, swollen or red skin also needs medical assessment. Tell your clinician about medication side effects.24
Where this answer comes from
- 1Comedones, comedonal cyst pathologydermnetnz.org
- 2Comedonal Acne: Causes & Treatmentmy.clevelandclinic.org
- 3Comedones: MedlinePlus Medical Encyclopediamedlineplus.gov
- 4Acnenhs.uk
- 5Acne: Signs and symptomsaad.org
- 6How to treat different types of acneaad.org
- 7Comedonal acnedermnetnz.org
