Why do I have closed comedones?

What do closed comedones look like?

Closed comedones are small, raised bumps that are usually skin coloured and not tender or swollen. Some look white or slightly yellow. Whiteheads can be skin coloured, which makes the name less useful than it sounds. They commonly appear on the forehead and chin, although other areas can be affected. Unlike blackheads, their contents are covered by skin rather than exposed through an open pore.234

Why are the pores getting blocked?

Normally, skin cells shed and sebum, your skin's natural oil, reaches the surface. With acne, cells and oil stick together inside the follicle instead. Increased oil production and changes in how cells build up inside the follicle help create the plug.15

• Hormones can increase oil production. Breakouts can occur during puberty, around periods, during pregnancy or menopause, and after starting or stopping birth control pills.
• Family history matters. Having close relatives with acne increases your likelihood of developing it.
• Oily or greasy personal care products can contribute to clogged follicles.
• High humidity, pressure from tight clothing or sports equipment, and harsh scrubbing can worsen acne.
• Stress can aggravate acne. Diet also plays a possible role, but whether particular foods cause acne remains unsettled.
• Some medicines can cause acne, including corticosteroids, lithium and medicines containing hormones.

Could my skincare be contributing?

Review your cleanser, moisturizer, sunscreen, makeup and hair products for labels such as "noncomedogenic," "oil free" or "won't clog pores." These products are less likely to cause acne. Hair products belong in the suspect list too, even if the bottle considers your face somebody else's department. Oily pomades and greasy products are possible contributors, but hormones and genetics can keep comedones returning even with careful skincare.257

What should I do next?

1. 1Wash gently morning and night. Use a gentle cleanser rather than scrubbing, and remove makeup at the end of the day.
2. 2Choose skincare and makeup labelled noncomedogenic or oil free. Include hair products in your review rather than checking facial skincare alone.
3. 3Ask a pharmacist about an acne treatment. Options for comedonal acne include salicylic acid, azelaic acid, benzoyl peroxide and retinoids. Treatments that help clear comedones are generally applied as a thin layer across the affected area, not just individual bumps, once or twice daily.
4. 4Leave the bumps alone. Picking and squeezing can damage follicles, cause more comedones and leave scars. If persistent plugs need extraction, have a licensed professional do it.

How long does clearing them take?

You may start noticing improvement after eight to twelve weeks of consistent skincare and treatment, but clearing comedonal acne can take several months. Treatment often needs to continue long term because comedones can return. If topical treatments are not helping, a clinician can assess whether prescription treatment is appropriate, including treatments aimed at hormonal contributors.25

When should I get medical help?

See a doctor if self treatment is not helping, you have many spots, deep painful lumps or scarring, or acne is affecting your mental health. Hot, swollen and red skin also needs medical assessment; redness can be harder to see on brown and black skin. Tell your clinician about medication side effects. If you suspect a prescribed medicine is triggering acne, keep taking it and speak with the prescriber rather than stopping it yourself.267