Comedonal acne is one form of acne that receives less attention than its close cousin, inflammatory acne or acne vulgaris. But just because some people suffer from flesh-colored bumps and black holes instead of angry, red pimples doesn’t mean that their skin condition doesn’t stress them out.
This form of acne, though considered milder, still casts a shadow on one’s self-esteem and confidence. As such, you should not be ashamed to seek help for it.
What is comedonal acne?
If you’re familiar with acne linggo, you would already know that comedones are blocked pores. Our pores are openings from which sebum comes out, and it usually occurs in tandem with a hair follicle.
When our bodies produce too much oil, it can accumulate within the pore, causing blockage. Another major cause behind comedone formation is jammed dead skin cells and the protein they make called keratin. All this debris is supposed to slough off and make way for the new layer underneath. But when the production of dead skin cells or keratin is too fast or the sloughing off is too slow, your pores get jammed up.
There are two types of comedones: a closed comedo or a whitehead, and an open comedo or a blackhead. The difference is basically whether the pore has been completely or partially blocked.
If we’re being politically correct, a whitehead should actually be called a skin-colored head, since these are small, fleshy bumps on the skin. Though your skin tone is still even, your skin texture is not. This is because your pore openings have been completely filled up with either sebum or dead skin cells.
This is as opposed to blackheads, which represents partially blocked pores that allow oxygen to enter. This reacts with the accumulated material in a chemical process called oxidation, which turns the blockage black. So no, blackheads are not caused by stuck dirt, but rather, oxidized skin excretions!
Differentiating between comedonal acne and acne vulgaris
Comedones are usually called “non-inflammatory acne” because aside from the swelling, they do not bear the usual hallmarks of inflammation: redness, pain, heat. Zits, on the other hand, do, so they are given the name “inflammatory acne”. But we now know that comedones do have an inflammatory component, so the term “non-inflammatory” acne is somewhat of a misnomer.
It is important to understand that pimples always begin as comedones, but comedones do not always progress into pimples. You might notice that you always have a smattering of blackheads on your nose, but you can thank your lucky stars that not all of them erupt into zits. That only happens when the trapped debris builds up so much pressure that it bursts under the skin and triggers inflammation. Pressure can be from a continuous production of keratin, dead skin cells, and oil, or by the multiplication of Propionibacterium acnes bacteria that thrive in the oil-rich, oxygenless environment of a blocked pore.
However, since all zits come from comedones, it is in your best interest to get rid of them before they get worse.
How is comedonal acne treated?
Comedonal acne is treated in much the same way as inflammatory acne, except for one key difference: antibiotics. Antibiotics may have some effect on blackheads and whiteheads, but they are nowhere near as effective as other treatments. Those who suffer from a mix of comedones and zits are usually prescribed antibiotics for the latter, because it addresses part of the pathophysiology of inflammatory acne, Propionibacterium acnes. Because bacteria does not play a significant role in blocking pores (they thrive when the pores are already blocked), then antibiotics won’t make much of a difference in getting rid of comedones.
This is just as well--use of antibiotics is more tightly regulated in an effort to stop antimicrobial resistance. Even in people suffering from inflammatory acne, antibiotics are rarely used as monotherapy, and definitely not for a long period of time.
However, the other superheroes in the acne cinematic universe are very well-equipped to fight against blackheads and whiteheads. Products that use topical retinoids, benzoyl peroxide, salicylic acid, and azelaic acid are usually recommended by dermatologists. Most of these have inexpensive options that are available over the counter.
If more than 3 months of consistent treatment have failed to produce results, it is best to consult a dermatologist. They may prescribe several sessions of physical techniques such as microdermabrasion, comedone extraction, electrosurgery, or cryotherapy. However, these are more expensive as they require professional treatment, and will likely still require topical treatments as maintenance.
Conclusion
Comedonal acne is a problem in itself. Knowing that it could progress to full blown inflammatory acne is just another great reason to address it immediately. Luckily, there are many easily-available products that can address blackheads and whiteheads. Mechanical removal of comedones is also possible under the hand of a dermatologist. And while the results are not immediate, keeping your regimen consistent will surely lead to a clearer, smoother complexion in the long run.
This content is for general information only and is not a substitute for medical advice.
Resources:
Oon, H. H., Wong, S. N., Aw, D., Cheong, W. K., Goh, C. L., & Tan, H. H. (2019). Acne Management Guidelines by the Dermatological Society of Singapore. The Journal of clinical and aesthetic dermatology, 12(7), 34–50.
Wise, Emily & Graber, Emmy. (2011). Clinical Pearl: Comedone Extraction for Persistent Macrocomedones While on Isotretinoin Therapy. The Journal of clinical and aesthetic dermatology. 4. 20-1.
