Acne is a very common skin condition characterised by comedones (blackheads and whiteheads) and pus-filled spots (pustules).
A comedone (or comedo) is a clogged hair follicle (pore) in the skin, resulting in a small black or white coloured spot which often occur as part of an acne outbreak and develops on the face, neck, chest and back. This is one of several physical changes that occur during puberty which affects boys more than girls.
Comedones are often seen in acne prone skin. The colour of the blackheads is not due to dirt, but rather because of the surface pigment called melanin. They are mainly found on the forehead and chin. As the comedones are full of acids, bacteria and other material, such as dead skin cells, scarring could be the end result if left untreated.
Open comedones (known as blackheads)
An open comedone is caused by over-production of sebum during adolescence due to rising hormone levels, in particular the male hormone testosterone. This over-stimulates the sebaceous glands into producing more sebum that is necessary which clogs both the hair follicles and skin pores.
The comedone allows air to access its centre, oxidising the sebum within which changes from white to a dark colour. A ‘blackhead’ develops due to a blockage in a skin pore as a result of excess sebum. These pores are larger than normal and when exposed to the air, trigger a chemical reaction involving melanin which changes the centre of the pore to the characteristic black colour.
The result is greasy, shiny skin which, when combined with bacteria, leads to the formation of blackheads and other types of acne spots, such as pimples, nodules and cysts.
Blackheads run the risk of turning into lumps, nodules or cysts which are extremely painful and unsightly.
Treatment of open comedones
If you have a mild form of blackheads then this can be treated at home. There are various over-the-counter remedies which can be purchased at your local pharmacy.
A severe case needs to be seen by your GP who may refer you to a Dermatologist for further investigation and treatment. The aim is to reduce the outbreak and prevent the existing blackheads from turning into cysts, which are small swellings under the skin and can become inflamed, leading to scarring.
Treatment will take the form of a topical remedy, e.g. cream which is applied to the skin or an oral medication. But these treatments take time so don’t expect an instant result. It takes 3 months or more before you notice any difference, the main one being the prevention of further outbreaks.
Other treatments include antibiotics, retinoids such as Roaccutane and surgical removal or excision.
You will also be advised about the importance of following a daily skin care routine, but do not overdo things. Excessive washing or cleansing of the affected areas will worsen things so do what is necessary but no more.
Use a moisturising cream or lotion to keep your skin soft and smooth and stop it from drying out.
Avoid picking or rubbing the affected areas as this will cause the blackheads to spread or become inflamed.
Closed comedones (known as whiteheads)
These develop in the same way as an open comedone, but they have blocked openings instead which prevents oxygen from reaching the centre of the spots and changing their colour. This means that closed comedones remain the same colour.
At puberty the sebaceous glands within the skin produce too much oil or sebum which clogs the pores and causes a build up of dirt, dead skin cells and bacteria. This causes inflammation in the skin and the formation of spots.
Treatment of closed comedones
Whiteheads can be treated at home. Use an over-the-counter cream, which can be purchased from a pharmacist, and keep your skin clean and dry. Avoid scented soaps and other skin care products and choose mild versions, avoiding excessive washing or scrubbing of the skin.
Do not pick, rub or scratch whiteheads as this will only worsen the symptoms and may lead to scarring. Choose non-oily or water-based make up and clean your skin each time you wear cosmetics.
If none of these work then see your GP, who will prescribe antibiotics, retinoids (Vitamin A based creams or gels) or topical steroids.
There are various types of treatment available, some of which are done under medical supervision. Several treatments for acne don't involve medication, including:
- Comedone extractor – A small pen-shaped instrument that can be used to clean out blackheads and whiteheads.
- Chemical peels – Where a chemical solution is applied to the face, causing the skin to peel off and new skin to replace it.
- Photodynamic therapy – Where light is applied to the skin in an attempt to improve symptoms of acne.
It is always advisable to have this procedure performed by a professional as any undue force applied when removing a comedone could result in an increase of inflammation and lead to potential scarring.
The technique involves a healthcare professional cleansing the area with spirit. For open comedones, a comedone extractor instrument is then placed central to the comedone and a firm downward pressure is applied. The unwanted material is then removed from the comedone. For closed comedones the top of the lesion is first pierced with a sterile needle. This will help make the extraction of the material less traumatic.
The area is then injected with a steroid which will reduce and stop any inflammation. The treated areas are then bandaged to prevent any infection. The bandage must remain on the treated area for 24 hours.
Note: Comedone extraction is not something you should try at home. Any time you squeeze a pimple, you risk spreading the bacteria, causing an infection and worsening your acne. This procedure should only be performed by a medical professional, so allow your Dermatologist to guide you.
There may be some bruising and pigment changes after the treatment, but healing is usually fairly rapid despite some soreness and inflammation to begin with. If there are any signs of infection or discomfort, the patient should contact their healthcare professional for advice.
See your GP for more information and advice on comedone extraction.
Sources used in writing this article are available on request
Information contained in this Articles page has been written by talkhealth based on available medical evidence. Our evidence-based articles are certified by the Information Standard and our sources are available on request. The content is not, though, written by medical professionals and should never be considered a substitute for medical advice. You should always seek medical advice before changing your treatment routine. talkhealth does not endorse any specific products, brands, or treatments.
Information written by the talkhealth team
Last revised: 1 May 2018
Next review: 1 May 2021