What are comedones? What causes them and how are they treated?

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What you need to know about comedones

Comedones, the earliest and most basic lesions of acne, are blackheads or whiteheads that form when sebum and dead skin cells accumulate at the opening of hair follicles. This common condition is one of the first signs that the normal function of the skin’s pores has temporarily become disrupted.

These small lesions are not limited to the face. They frequently appear on the forehead, nose, and chin, as well as on areas where sebaceous glands are particularly active, such as the chest, shoulders, and back. Although they generally do not cause significant redness or pain in the early stages, if they are not treated appropriately, they may eventually develop into deeper and inflamed acne lesions.

In the rest of this article, we will examine why comedones form, how they can be distinguished from other skin conditions, and the treatment steps that can be taken while protecting the skin.

What are the differences between open and closed comedones?

The main difference between open and closed comedones depends on whether the blocked hair follicle remains open to the skin surface. Although both are considered non-inflammatory forms of acne, the condition of the pore opening completely changes the clinical appearance of the lesion.

When the follicle remains open, the cellular material inside comes into contact with air and oxidizes, forming open comedones, commonly known as blackheads. Although their dark color is often mistakenly thought to be caused by dirt, it is actually the result of a chemical reaction that occurs when the contents of the follicle are exposed to air. For this reason, trying to remove blackheads by scrubbing the skin with harsh exfoliating tools or vigorous rubbing does not help and may instead irritate the skin.

When the pore is covered by a thin layer of skin, sebum becomes trapped beneath the surface. These white or skin-colored bumps, which are particularly common on the forehead and chin, are known as closed comedones or whiteheads. Clinical observations show that open and closed forms often occur together in the same person and may eventually accompany other types of acne lesions.

Are comedones, milia, and sebaceous filaments the same thing?

Comedones caused by clogged pores are frequently confused with other skin conditions. However, not every lesion visible on the skin surface develops for the same reason. The most common structures that may look similar can be distinguished as follows:

• Milia: Although they closely resemble closed comedones, milia are small, firm, benign cysts containing keratin that develop just beneath the skin surface. They are usually pearly white or yellowish and are particularly common around the eyes and on the cheeks. Some milia may disappear on their own over time.
• Sebaceous filaments: These are not a disease or acne lesion but normal anatomical structures that help transport naturally produced sebum to the skin surface. They are commonly seen around the nose and chin as small gray-yellow or light brown dots. Unlike blackheads, even if they are cleared, they quickly become visible again because they are a natural part of the skin’s structure.

The visual similarity between these lesions is one of the main reasons for inappropriate interventions at home. In other words, people frequently make the mistake of treating different-looking but similar lesions in exactly the same way. Unnecessary squeezing or peeling procedures performed after incorrectly identifying a lesion can cause significant irritation to the skin barrier.

Therefore, if the type of lesion cannot be clearly distinguished, the safest approach is to avoid unsuitable products or interventions that may damage the skin and consult a dermatologist for an accurate diagnosis and appropriate treatment.

What causes comedones?

Comedones develop when pores become clogged with sebum and dead skin cells. Under normal circumstances, oil and cells within the follicle are naturally carried to the skin surface and removed. However, disruption of the normal cell turnover cycle and increased sebum production can contribute to blockage of the follicle.

Contrary to common belief, comedone formation is not associated with having dirty skin. Hormonal changes, particularly during puberty or the menstrual cycle, genetic predisposition, and increased sebum production are among the main factors involved in this process.

Apart from genetic and hormonal factors, which incorrect practices in a daily skincare routine can increase these blockages, and what should be considered to protect the skin?

Which skincare mistakes can increase comedones?

In addition to genetic and hormonal factors, certain inappropriate external interventions and habits can directly increase the number of skin lesions. The main factors commonly associated with lesion development include:

• Use of comedogenic products: Certain cosmetics and haircare products with a high oil content or a tendency to clog pores may accelerate lesion formation, particularly around the forehead and hairline.
• Physical irritation of the skin: Scrubbing blackheads or whiteheads with harsh exfoliating tools, using aggressive peeling procedures, or squeezing existing lesions can damage the follicular structure and worsen acne.
• Environmental factors and diet: Although the relationship between diet and acne varies from person to person, it is not medically accurate to identify a single food or habit as a direct cause. However, stress-related hormonal fluctuations may indirectly influence sebum production.

On the other hand, a comprehensive assessment of products used at home and possible environmental factors during a dermatological examination is particularly important in the following situations:

• If the number of lesions suddenly increases significantly
• If the lesions first appear in adulthood
• If they occur together with inflammatory acne lesions

How are closed comedones on the face treated?

The main goals of treating closed comedones on the face are to open clogged hair follicles, reduce the accumulation of keratin and sebum, and control the formation of new lesions. Above all, treatment requires patience and consistent skincare.

The answer to the frequently asked question “How can closed comedones on the face be treated?” lies not in short-term applications lasting only a few days, but in maintaining a consistent routine. Time is needed to properly assess the effectiveness of acne treatment, and noticeable improvement often requires at least 6–8 weeks of regular care.
So, which ingredients can be used at home to help control comedones, and which dermatological methods may be considered for persistent lesions?

Ingredients that can be used for comedone care at home

Comedone care is not limited to the use of active acids. Gentle cleansing and choosing products with a low risk of clogging pores are also important parts of the process. Salicylic acid is commonly used in home skincare routines. It is an effective option that can help remove cellular buildup from within the pores. Azelaic acid is also frequently used to help manage both acne lesions and discoloration that may develop after acne.

However, using several exfoliating acids or strong active ingredients together without proper guidance in an attempt to achieve faster results may irritate the skin barrier rather than accelerate improvement. For this reason, the choice of ingredients and whether they can be used together should be determined according to the skin’s tolerance level.

Dermatological methods used in comedone treatment

Topical retinoids are among the most commonly used medical treatments for persistent comedonal acne. Retinoids help regulate cell turnover within the follicle, promote the opening of clogged pores, and reduce the formation of new lesions.

Mild dryness, peeling, or irritation may occur during the first few weeks of treatment. Particularly in special circumstances such as pregnancy or plans for pregnancy, treatment should always be initiated under medical supervision. When necessary, medical comedone extraction may be performed by dermatologists in a clinical setting using appropriate sterile techniques.

If lesions do not improve despite consistent care, continue to spread, or develop into inflammatory acne lesions, a comprehensive dermatological evaluation is necessary. At this stage, rather than focusing solely on removing individual lesions, the overall extent of the acne, cosmetic products being used, and possible hormonal factors are evaluated together to create a personalized treatment plan.

Warnings and recommendations from the dermatology doctors at Aktif International Hospital

Our dermatology specialists draw attention to the following important points regarding common mistakes made during comedone treatment and daily skincare:

• Constantly changing products or using several strong active ingredients at the same time in an attempt to achieve rapid results can place unnecessary stress on the skin. Treatment should be given sufficient time to work, and a consistent routine suitable for the individual’s skin type should be preferred in order to determine which applications are actually beneficial.
• Medical products applied to the skin should not necessarily be used only on existing blackheads or whiteheads. To help prevent new blockages from developing, they should be applied to all affected areas as instructed by the physician.
• The idea that “more exfoliation means cleaner pores” can directly damage the skin barrier, so aggressive approaches should be avoided. Burning, significant redness, or excessive peeling after using a product does not mean that the treatment is working; it may indicate that the skin has become irritated or damaged.
• As skin sensitivity may increase during treatments containing retinoids, a non-comedogenic sunscreen with at least SPF 30 should be included in the daily skincare routine.
• If lesions continue to increase or develop into inflamed and painful acne, trial-and-error methods at home should be discontinued and medical support should be sought for a comprehensive treatment plan.

Should comedones be squeezed? Can they leave scars?

One of the most common mistakes made when dealing with clogged pores is physically manipulating the lesions. Particularly with closed comedones, the contents remain trapped beneath the skin surface, so forceful manipulation can directly damage the follicle wall.

Damage to the follicle wall can increase redness and inflammation and, in some cases, may lead to infection, discoloration, or permanent acne scarring. For this reason, dermatologists frequently emphasize that improperly squeezing blackheads and whiteheads can significantly increase the risk of scarring.

The answer to the question “Do comedones leave scars?”, which is a major concern for many patients, depends largely on how the lesion progresses and whether it is physically manipulated. Superficial lesions that are not accompanied by inflammation generally heal without causing permanent tissue damage.

In addition, not every red or dark mark that appears on the skin after a lesion is a true scar. These marks are often temporary post-inflammatory changes in skin color and, unlike permanent depressed scars, tend to fade over time. The risk of true and permanent scarring increases mainly when a lesion develops into inflammatory acne, becomes deeper, and is repeatedly picked or squeezed.

It is not possible to permanently clear the pores by squeezing blackheads, particularly around the nose and chin. Because the biological process responsible for the blockage continues, the lesions can reappear within a short time, while repeated pressure only irritates the skin. For persistent lesions, instead of potentially harmful interventions at home, medical treatments performed by dermatologists under sterile clinical conditions may be considered a safer option.