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Guide on Comedones (Comedonal Acne)

Comedonal Acne Treatment Patient

What are Comedones?

Comedones, also known as comedonal acne, are a form of acne that presents as small, different-coloured bumps (usually flesh-coloured, white, or darker) that give your skin a rough texture, predominantly on the chin, cheeks, and forehead. You can often see a solid core in the middle of the small bump, usually presenting as a pustule or white head, and comedones are found at the opening of skin pores.

Types of Comedones

There are two main types of comedonal acne: open and closed. The main difference between the two lies in their colour.

Open Comedones

Open comedones, also known as blackheads, result from surface pigment collecting in the pores, forming dark dots and full pores on the skin. While you may think these dots are dirt, they are not. Open comedones can also come in the form of giant comedones, a type of cyst/large lesion with a blackhead-like opening.

Closed Comedones

Closed comedones, also known as whiteheads, occur when the skin follicle is blocked. Closed comedones come in two forms, microcomedones and macrocomedones. Microcomedones are extremely small and not visible to the naked eye, while macrocomedones are usually 2-3 millimetres in diameter. They present as pustules or bumps under the skin where bacteria collects.

Causes of Comedones

When thinking about what causes comedones, you have to think about factors that typically cause acne. The anatomy of comedone formation and why they tend to appear during adolescence is due to the role of hormonal changes during puberty and the increase in sebum secretion, a naturally occurring oil on the skin that can cause acne (comedones) when too much builds up or mixes with bacteria.

Comedones can appear on the skin when cells experience increased sebum production, causing a blockage with debris in sebaceous ducts and hair follicles. Comedones can also be inflamed and typically appear on more susceptible skin types, such as oily skin or dry skin, with environmental factors that clog the pores.
Factors that can also create or further worsen comedones include diet, improper skin care, alcohol, smoking, and environmental aspects. The development of comedones is predominantly due to the below causes.

Hormonal Changes

During puberty, there is an explosion of hormones coursing through your body, causing a myriad of frustrating issues – one of them being acne, or comedones. Excessive testosterone activity within skin cells can cause both open or closed comedones, and fatty acids from sebum caused by acne bacteria create clogged pores.

Whether it’s a simple zit or a complex comedone, it’s completely normal to experience acne during hormonal changes, such as puberty or pregnancy. But if the comedones stick around, you may want to seek a skin rejuvenating treatment.


Dietary factors, such as sugar, fat, or lactose consumption from dairy, can cause breakouts on the skin due to adverse reactions or the body’s inability to break down these substances. Even if you eat healthily, a sudden switch in diet can cause comedones as it confuses your body and skin.

Oily Cosmetic Products

Overhydrated skin from moisturizers, hair pomades, or humidity can cause a buildup of sebum, bacteria, and moisture that creates comedones. Contact with oily chemicals and certain dyes in cosmetics can also cause adverse reactions, resulting in acne and comedones. If changing your skincare routine doesn’t work, a skin treatment from SpaMedica can.

Unhealthy Lifestyle

Partaking in smoking, drug use, or excessive alcohol consumption clogs pores and restricts blood flow to the skin, causing comedones to form. If you can’t quit these vices completely, SpaMedica at least suggests that you stop partaking 2 weeks before and after your treatment to optimize your healing.

Aggressive Facial Cleansing

Reduced salt content of the essential linoleic acid – which can be found in gentle cleansers – can cause sebum to scale and reduce barrier function. When you continue to use aggressive exfoliants and cleansers with harsh chemicals, a rupture of follicles and pores can occur, especially if you pop your pimples when they show up. Try to stick with gentle skincare products that have natural ingredients and no fragrance.

Environmental Factors

Environmental factors such as air pollution, humidity, and a lack of sunshine can clog your pores and leave you with dull-looking, unhealthy skin. Cell signaling proteins lining the follicles in response to activation of the immune system cause comedones to pop up, and unless you leave the environment you are in, it is difficult for them to go away on their own.

What is the Difference Between Fungal Acne, Milia, and Closed Comedones?

Similar factors may cause these three forms of acne and appear in similar forms, but they are also present in different ways – highlighted in the tables below.

Fungal Acne vs. Closed Comedones

Fungal acne and closed comedones are often mistaken for one another, as they are often unresponsive to typical acne medication, but only fungal acne can cause inflamed, irritated hair follicles and pores with clusters of pus-filled bumps.

Differences and Similarities Fungal Acne Closed Comedones
Appearance Presents as small, red bumps on the skin. Presents as whiteheads on the skin.
Areas Affected Fungal acne appears wherever hair grows, usually on the cheeks, forehead, chest, and upper back. Comedones are usually present on the face, chin, cheeks, and forehead.
Causes Fungal acne is commonly caused by skin rubbing against skin, leaving skin hot or damp, shaving, plucking, waxing, touching skin too frequently, using a hot tub or bathtub often, or wearing tight clothes. Closed comedones can be caused by an excess of sebum oil on the skin mixed with dead skin cells and surface debris. This oil and debris collects in your pores and blocks the hair follicle, creating small bumps.

Milia vs. Closed Comedones

While Millia generally appears around the eyes as hard, white, or yellow bumps that you cannot pop, closed comedones appear as typically poppable whiteheads on various areas of the face. Below, you can learn if your blemishes can be categorized as milia or closed comedones so you can seek out the necessary treatment.

Differences and Similarities Milia Closed Comedones
Appearance Milia presents as white or yellow bumps that occur in clusters on the skin. Presents as whiteheads on the skin.
Areas Affected Milia can be seen on both the face and body and can feel hard but are not painful. Comedones usually present on the face, on the chin, cheeks, and forehead.
Causes These clusters of bumps on the skin are caused by dead skin cells not leaving the area properly and getting trapped within the skin, causing cysts. Closed comedones can be caused by an excess of sebum oil on the skin mixed with dead skin cells and surface debris. This oil and debris collects in your pores and blocks the hair follicle, creating small bumps.

Comedones Treatment

Dietary Changes

Some changes you can make to your diet as a way to reduce the appearance of comedones on your skin include consuming low-glycemic foods, such as fresh vegetables, fresh fruits, beans, and oats. Reducing the amount of sugar, fat, oil, and dairy you consume is also beneficial.

Skincare Procedures

SpaMedica provides various skin rejuvenating and acne-reducing treatments, including:

Blue Light Therapy

A blue light therapy treatment involves a series of intense blue lights applied to the area requiring treatment. The heating light will evaporate or absorb any acne, spots, freckles, or hyperpigmentation. Unlike traditional laser treatment, blue light therapy penetrates all layers of the skin, seeking out and attacking the acne bacteria living in the sebaceous gland.
For moderate or advanced acne, SpaMedica dermatologists recommend applying Alpha Levulinic Acid (ALA) before your blue light treatment, which is activated by the blue light and targets the acne bacteria.

Chemical Peels

A chemical peel is a non-surgical cosmetic procedure used to improve the overall texture and appearance of new, healthy skin. Superficial peels use a chemical solution applied to the skin, which can include salicylic, azelaic, and/or glycolic acids, that gently removes the skin’s outermost layer, revealing more youthful skin with fewer imperfections and fine lines, more even texture and tone, and minimized scarring and pitting.


This treatment uses a special application that sands away the thick outer layer of the skin to rejuvenate it, eliminate skin concerns, and promote collagen production. Different microdermabrasion techniques like Crystal Peel spray fine aluminum particles combined with suction to create the same abrasive effect on the outer layer of the skin.
SpaMedica offers three types of microdermabrasion: SilkPeel, Crystal Peel, and SonoPeel. Learn more about them here.

Products for Closed Comedones

Benzoyl Peroxide

Benzoyl peroxide is commonly used to treat mild to moderate acne by reducing the amount of bacteria on the treatment area and causing the skin to dry out and peel off, revealing the new layer of skin underneath.


Differin is a topical acne medication that contains a form of retinoid derived from vitamin A that slows down the process of growth in the lining of your pores, desensitizing the skin to inflammation.


Retinol is known to increase skin cell production, helping to unclog pores, exfoliate your skin, and increase collagen production – giving your skin a fresher appearance.

Skincare Advice

Some simple skincare advice you can incorporate into your routine before or after seeking out a SpaMedica treatment includes:

  • Wash acne-prone areas no more than twice a day to avoid skin irritation.
  • Opt for oil-free products for washing, moisturizing, and makeup use to minimize pore clogging.
  • Clean all makeup brushes and applicators regularly.
  • Remove all makeup before going to bed.
  • Wash your sheets and pillowcases weekly.
  • Avoid allowing sweat and oil to remain on your skin by showering after workouts or other strenuous activities.
  • Maintain a healthy lifestyle by participating in a balanced diet, regular exercise, and a skincare routine suited to you – all of this can help reduce comedones production.

Choose SpaMedica for your Comedones Treatment

Take the first step towards an effective comedone treatment that works by contacting the SpaMedica team to book a consultation. Over the past 22 years, SpaMedica has used industry-leading technology to pioneer new, non-invasive skincare combinations and therapies, becoming Canada’s most recognized aesthetic skincare centre.

By SpaMedica Infinite Vitality Clinic Non-Surgical

The team at Toronto's SpaMedica comprises a distinguished group of Canada's top dermatologists, nurses, and technicians, specializing in non-surgical cosmetic procedures. With a wealth of experience and credentials, the team expertly delivers anti-aging, body contouring, laser skin, skincare, and vaginal treatments. Known for their commitment to patient care and exceptional results, the medspa team continues to lead the industry in innovative techniques.
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