What Are Closed Comedones? Here's How To Identify & Treat Whiteheads
When most of us think of "acne," we think of big red, poppable pimples. These are not the only kinds of zits or breakouts, however. Breakouts, like skin itself, can come in many different varieties—some obvious and some less so. Closed comedones fall into the latter category: This pesky subgroup of acne may not be as pronounced as visibly inflamed zits, but they form under skin and they can cause textural issues.
What are closed comedones?
"Closed comedones are whiteheads; they look like tiny whitish or flesh-colored bumps on the surface of the skin," says board certified dermatologist Daniel Belkin, M.D. "By definition, they are non-inflamed, meaning they are not red. The next stage of acne occurs when non-inflamed whiteheads and blackheads become inflamed and turn into 'pimples' or inflammatory papules and pustules."
The problem is many people get confused about what an actual "whitehead" is—whiteheads are not the large, tender zits with a big pus-filled center (those are pustules). Instead, whiteheads are not visibly inflamed and therefore are much more subtle. Also, not every whitehead needs to have a white dot at its center; whiteheads can just appear as small, fleshy bumps on the skin. You may not even be able to notice the bumps in your reflection: Sometimes they are so subtle that you can only feel them when touching your face.
This type of acne is more often caused by excessive sebum production, occlusive or comedogenic creams or makeup ("Often heavy products with oils can worsen or cause this type of acne," says board-certified dermatologist Jennifer Herrmann, M.D.), regular friction on a specific area, or humid weather. It can also be hereditary, meaning if you have it, you may just be genetically predisposed to the condition and it is out of your control. Annoyingly, they can also be the result of irritation from skin care products designed to keep them away, notes board-certified dermatologist Kautilya Shaurya, M.D.: "[These can be formed by] causing irritation to the hair follicle by squeezing pimples, chemical peels, or laser treatments."
Closed comedones can lead to inflamed zits down the line, especially when left untreated. That's why it's vital to tend to these from the start—you'll likely save your skin some strife in the long run. Not to mention, if you accumulate enough of them, they can start to change your skin's texture and overall appearance, making the skin look "congested."
Closed comedones versus other types of acne.
All forms of acne have a similar origin story ("Dead skin cells accumulate in and block the pore, after which debris and bacteria accumulate," says Belkin) but have different results based on several variables. Here's the difference between closed comedones and other types of acne:
- Blackheads and sebum plugs: These are the most similar to closed comedones, but instead of the debris staying below the surface, blackheads and sebum plugs have an open pore leading to the darker appearance. "An open comedone, or blackhead, occurs when this debris is exposed to the air, whereas a closed comedone, or whitehead, occurs when the debris is just under the surface of the skin and not exposed to the air," says Belkin.
- Pustules and cysts. These are inflamed pimples. These are the classic blemishes that come to mind when you think of acne. These start off as closed comedones (meaning, a blocked pore below the surface of the skin) but then become inflamed. These are much harder to treat and can lead to scarring, so it's important to look for signs of comedones before they become red.
How to treat them.
All the dermatologists surveyed agreed: To treat these, stick to the tried-and-true acne-mending ingredients. This includes AHAs, BHAs, and retinoids. Of course, consult with your skin care practitioner for a more tailored treatment that works for you, too. "Comedonal acne should be treated with chemical exfoliators such as the alpha-hydroxy acids glycolic acid and lactic acid, as well as the 'pore-busting' beta-hydroxy acid, aka salicylic acid," says Belkin. You should use chemical or physical exfoliators for this type of acne as the root of the problem is under the skin, so you need to use actives that are able to penetrate deeper into the epidermis. Physical exfoliators only work on the outermost layers.
As for in-office treatments, you can get a professional-grade peel or find a trusted derm to perform extractions: "Extractions can be helpful for comedonal acne with your board-certified dermatologist," says Belkin.
Given that we know that closed comedones can also be the result of overexfoliation or acne treatments, it's vital that you find the right balance. Do not exfoliate to the point of burning or irritation, full stop. And it's wise to buffer AHAs, BHAs, and retinoids with a soothing, non-clogging moisturizer on top so your skin stays moisturized while sloughing off dead skin cells.
If you occasionally feel or see small bumps on the skin, that aren't tender or inflamed nor have a black dot at the center, you're dealing with closed comedones. These pesky zits may not register as "acne" the way we typically think of it, but they are no less frustrating—and if left untreated can lead to bigger issues down the line.
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