All About Closed Comedonal - The Dermatology Review

All About Closed Comedonal

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07.26.19 AD DISCLOSURE

Do you struggle with rough, bumpy skin and whiteheads? If so, did you know that this type of acne is called closed comedonal acne? Closed comedonal acne is different than blackheads, pimples, milia, and other skin conditions that seem very similar. This post is all about closed comedonal acne: what it is, what causes it, how to prevent it, and, of course, closed comedonal acne treatment.

What is closed comedonal acne?

Generally speaking, closed comedonal acne is bumpy skin and non-inflamed blemishes. However, it is probably not what you picture when you think of acne. The most common type of acne involves pimples, also known as pustules, which are usually red, inflamed, and painful. With closed comedonal acne, your skin will look and feel bumpy. These bumps won’t be red like a pimple, and they typically are the same color as your skin. In addition, closed comedones are not painful (although they are annoying!).

All inflamed pimples begin as a closed comedone. For example, if bacteria invade or the follicle wall ruptures, closed comedones can develop into inflamed pimples. However, closed comedones don’t always progress to inflamed pimples. They can remain as a non-inflamed blocked pore just under the skin’s surface. Closed comedones are considered to be a mild form of acne, appearing most often on the nose, chin, and forehead.

Closed comedones vs. blackheads

Did you know that blackheads are a type of acne known as open comedones? They appear as small, dark lesions on the skin, primarily on the face and neck. Similar to closed comedones, blackheads form when the skin pores become clogged with dead skin cells and sebum. While most people think that blackheads occur as a result of trapped dirt in the pores, this is actually not true. Rather, when pores are clogged, the melanin in the dead skin cells reacts with oxygen in the air and turns black, forming a blackhead. Thus, blackheads are made of oxidized melanin and not trapped dirt. Since closed comedones completely obstruct the pore openings and are not exposed to air, the melanin will not be oxidized. This is why closed comedones have a light color and blackheads are dark brown/black.

What causes closed comedonal acne?

Closed comedonal acne occurs when excess oil on the skin combines with dead skin cells, thereby clogging the hair follicle. There are many factors that contribute to extra oil on the face, including the following:

  • Genetics
  • Puberty
  • Hormonal imbalance
  • Hot, humid climate
  • Using harsh cleansers or skin treatments
  • Applying a lot of makeup
  • Eating a diet high in sugar and/or dairy
  • Chronic stress

If any of these factors apply to you, it’s important to use products that will help balance oil production. It’s also imperative to exfoliate on a regular basis to prevent excess dead skin cells from accumulating on the surface of skin. We will discuss closed comedonal acne treatment in more detail in the next section.

Closed comedonal acne treatment

Now that you know what closed comedones are and what causes them, you’re probably wondering what is the best closed comedonal acne treatment. Fortunately, there are several over-the-counter (OTC) options to prevent and treat closed comedonal acne.

Salicylic acid
Salicylic acid is a type of beta hydroxy acid (BHA) that is oil-soluble, which means it can easily penetrate deeply into pores. Salicylic acid exfoliates the pore lining, which loosens clogged dirt and oil and helps to wash these impurities away. It also has the ability to dissolve keratin, the protein that acts as a “glue” to keep dead skin cells together in the stratum corneum. This is effective because dead skin cells can build up on the surface of your skin, which can lead to closed comedonal acne. Salicylic acid also has antibacterial and anti-inflammatory properties. These properties help to prevent closed comedones from turning into inflammatory pustules. Overall, salicylic acid is considered to be one of the best closed comedonal acne treatments.

Benzoyl peroxide
As the name implies, benzoyl peroxide is something known as a peroxide, the technical term for an unstable bond between two oxygen atoms that can create free radicals. While free radicals often have a negative connotation, in this case they can be used to effectively kill P. acnes bacteria by destroying the cell walls. Thus, benzoyl peroxide helps to prevent closed comedonal acne from turning into inflammatory pustules. Additionally, benzoyl peroxide can exfoliate and help peel the outer layer of skin.

One drawback of benzoyl peroxide is that while it does effectively kill P. acnes, it also kills the good bacteria that keep your skin healthy. This can leave skin feeling dry and irritated, which for some people can make skin look worse. Benzoyl peroxide is available in many different types of products, including washes, creams, gels or pre-moistened cloths. The strength of benzoyl peroxide in these products varies considerably – between 2 and 10 percent.

Retinoids
The term “retinoid” includes retinol and all of its derivatives, such as retinyl palmitate, tretinoin, retinaldehyde, and more. While retinoids are well known to help decrease the appearance of fine lines and wrinkles, they can also be an effective closed comedonal acne treatment. You can use OTC retinol products, or see your dermatologist for a prescription-strength retinoid.

Closed comedones extraction tips

The skin care ingredients mentioned above are effective for both the prevention and treatment of closed comedonal acne. But what if you need to get rid of a closed comedone, like, today? We understand that closed comedonal acne can often be embarrassing, which is why below we have our top 3 closed comedones extraction tips.

1. Don’t use your fingers
While it’s nearly impossible to resist squeezing a whitehead when you get an up-close glance at it in the mirror, ignoring this temptation would be in the best interest of your skin. Picking at closed comedonal acne can cause irritation and lead to inflammation, as well as lead to scarring, infection, and dark spots due to post-inflammatory hyperpigmentation. Since the risks clearly outweigh the benefits when it comes to using fingers to extract comedones, we have some safer closed comedones extraction tips below.

2. Invest in extraction tools
Since you now know why using your fingers to extract closed comedones is not the best idea, you’re probably wondering what you can use to extract those pesky little guys. This is where extraction tools come into play. Extraction tools can be used for both blackheads and whiteheads. They come in a set with a variety of shapes and sizes because each tool is designed to tackle a different problem. After determining which type of extraction tool is best for your needs, gently press down around the clogged pore to extract the closed comedone. It’s important not to apply too much pressure, as this could lead to skin damage and inflammation. Overall, it’s worth investing in a set of extraction tools so you won’t be tempted to squeeze with your fingers.

3. Prep your skin before you extract
Before you get started with your extraction tools, it’s important to properly prep your skin. Start by washing your face with a mild cleanser while taking a warm shower. The steam from the shower will help to soften hardened oil in pores, allowing the oil to be emulsified by your cleanser. (Note: it is a myth that the warm water will “open” pores because pores don’t have muscles around their opening to allow them to open and close!) After your shower, it’s almost time for extraction! The final step to get your skin ready is to apply a thin layer of a heavy moisturizer immediately after getting out of the shower. The moisturizer should contain occlusive ingredients, such as shea butter or jojoba oil, because these ingredients will create a temporary occlusive seal to trap heat in the skin. This allows for easier closed comedonal extraction.

One thing to keep in mind with closed comedones extraction: give up on stubborn ones. If you encounter a stubborn whitehead that just won’t dislodge, it is best to leave it alone! A good rule of thumb is to try removing the closed comedone two times, then give up to avoid the risk of damaging your skin or possibly breaking a capillary.

References: VeryWellHealth.com “Causes and Treatment of Closed Comedones” May 2019, Healthline.com “What Is Comedonal Acne and How Is It Treated?”

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