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Comedonal acne is an extremely common, yet often misunderstood, form of acne. It is not characterized by inflamed pimples and pustules, characteristic of acne vulgaris (the most common presentation of acne). Instead, comedonal acne causes bumpy skin, blackheads, non-inflamed blemishes, and microcomedones to form on the skin. Microcomedones signal the beginning of an acne lesion and occur when the skin’s sebaceous ducts and pore openings become clogged with excess sebum and dead skin cells. Providing effective, clinical treatments for all stages and types of acne, our dermatologists in Gainesville are committed to helping our patients achieve healthy, beautiful skin.

Contact our Gainesville dermatology practice today to schedule an appointment and to learn more about our acne treatments and other skin conditions.

What Is A Microcomedone?

 A microcomedone signals the primary stage of acne. Several factors contribute to the start of acne lesions. Corneocytes, also known as skin cells, take on a sticky texture as they are shed from the skin’s surface, accumulating within pores instead of dispersing out onto the skin. A greater number of skin cells are shed at the top of the skin’s pores than at the bottom. Thereafter, sebum production increases. During this stage of acne, the pore may appear normal to the naked eye, but there are noticeable changes in the cells that surround the pore.

As shed skin cells, sebum, and bacteria accumulate within the pore, they create a bottleneck that prevents the skin from sloughing off the dead skin cells. The clinical term for this is called a microcomedone. Propionibacterium acnes, or P. acnes, is a bacterium that normally resides inside our pores. This bacterium uses sebum as a nutrient for growth, and as sebum production increases, so too do the number of P. acnes bacteria. 

What Is Comedonal Acne?

A common but often misunderstood form of ance, comedonal acne doesn’t feature inflamed pimples, pustules, and lesions, but instead, it causes the skin to become bumpy and develop blackheads and other non-inflamed types of blemishes. The body is covered with hair follicles. Comedonal acne develops when a hair follicle becomes blocked by sebum, a waxy type of skin oil, and dead skin cells, among other types of debris. A single lesion is known as a comedo, while multiple bumps are referred to as comedones. Comedones are small, flesh-colored papules that usually develop on the forehead or chin, though they can occur anywhere. Whiteheads and blackheads are among the most common types of comedonal acne, though other types of comedonal acne may occur as well.

Open Comedones

Open comedones, or blackheads, occur when the debris and oil that plug the pore is located near the pore’s opening. They can be grey, black, brown, or another deep color. Blackheads are open-faced. When the melanin pigment found in the sebum produced by oil glands makes contact with the air at the top of the open comedone, the comedone oxidizes and turns dark. This is why blackheads have a dark appearance. 

Closed Comedones

Closed comedones, also called whiteheads, form when a hair follicle becomes completely blocked or clogged. They can range in color from white to flesh-colored. They often appearon the forehead, chin, and cheeks, though they can appear anywhere on the skin. Whiteheads are not usually painful, and unlike blackheads, which can be pushed out, whiteheads are closed within the pore and cannot be pushed out. 


A microcomedo cannot be seen with the naked eye and can only be seen under magnification with a microscope. Microcomedones occur with the minor clogging of the hair follicles with sebum, dead skin cells, and other debris. These comedones can develop into acne lesions and are typically treated with topical medications.


Macrocomedones are typically larger than 2 or 3 millimeters in diameter. They appear as white or skin-colored bumps that develop just under the top layer of the skin. You may be able to see them by stretching the skin and observing them using a sidelight. They are either closed or open comedones, but they are often open as they are large enough to push to the opening of a pore. 

Giant Comedo

A giant comedo is a type of blackhead that ranges in size from several millimeters to 2 centimeters in diameter. They usually occur as a single blackhead and primarily affect older adults, though they may occur in people at any age. Also known as an epidermal cyst, or a dilated pore of Winer, giant comedones are exceptionally large blackheads.

Solar Comedones

A solar comedone, also known as a senile comedo, is a small, skin-colored papule found on the face of individuals who are middle-aged or more mature. These non-inflammatory lesions affect the areas of skin that have been exposed to sunlight for extended perioda. They may be either whiteheads or blackheads, and they don’t typically become inflamed.

What Causes Microcomedones?

Microcomedone acne occurs when the skin’s sebaceous ducts and pore openings become clogged with excess sebum and dead skin cells. This causes the affected pores to bulge outward, creating bumps. Several factors can contribute to the development of microcomedones and comedonal acne, including the following.

  • Irritation to the skin from contact with oils, dyes, and other irritants
  • Excessive production of testosterone, which increases oil production
  • Aggressive contact with the skin, such as squeezing or attempting to pop pimples and acne lesions, as well as chemical peels, or rough exfoliation. 

People who smoke are typically more likely to experience microcomedones and comedonal acne. Additionally, for some individuals, certain dietary factors may play a role in the development of this form of acne.

Where Do Microcomedones Appear?

Dermatologists generally consider comedonal acne to be a mild-to-moderate form of acne that usually lasts 1–3 weeks but can remain longer in some cases. Microcomedones and other forms of comedonal acne can appear anywhere on the body that is covered with skin that contains pores and hair follicles. This form of acne commonly appears on the face, such as the cheeks, forehead, chin, and nose, as well as the body, such as the back, chest, and neck, though it may appear elsewhere. For additional information, please contact Gainesville Dermatology & Skin Surgery to schedule an appointment with our dermatologists.

How Are Microcomedones Diagnosed?

Comedonal acne can usually be diagnosed by your dermatologist based on the appearance of the lesion alone. As with most other forms of comedonal acne, microcomedone lesions tend to be small. Nodular acne lesions, in contrast, can cause larger, tender, fluid-filled lesions to form. Due to their small size, microcomedones can be too tiny to see with the eye and can only be seen under a microscope or with specific lighting and magnification.

Your dermatologist will inspect your skin and provide recommendations about any possible tests they recommend for confirming a diagnosis and possible treatments. If your comedonal acne does not improve with topical treatments, your dermatologist may test your skin to determine whether you have another skin condition, such as keratosis pilaris, sebaceous hyperplasia, basal cell carcinoma, and fibrofolliculoma, among other skin conditions.

How Do Dermatologists Remove Comedones?

The best way to stop comedonal acne and microcomedones is to target the source of the lesions, which is excessive sebum production from the body’s sebaceous glands. As a result, individuals using over-the-counter medications and products to clear up their comedonal acne may not achieve the results they seek. Patients should speak with their skincare specialist and dermatologist about possible comedone removal procedures and microcomedone treatment options for their skin’s unique needs. Your dermatologist may recommend one or more of the following treatments for your comedonal acne and microcomedones.

Topical Treatments

Topical acne treatments are applied directly onto the face to control excess production ofsebum and to unclog existing comedones and blocked pores. Common topical treatment options for acne may include the following ingredients. It’s important to note that those who use topical acne treatments should maintain extra vigilance regarding protecting their skin from the sun. Wear sunscreen (with an SPF of 35, at minimum) every day, and reapply it throughout the day, while using these products, especially acids and retinol-based ingredients. These powerful treatments remove the skin's outermost layer, drastically increasing your skin’s sensitivity to the sun.

  • Azelaic acid
  • Benzoyl-peroxide
  • Glycolic acid
  • Salicylic acid
  • Retinoids
  • Sulfur

Prescription Medications

Some over-the-counter products may be beneficial to start managing your acne, but they might not always prove successful. When these products fall short, you may require a prescription-strength topical or oral medication from your dermatologist. Your dermatologist may recommend the following medications. As with topical medications, prescription medications can put you at high risk for skin damage and sunburn, so it is vital that you wear and reapply sunscreen every day. Ask your dermatologist about their recommendations for sunscreens and sun-protective products.

  • Antibiotics
  • Oral contraceptives
  • Isotretinoin (Accutane)
  • Spironolactone

How To Prevent Comedonal Acne

In many cases, there may be effective ways to help reduce the number of comedonal acne lesions and microcomedones. These tips can help you reduce acne breakouts, achieve greater skin health, and clear your skin of comedonal spots. For additional information about inflammatory and noninflammatory acne and our available microcomedones treatments, please contact our Gainesville dermatology office. We look forward to helping you achieve healthy, beautiful skin.

  • Schedule and attend regular appointments with your dermatologist
  • Be mindful of ingredients in your skincare products
  • Avoid exposure to natural sunlight
  • Center your diet around fresh fruits and vegetables
  • Exercise regularly and bathe immediately afterward
  • Maintain clean skin using dermatologist-recommended products
  • Reduce the amount of stress you experience regularly