Comedones: What Causes Them, How a Dermatologist Tells Open from Closed Types, 5 Conditions Mistaken for Comedones, and Treatment That Lasts
Comedones (clogged pores) are "non-inflammatory" acne lesions that form when hair follicles become blocked with oil and dead skin cells. They are not caused by dirt from outside, and they do not result from "not washing your face clean enough" alone, as many people believe. Understanding the real mechanism is the first step toward the right treatment. In this article, Dr. Patara Voravutinon, a dermatologist, explains what truly causes comedones, why many conditions that "look like comedones" are not acne at all, and the evidence-based approach to treatment that clears them without constant recurrence.
What Are Comedones, and Why Does Every Pimple Start with One?
In medicine, a comedone is the earliest lesion of acne, appearing before a pimple becomes an inflamed red bump or pustule. It is formally called a comedone, and there are two main types depending on whether the pore opens to the skin surface.
Open comedone (blackhead): the follicle opens onto the skin surface. The oil trapped inside is exposed to air and oxidizes until it turns black. It is not dirt, so it cannot be washed away.
Closed comedone (whitehead): the follicle is covered by a thin layer of skin, so oil is trapped underneath as a small skin-colored or white bump that feels rough to the touch. It usually has no head to squeeze.
Because comedones are the starting point of inflamed acne, managing them well from the beginning is the most effective way to prevent inflamed pimples, redness, and the acne scars that follow.
What Causes Comedones? Four Factors Working Together
Comedones do not have a single cause. They result from several processes in the hair follicle happening at the same time. Dermatologists describe it as a four-step process.
The oil glands produce more oil: this is often driven by androgen hormones, which is why acne flares in teenagers, around menstruation, or when hormones are out of balance.
Skin cells in the follicle shed abnormally (hyperkeratinization): cells that should shed instead stick together and plug the pore. This is the core of how comedones form and is often overlooked.
The bacterium Cutibacterium acnes: it lives in oil-rich follicles and plays a role once the pimple becomes inflamed.
Low-grade inflammation: current research shows that inflammation is present even in comedones that are not yet red.
External factors that "fuel" these processes include comedogenic products, heavy makeup, hats or masks that rub and trap moisture (mask acne), humidity and sweat, and certain medications such as steroids.
Blackheads vs. Whiteheads: How Do They Differ, and Why Is Treatment the Same?
Many people think blackheads are "deep-seated dirt" and try to scrub or peel them away. This is a misunderstanding.
Blackheads get their black color from melanin pigment and oil reacting with air, not from dust, so scrubbing only irritates the skin.
Whiteheads sit beneath closed skin, so they are more likely to become inflamed pimples when squeezed or picked.
Although they look different, both have the same root cause: a blocked follicle. The main treatment is therefore the same, which is to use medication that normalizes skin cell turnover rather than scrubbing or squeezing them out one at a time.
5 Conditions Mistaken for "Comedones": The Most Common Misdiagnoses
This is the most important section, and the reason many people "treat comedones for ages without results": what they have is actually not comedones. A dermatologist will always rule out the following conditions first.
Milia: tiny, hard white bumps under the skin, often around the eyes and on the cheekbones, caused by keratin cysts beneath the surface. They cannot be squeezed out like pimples and need to be removed by a doctor with a needle. They do not respond to face washing or extraction.
Sebaceous hyperplasia: yellowish raised bumps with a small dip in the center, usually on the forehead and cheeks of middle-aged and older adults. They are enlarged oil glands, not blocked follicles.
Keratosis pilaris: small rough bumps like goose bumps on the upper arms, thighs, and cheeks, caused by keratin plugging the base of hair follicles. It is not acne and does not improve with ordinary acne medication.
Sebaceous filaments: tiny gray dots on the sides of the nose that are a normal skin structure. They are not blackheads. Repeatedly squeezing or peeling them off can make pores look larger.
Fungal acne (Malassezia / Pityrosporum folliculitis): small, uniform bumps in clusters on the forehead, hairline, back, and chest, with mild itching. It is caused by yeast, so acne spot treatments and antibiotics tend to make it worse, and it needs antifungal treatment. This is the most common reason that "small clogged-pore bumps" never clear up.
If you have followed proper comedone care consistently for several weeks with no improvement at all, suspect that you may have one of the conditions above and see a dermatologist for an accurate diagnosis.
Why Squeezing, Pressing, and Peeling Make Comedones Worse
Trying to "clear" comedones yourself often makes them worse, for clear medical reasons.
Squeezing or picking pushes oil and bacteria deeper into the skin, turning a non-inflamed comedone into an inflamed red pimple and raising the risk of dark marks and permanent acne scars.
Pore strips only pull out the top of a normal sebaceous filament without treating the cause, and repeated use irritates the skin.
Harsh scrubbing or coarse scrubs damage the skin barrier and can push oil glands to work harder.
Washing your face too often leaves skin dry and tight, and it then produces more oil to compensate.
A dermatologist's principle is that comedones are treated by correcting the "skin cell turnover process inside the follicle," not by removing them one at a time.
How to Treat Comedones Effectively: An Evidence-Based Approach
Evidence-based treatment of comedones relies on topical medication that regulates skin cell turnover, rather than antibiotics, because comedones are not yet an inflammatory infection. Dermatologists usually proceed in the following order.
Topical retinoids such as adapalene or tretinoin are the main and most important medication for comedones, because they normalize skin cell turnover in the follicle and prevent new blockages. Start gradually, every other night, so the skin can adjust, and apply at night.
BHA exfoliating acid (salicylic acid) is oil-soluble, so it cleans inside the follicle well and works well alongside a retinoid.
Azelaic acid helps reduce blockages and dark marks, and suits sensitive skin and pregnant women who cannot use retinoids.
Benzoyl peroxide is used when inflamed pimples begin to appear as well, to reduce bacteria.
Comedone extraction by a doctor is done in a clinic with sterile instruments and can remove stubborn clogged pores faster, but it must be combined with topical medication to prevent recurrence.
Adjunct procedures such as chemical peels or certain lasers may be considered by a doctor case by case, and are not a necessary main treatment for everyone.
For people with very many comedones, stubborn cases, or accompanying inflamed acne, a doctor may consider oral medication as appropriate. The key is consistency and patience, because retinoids take about 8-12 weeks to show clear results, and acne may temporarily flare in the early weeks (purging), which is normal.
Do Comedones Go Away on Their Own? How Many Days Until They Clear?
Individual comedones may gradually clear on their own, but as long as the blockage mechanism remains, new ones keep forming, so they usually do not go away permanently just by waiting.
A single comedone may take several weeks to clear on its own.
With proper retinoid treatment, the number of comedones usually drops noticeably within 8-12 weeks.
If the underlying cause is not treated, comedones tend to become inflamed pimples and leave marks.
Waiting for them to "clear on their own" is therefore not a good strategy, and starting proper care early always gives better results.
How to Prevent Comedones from Coming Back
Once comedones are under control, ongoing care helps keep them from returning.
Choose products labeled non-comedogenic, including moisturizer, sunscreen, and makeup.
Remove makeup completely every night with a gentle cleanser, followed by a mild face wash, and do not wash your face more than twice a day.
Wear sunscreen every day, especially when using a retinoid, which makes skin more sensitive to sun.
Use a light, thin moisturizer to maintain the skin barrier and reduce irritation from acne medication.
Avoid squeezing, picking, and peeling off blackheads yourself.
Keep applying your treatment consistently as your doctor advises, even after your skin improves, because stopping early often leads to recurrence.
When Should You See a Dermatologist?
Comedones can be managed at home in many cases, but you should consult a dermatologist when
you have cared for your skin properly and consistently for several weeks with no improvement, or suspect it may not be comedones (for example, fungal acne or milia)
comedones are becoming inflamed pimples, with red bumps, pus, or lumps under the skin
dark marks or acne scars are starting to appear
you have signs of a hormonal problem, such as acne along the jawline, irregular periods, or excess hair growth
you want to use retinoids or procedures safely and in a way that suits your skin
A dermatologist can confirm that it really is comedones, choose medication suited to your skin, and plan long-term care to reduce the chance of permanent marks and acne scars.
Frequently Asked Questions About Comedones
What causes comedones?
They form when hair follicles are blocked by oil from the oil glands together with skin cells that shed abnormally and stick together. They are not caused by dirt from outside. Triggers include hormones, comedogenic products, trapped moisture, and friction.
How do I get rid of comedones?
Use topical retinoids as the main treatment to regulate skin cell turnover, together with BHA exfoliating acid and gentle skin care. Use them consistently for about 8-12 weeks, rather than squeezing or pressing them out one at a time.
Do comedones go away on their own? How many days until they clear?
A single comedone may clear on its own within several weeks, but if the cause is not treated, new ones keep forming, so they usually do not go away permanently just by waiting.
Should I squeeze comedones out?
You should not press or squeeze them yourself, because this risks inflammation and marks. Extraction should be done by a doctor with sterile instruments, together with topical medication.
I have small bumps all over my face that never clear up. Is it really acne?
It may not be comedones. It could be fungal acne (Malassezia folliculitis), which needs antifungal treatment, or milia or keratosis pilaris. See a dermatologist for an accurate diagnosis.
What should I use for comedones? Can I buy it myself?
Products containing adapalene, salicylic acid, or azelaic acid can be used to start basic care, but start gradually and use sunscreen alongside. If there is no improvement or your skin is sensitive, consult a dermatologist.
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed 10 August 2026
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