Comedonal acne

The term comedonal acne refers to the pattern of acne in which most lesions are comedones (blackheads and whiteheads). Comedonal acne most often affects the forehead and chin.

Comedones form because plugs of sebum and keratin (old skin cells) block the skin pores (follicles).

Comedonal acne may be aggravated by:

• Hormonal factors
• Humid weather
• Oily products such as pomades, sunscreens and petroleum-based moisturisers
• Smoking.

Comedonal acne

Acne electrosurgery

Management

Choose oil-free cosmetics and wash twice daily with a mild soap and water.

Choose ‘comedolytic’ topical medications. These should be applied once or twice daily as a thin smear to the entire area affected. It may take several months before worthwhile improvement occurs. Treatment needs to be continued long term (sometimes for many years).

Suitable topical agents include:

• Benzoyl peroxide 2.5-10%
• Azelaic acid 20%
• Salicylic acid +/- sulphur & resorcinol 1-3%
• Glycolic acid 10-20%
• Retinoids such as tretinoin, isotretinoin, adapalene (these require a doctor's prescription)

Prescription oral medications for comedonal acne include:

• Hormonal therapy
• Isotretinoin

Antibiotics are not usually very effective for this pattern of acne.

Surgical treatments are sometimes recommended to remove persistent comedones:

• Cryotherapy
• Electrosurgery (cautery or diathermy)
• Microdermabrasion