Closed comedones (aka whiteheads) are one of the most frustrating forms of acne to get rid of. Although they don’t inflame dramatically, they also don’t come to a head and seem to just stick around. So you’re not alone in feeling that no matter you do, they seem permanently embedded in the skin. In fact for a lot of people, these bumps persist for months or even years despite what seems like a rigorous skincare routine. What most don’t realise is that closed comedones can be stubborn because they’re not targeting the underlying cause of them. They are a disorder of follicular function and clearing them requires the right approach and enough time for the skin to respond. In this article we review why closed comedones won’t go away and the best treatments to clear them.
What are Closed Comedones?
Better known as whiteheads, closed comedones are a type of non-inflammatory acne spots. They form when a follicle becomes blocked by a mixture of sebum (oil) and dead skin cells. These microscopic blockages result in microcomedone formation which is the earliest stage of acne development and give rise to open or closed comedones. If they persist and become inflamed then you can develop inflammatory pimples like papules, pustules or cysts. Unlike blackheads (open comedones) which are the other type of non inflammatory acne, the follicular opening (aka pore) remains closed. This traps material beneath the surface and giving the skin a flesh-coloured or slightly white, uneven texture. Closed comedones usually feel slightly firm and tend to cluster on the oiliest parts of the face such as the forehead, jawline, cheeks and chin.
Why Won’t Closed Comedones Go Away?
First of all, everyone is different and not all closed comedones behave the same way. Some people find it easier to clear closed comedones than others even if they use the same treatments. This can be due to a number of factors that affect the biology of the whiteheads. As a general rule rule, closed comedone that won’t budge usually share a few features such as:
- Follicular hyperkeratinisation: The skin cells lining the pore are shed abnormally and stick together instead of exfoliating smoothly. This creates a dense, compact plug that a lot of exfoliants struggle to reach.
- Sebum trapping: The combination of excess oil and retained dead skin cells creates a stubborn blockage that is harder to clear.
- Slow epidermal turnover: Genetics, hormones, age and chronic irritation from overuse of harsh products can mean that skin lining the pore is shed more slowly. Closed comedones form when keratinocytes accumulate within the follicle faster than they are shed.
- Inflammation: Low-grade inflammation can coexist with comedonal acne and interfere with clearance.This is because background inflammatory signalling alters follicular behaviour and slows down normal cell turnover and exfoliation.
- Skin barrier damage: When the barrier is compromised, it makes it impossible to tolerate treatments that would otherwise be effective. It also can cause irritation and background inflammation. Both of these factors make it difficult to clear closed comedones.
- Wrong products: Some serums, oils and creams can cause occlusion and contribute to closed comedone formation.
- Impatience: Closed comedones visible today began forming weeks or sometimes months earlier. This means that a lot of the time, there is a delay between starting a new treatment and seeing the results. Failure to understand this can lead to frequent unnecessary treatment changes that ultimately holdback progress.
Common Mistakes That Keep Closed Comedones Stuck
Just as important as finding the right treatment, it’s important to avoid doing anything that can make your closed comedones worse. Below are some of the most common skincare habits that make it harder to clear closed comedones:
- Doing too much: Many people attempt to fix closed comedones with increasingly aggressive cleansing or over exfoliation. Unfortunately, this usually backfires. Instead, it can actually result in background inflammation, stripping the face off oil which increases sebum production and skin barrier damage.
- Doing too little: being overly cautious can also make it harder to clear closed comedones. Unless you have sensitive or reactive skin, using very gentle exfoliants or retinoids infrequently and exclusively focusing on supporting the skin barrier can lead to under treatment.
- Incorrect actives: Ideal treatments will include oil soluble exfoliants as these can reach deep into the pore and retinoids which normalise follicle turnover. Using anti-inflammatory ingredients like benzoyl peroxide and hypochlorous acid are unlikely to help with closed comedones since they are not inflammatory lesions.
- Inappropriate formulas: Actives should be used int he form of leave on products like toners or serums. Using them in cleansers (unless your skin is very sensitive) that you quickly rinse off can lead to under treatment.
- Abandoning treatments too early: Most people don’t realise that acne treatment takes weeks if not months. This runs the risk of stopping effective treatments before the skin has had time to respond.
How to Clear Closed Comedones that Won’t Budge
The best way to get rid of closed comedones is with using the right treatments correctly, consistently and for a long time. In fact, you should give closed comedones at least 12 weeks to respond before assessing whether the treatment is working. This is because when you see acne, you’re always looking into the past. The closed comedones visible today began forming weeks earlier. As such, even when you start a new treatment and it is effective, what you’re seeing on the surface are closed comedones that already formed several weeks ago. The best treatments that will help clear closed comedones are:
- Retinoids: Retinol or prescription retinoids like adapalene and tretinoin are the single most effective treatment for closed comedones because they act at the source of the problem. They normalise keratinisation within the follicle, prevent new microcomedones from forming and gradually clear existing blockages. Improvement is slow and incremental. Meaningful texture change typically appears after 8–12 weeks, with continued improvement beyond this point. Beware that early purging can occur as existing microcomedones surface and is not a sign of treatment failure.
- Azelaic Acid: This gentle exfoliant is useful in comedonal acne particularly for people with sensitive or reactive skin. It helps normalise keratinisation and reduce inflammation. Azelaic acid usually best alongside a retinoid for persistent closed comedones.
- Salicylic Acid: This oil-soluble exfoliant can penetrate into pores and clear them. It helps increase cell turnover and works best alongside retinoids.
- Prescription treatments: Topical or oral retinoids, hormone blockers and high strength azelaic acid may be necessary for more persistent or severe acne treatment.
- Professional treatments: Chemical peels and lasers can help accelerate epidermal turnover and loosen compacted follicle blockages. They are often a useful adjunct to a skincare routine containing exfoliating acids and retinoids. Extractions can also help temporarily clear closed comedones when performed selectively and conservatively. However, repeated or aggressive extraction can damage the follicle, leading to scarring or post-inflammatory pigmentation. They should never replace corrective treatment.
How Long Does it Take to Clear Closed Comedones?
Even with the best treatments and consistent use, closed comedones clear slowly. This is because effective treatments requires tacking the source of teh problem to prevent microcomedone formation. Although timelines vary hugely, as a general guide the below is an idea of how long it takes to see results with the correct treatments:
- Weeks 1-8: Usually no changes or even initial period of purging as skin adjusts to retinoids and exfoliating acids.
- Weeks 6-8: Early textural change leading to smoother looking/feeling skin.
- Weeks 12-16: Visible reduction in number of closed comedones.
- Weeks 16+: Ongoing reduction in number and rate of closed comedones formation
Having closed comedones that do not budge is very common and simply reflects the underlying biology of acne formation. The best way to treat them is to directly tackle the processes that cause microcomedones at the source with the correct treatments. Just as important is to avoid skincare habits that seem like common sense but can actually make things worse. Ultimately, even with the correct treatment, like all forms of acne, closed comedones take a lot of time and patience to clear.
At City Skin Clinic, we believe that skincare is personal and should always centre around your individual needs. Our doctors offer custom topical skin treatments for acne using ingredients like tretinoin, azelaic acid, clindamycin and spironolactone where appropriate. If you are interested in a personalised skincare treatment please use our online skin consultation form or book a video consultation. Start your treatment journey today and take your first step towards great skin.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any medical concerns or questions you might have.
