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Acne is the most common skin disease treated by physicians. It is a chronic condition that affects over 85% of adolescents and young adults. One study showed that two-thirds of teenagers with acne wanted to talk to their physician about their acne, but only one-third actually did.

Types of Acne
Not all acne is the same. Simplistically, acne can be divided into red bumps and blackheads/whiteheads. This division is important because each type is treated differently. Blackheads and whiteheads, known as comedones, can be more numerous on the face and shoulders than red bumps filled with pus. Good, consistent skin hygiene can help improve this condition. Therefore, knowing more about what causes comedones and how to treat them is a step towards clearer skin.

Why Does Acne Occur?
This article walks through step-by-step how acne is formed.

Blackheads
Blackheads, also known as open comedones, are follicles that have a wider than normal opening.
They are filled with plugs of sebum and sloughed-off cells and have undergone a chemical reaction resulting in the oxidation of melanin. This gives the material in the follicle the typical black color.

- Picture of several blackheads
- Picture of blackheads close-up

Whiteheads
Whiteheads, also known as closed comedones, are follicles that are filled with the same material, but have only a microscopic opening to the skin surface. Since the air cannot reach the follicle, the material is not oxidized, and remains white.

Skin Care for Blackheads and Whiteheads
The key to skin care for acne is consistency. An overnight cure has not been found. But using good skin care methods aids in the daily, steady improvement of follicle health. Since acne is not caused by eating certain foods, restricting the diet is not helpful. Since it is also not caused by "dirty" skin, excessively scrubbing does not help and can even make the skin more irritated.

The best skin care for comedones consists of once-a-day cleansing with a mild soap or facial scrub to aid in the removal of excess sebum and dead skin cells. Oil-based makeup should not be used since these can contribute to the buildup of oil in the follicles. Water-based makeup labeled as non-comedogenic can be used safely.

Treatment of Blackheads and Whiteheads
Treatment of whiteheads and blackheads takes time. Most treatments take several weeks to months before a noticeable change is seen.

Benzoyl Peroxide
Benzoyl peroxide has an antibacterial effect and may also decrease the chemical reaction that changes the lining of the hair follicle. This may help reduce the plugging that causes comedones. Benzoyl peroxide may be used for a mild case of comedones or to help prevent formation of others.

Tretinoin (Retin-A)
Tretinoin (Retin-A, Avita, Renova) is the mainstay of treatment for whiteheads and blackheads. Tretinoin is a derivative of vitamin A and works by increasing cell turnover and reducing the "stickiness" of the sloughed cells. It helps expel the plugged material returning the pore to normal. Tretinoin can be irritating, so specific instructions on how to use it can be found here.

Antibiotics
Prescription topical antibiotics or oral antibiotics might be used if some of the blackheads and whiteheads are infected, but antibiotics do not help with comedones that are not infected.

Isotretinoin (Accutane)
Isotretinoin (Accutane) is used for severe cystic acne and has many side effects. It is very effective for comedones when used properly, but is not usually prescribed for mild acne of either type.

Extraction
Extraction may be used by a health care provider on open comedones. This process is performed using a device called a comedone extractor. This is a small, metal, circular instrument that is centered on the comedone and pushes down the surrounding skin, causing the plug to extrude.

No Need to Suffer
Whiteheads and blackheads are types of acne that affect many people. There are good treatment options available, so there is no need to suffer with this condition in silence. A primary care provider can initiate treatment for acne and follow mild to moderate cases. Severe cases or those resistant to treatment should be seen by a dermatologist.

Sources:
Feldman, Steven, et al. "Diagnosis and Treatment of Acne." American Family Physician 69(2004): 2123-36.

Habif, Thomas. "Acne, Rosacea, and Related Disorders." Clinical Dermatology, 4th Edition. Ed. Thomas Habif, MD. New York: Mosby, 2004. 167-71.

Haider, Aamir, and James Shaw. "Treatment of Acne Vulgaris." Journal of the American Medical Associaion 292(2004): 726-35.

Zaenglein, Andrea and Diane Thiboutot. "Acne Vulgaris." Dermatology. Ed. Jean Bolognia. New York: Mosby, 2003: 531-5.