Comedonal Acne: White Pimples on the Face, What They Are and Why They Occur

White pimples on the face are most often closed comedones: follicles clogged with sebum and dead cells. This form of acne is called comedonal. I explain how it differs from inflammatory acne, without promising miracle remedies.

What comedonal acne is

Acne is a long-term skin condition that occurs when a hair follicle becomes blocked with sebum. Typical signs are comedones, pustules, oily skin, and possible scarring. Areas with a large number of sebaceous glands are affected: the face, upper chest, and back.

The comedonal form means that the basis of the breakouts is blocked follicles rather than inflammatory lesions. Comedones with isolated inflammatory lesions confined to the face are classified as mild. More papules and pustules on the face and trunk indicate moderate severity. Painful nodules under the skin and extensive involvement indicate severe acne.

Where white pimples and acne on the face come from

The follicle becomes blocked by excess sebum and dead cells. Bacteria can multiply in the blocked follicle, and then inflammation and pus appear. As long as there is no inflammation, the lesion looks like a white pimple or a skin-colored bump.

Causes that are cited include changes in hormone levels (adolescence, menstruation, menopause, pregnancy), conditions such as polyendocrine metabolic ovarian syndrome and rosacea, medications, and skin and hair products that make the skin oilier. Genetics account for about 80% of cases. The exact triggering mechanism is not fully understood.

What is sold as a cause but is not supported by data: dirty skin, chocolate and fatty foods, stress. Comedones do not arise from dirt, the influence of food is weak in most people, and stress does not cause acne, although it may worsen the manifestations.

Closed and open comedones: how they differ

A closed comedon is a bump the same color as the skin: the contents of the follicle are closed off on top. An open comedon is a black or brown spot, usually flat, sometimes raised. The black color is not related to dirt: comedones and pimples are not caused by skin contamination.

Both variants are non-inflammatory. Inflammation begins when bacteria join the blockage: papules appear (pink or red on light skin, brown or purple on dark skin), pustules with pus, and nodules. A person usually has several types of lesions at once.

How a doctor diagnoses the comedonal form of acne

Diagnosis begins with an examination. The doctor assesses which types of lesions are present—comedones, papules, pustules, nodules—how many there are, which areas are affected, and whether there is scarring.

Then severity is assessed. There is no generally accepted scale for it, so the wording depends on the overall picture. If acne does not respond to treatment, is deep, painful, or leaves scars, the doctor may refer the patient to a dermatologist.

• the type of lesions and their number;
• the affected areas and the presence of scars;
• the degree of severity: mild, moderate, severe.

When white breakouts require a dermatologist consultation

See a doctor if self-care does not improve the picture, if there are many lesions, or if they are deep, painful, or leave scars. A separate point is signs of a skin infection: the skin is hot, swollen, and reddened; redness is harder to notice on dark skin.

Mental health is just as much a medical criterion. Acne can cause anxiety and depression and lower self-esteem; people go to a doctor for this rather than enduring it.

Scars affect 95% of people with acne, and atrophic scars account for about 75% of all scars. The likelihood is higher with severe forms, but scars are possible with any form.

Comedonal acne by itself is not a reason to call an ambulance; 103/112 are only for a life-threatening condition (for example, loss of consciousness, acute breathing problems).

This material is for reference: it explains the mechanism but does not replace a doctor's consultation—the diagnosis and treatment approach are discussed at an appointment.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer