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Comedonal acne consists of blackheads, or comedones. The skin may look and feel bumpy, or have a "sandpapery" texture. For some, inflamed pimples only occur occasionally. For others, breakouts may become inflamed.
Comedones (whiteheads and blackheads) are the primary lesions of acne. Sebum production increases, follicular wall cells fail to desquamate to the surface in the normal manner and Propionibacterium acnes grows in the sebum-cell mixture and forms a plugged pore or a microcomedo and then a visible comedo.

a) Retinoids are comedolytic and are drugs of first choise. Creams are for dry skin and less irritating, gels are for oily skin.

Open comedones and closed comedones are the first acne lesions to appear. Some become inflamed and become papules or pustules.

Closed comedones or whiteheads have a very small orifice. This impedes drainage. They respond slowly to treatment.

Open comedones remain for months. Stretch the skin for support and remove them with a comedone extractor.

Open comedones in the ear are unsightly. They respond slowly to topical treatment and should be removed.