Comedones are tiny bumps that affect the skin, making it rough to the touch,

and these bumps can be dark, white or skin colored. Most people know
comedones by their more commonly used names – blackheads and
whiteheads. These comedones are found at the opening of the pores on the
skin, and on those prone to Pimple are usually found around the chin and
forehead areas. The pigmentation of open comedones causes them to be
dark, thus they are referred to as blackheads. However, those that are
closed, and where the follicle is totally blocked, are referred to as
whiteheads.

Comedones are a primary sign of Pimple. With the open comedone, or

blackhead, excess oils collect in the duct of the sebaceous gland and the
pigmentation makes them appear as black bumps on the surface of the skin.
With a closed comedone, or whitehead, the trapped sebum remains
underneath the skin, causing a bumpy effect but no actual coloring is visible.

These comedones can vary in size – for instance, comedones that are larger
than around two or three millimetres in diameter are known as
macrocomedones. Pimple is not a condition that is exclusive to teenagers, as
many people assume, and therefore both comedones and Pimple can affect a
person at any age, such as during pregnancy or during a highly emotional
period.

What can aggravate comedones?

There are a number of factors that can aggravate and exacerbate

comedones, and these include:

* Injuries that result in rupture of the follicle, such as abrasive facial washes
or pimple squeezing
* Over hydration or over moisturization of the skin
* Excessive hormonal activity
* Free fatty acids caused by bacteria
* Various chemicals, such as those found in dye and some cosmetics
* Emotional factors

Treatment for comedones

There are various treatments available for those with comedones, but these
treatments may take some time to be effective and are certainly not
overnight miracles. Depending on the severity of the condition sufferers may
need to see a dermatologist in order to get effective treatment. Amongst the
treatments available are: Tretinoin, Isotretinoin, Benzoyl Peroxide, and even
extraction, which can be used on open comedones.

Those with open or closed comedones also need to ensure that they look
after their skin properly. This means avoiding the temptation to scrub at the
skin in a bid to get rid of blackheads, as the dark coloring is not dirt that can
be scrubbed away, and scrubbing or abrasive washing may actually make the

1
condition worse. Using a mild wash once daily, and patting the skin dry is the
best way to keep skin clean. Also, those with comedones should avoid using
oil based cosmetics, as these can aggravate the condition by adding to the
build up of oil in the follicles.

SKIN COMEDONES TREATMENT

Acne is one of the most common dermatological problems, experienced by

approximately 80% of Western adolescents. If left untreated it can be the
source of significant physical sequelae and psychological problems.
Prevalence studies show that acne breakouts, comedogenesis, is not just a
problem of youth but for some, it persists into middle age. Study of
comedones finds its importance in blackheads treatment since they are
precursor of all acne lesions.

Effective acne management involves understanding of its mode of

development. Prevention from acne scarring, one of the major complications
of long-term acne inflammation motivates patients to pay attention to initial
lesions and seek treatment promptly. There are four major changes
associated with development of a comedone (blackheads and whitehead).
First an increase in secretion of sebum, second a proliferation of ductal
epidermis, third a colonization of bacteria specially Propionibacterium acnes,
fourth an addition of inflammation to the scenario.

Sebum excretion and production is hormonally adjusted and the role of

androgens is well known in this process. Regulation of sebum is one of the
rationales in treating acne breakouts and whitehead removal. Change in lipid
composition of epidermal ducts in particular a decrease in linolenic acid
fraction of the skin surface lipids preceded by hyperproliferation of ducts may

2
explains comedones (blackheads and whiteheads) formation. Virtual skin
blackheads treatment may aim at regulation of sebum, reduction of
inflammation, control of bacteria and reduction of hypercornification.

What comedones are? Comedones are small papules (bumps) with a color
similar to that of the skin, their head might get open and darkened
(blackheads). Comedones are divided into two major categories, open
comedones or blackheads and closed comedones or whiteheads (see photo).
Hyperproliferation of ductal keratinocytes is mainstay of its pathophysiology.
Here you can read more of pathology of comedone formation. Skin
blackheads (see photo) are open comedones with a hyperpigmented head. In
blackheads accumulation of melanin (epidermal pigment) makes them darker
almost black colored. Nose blackheads are commonly seen due to the larger
skin pores of the area. Excessive proliferation of epithelial cells in sebaceous
ducts cause formation of comedones. Comedones usually are precursors of
acne. Sebaceous ducts (follicles) are tubules that conduct sebaceous glands
secretions ( sebum ) to the surface of the skin. Blackheads are usually
associated with hyperactivity of sebaceous glands and hypercornification of
sebaceous follicles (overproduction of epithelium lining the ducts).

Hormonal part (DHT) and comedones treatment: Hormonal factors obviously

play an important role in development of a blackhead. Sebaceous glands
( part of sebaceous follicles ) are extremely sensitive to androgenic
stimulation, and their enlargement usually precedes other obvious signs of
puberty even before any sign of acne breakouts. They are under endocrine
control and so it is not surprising that sebum production varies with age and
sex. Among androgens DHT, dihydrotestosterone increase is more
noticeable.This excessive activity is one of aggravating factors in treatment.
Increase in linoleates and free fatty acids also is seen in conjuction with
blackheads. Increase in sebum production is associated with increase in free
fatty acids rather than an increase in essential fatty acids. Males have a
significantly greater sebum production than females.

Emotional influences also significantly affect comedone formation. As with

any disease whose course is prolonged , the importance of psychological
factors in acne therapy has been repeatedly stressed and should be seriously
taken into account for blackheads treatment. There seems to be no doubt
that stressful situations such as final examinations regularly cause
exacerbations in patients. This is probably the result of increased
glucocorticoid secretion by the adrenal glands that seem to potentiate the
action of androgens.

Environmental agents also play a major role in determining the severity and
extent of acne breakouts and affect its treatments. In most cases the
manifestations are worse in winter and improves during the summer,
suggesting a salutary sequel of sunlight. However, in some cases exposure to
sunlight worsens the disease. The constant friction caused by protective
devices such as a helmet, shoulder pads or pillows will make its management
more difficult simultaneous with higher likelihood of scar lesions. Rupture of
sebaceous follciles is among other aggravating factors. Rupture could be

3
result of skin injury by mechanical squeezing of lesions, abrasive skin
scrubbing or resurfacing methods such as dermabrasion. To get rid of nose
blackheads scrubs could bring satisfactory results if your facial skin is clear
otherwise. However in inflammatory cases of acne scrubbing is not
recommended.Here you can find more information on comedones
aggravating factors.

Salicylic acid preparations such as creams and cleansers are effective in

treatment of whiteheads and blackheads. Other keratolytic agents such as
retinoids may be used for treatment, however, they are saved for more
severe cases. There are two important points that acne patients should be
aware of. To get rid of various acne forms at least six to eight weeks of
therapy is essential since this period of time may be required before
improvement is noted, improvement may be noted earlier. Second, body
lesions including back, chest and shoulder lesions respond more slowly to
treatment than do those on the face. Inflammatory lesions are represented as
papules, postules, nodules, cysts, macules and scar lesions. Papules and
postules are more superficial compare to the rest of inflammatory acne and
their cure takes a shorter period of time, 5-10 days. Nodules are deep-seated
structures and tend to remain for as long as eight weeks before finally
resolving. Cysts ( cystic acne ) are not very common but when they occur
they may reach several centimeter in diameter. Cystic acne is considered a
severe form of acne and its treatment should be consulted with a physician.
To get rid of cystic acne combination therapy is required.

Acne precursors treatment goals

Elimination of microcomedones, the precursor to all subsequent lesions,

would optimize acne therapy by preventing the later inflammatory stages of
disease. Prevention can be achieved by reducing sebum production and
tightening enlarged pores, accelerating skin cell turnover, fighting bacterial
infection or doing all three. With most prescription types treatment of acne,
you may not see results for 6 to 8 weeks, and your skin is likely to get worse
before it gets better. Skin care especially tailored to remove blackheads are
very recommendable. Pregnancy, especially during the early stages is a
contraindication for oral prescription types treatment of acne.

You may find one or more of the following treatments to remove blackheads
through your doctor or over the counter.

Topical preparations to get rid of bacteria and inflammation

Acne lotions dry up the excess oil, kill bacteria, promote shedding of dead
skin cells and help to remove comedones . Over-the-counter acne lotions are
generally mild and contain benzoyl peroxide, sulfur, resorcinol or salicylic

4
acid as their active ingredient. These products can be helpful for very mild
forms of acne lesions. If your acne doesn't respond to an otc treatment, you
need to see a doctor or dermatologist to get a stronger prescription lotion.
Tretinoin treatment (Retin-A) and adapalene are topical prescription products
derived from vitamin A. They work at the skin pore level to prevent plug
formation. A number of topical antibiotics also are available. They work by
killing excess skin bacteria. Often, a combination of such products is required
to achieve optimal results. Antibiotics: For moderate to severe acne,
prescription oral antibiotics may be needed to reduce bacteria and rid
inflammation. You need to take these antibiotics for months and often need
to use them in combination with topical products such as Isotretinoin. Acne
spots and other pigmentations are another concern of many patients
suffering acne. More new treatment options.

Combination therapy

Treatment combinations is essential to get rid of deep cysts and severe

blemishes. Isotretinoin (Accutane) is an effective medication available for
severe forms such as cystic acne or a blackhead that doesn't respond to
other treatment options. Patients who take Isotretinoin require close
monitoring by a dermatologist because of the possibility of severe side
effects such as allergic reaction (inflammation of face and tongue) blurred
vision, dryness of the vision and etc.
Oral contraceptives. Oral contraceptives, including a combination of
norgestimate and ethinyl estradiol (Ortho-Cyclen, Ortho Tri-Cyclen), have
been shown to improve acne in women. Oral contraceptives may cause other
side effects that you'll want to discuss with your doctor.
Cosmetic surgery. Doctors are able to use cosmetic surgery to diminish scars
left by cystic acne. Procedures include peeling away damaged skin with
chemicals or by freezing it, dermabrasion and laser resurfacing. Peeling
procedures eliminate superficial facial scarring. Dermabrasion, which is
usually reserved for more severe scars, involves removing the top layers of
skin with a rapidly rotating wire brush. Laser resurfacing involves using short
pulses of intense light to remove the outer layer of your skin. If your skin
tends to form scar tissue, these procedures can make your complexion
worse.

Comedones (whitehead and blackhead) prevention

Whitehead and Blackhead control can be achieved in most cases with good
basic skin care and the following grooming ideas:

How to efficiently get rid of acne

Wash problem areas with a gentle non-alcoholic cleanser. Soaps are not
recommended since they can stimulate the skin to secrete more oil. Products
such as facial scrubs and astringents generally aren't recommended because
they tend to irritate skin, which can aggravate initiation of your whiteheads,
blackheads. Excessive washing and scrubbing also can irritate skin.
Scrubbing the skin may be avoided. Try over-the-counter solutions to dry

5
excess oil and promote peeling. Look for products containing benzoyl
peroxide, resorcinol or salicylic acid as the active ingredient.

Avoid irritants. You should avoid oily or greasy cosmetics, sunscreens, hair-
styling products or acne concealers. Use of products labeled "water-based" or
"noncomedogenic" does not guarantee their safety to your skin. Unlike a
common misbelief use of oily products could be good when they use good,
penetrating oils. These oils can regulate sebum overproduction and reduce
oiliness of your skin. If the sun worsens your acne breakouts, protect yourself
from sunlight which is a good idea in general. If stress causes outbreaks,
work on reducing your stress level.

Mechanical stimulation of blemishes may lead to infection or scar tissue. Try

to sleep in a way that your face does not touch pillow. Avoid using tweezers
or any other removal objects. Hair products can contribute to blemishes on
your forehead. Watch what touches your face. Keep your hair clean and off
your face. Also avoid resting your hands or objects on the affected areas.
Sweating in tight clothing also can pose a problem. Sweat, dirt and oils can
contribute to acne breakouts, so if you exercise take a shower right after and
don't let the sweat on your body for any time. Don't pick or squeeze
blemishes. This might lead to severe scars.

Some common questions regarding acne , and how to get rid of them

1. I heard hot water kills bacteria and relives acne, should I take a hot shower
everyday?

The answer is NO. Hot water does not kill bacteria, however, it can aid
clearing the skin pores. At the same time it washes away epidermis own
natural secretions which are very protective for your skin. Every-day hot
showers could result in over activity of the sebaceous glands and aggravate
the situation. Now, what should I do then? Take a hot bath once a week,
maximum twice a week, not more, however, take a cold shower everyday.
This should become your routine, everyday cold shower and once a week hot
bath. This routine is especially helpful if you exercise. Never leave your skin
unwashed after an exercise. Working out your muscle definitely helps your
skin by balancing your endocrine system and hormone regulation. In addition
it helps your skin by increasing micro circulation of your skin. This in
particular is important in relieving inflammation and helping skin get rid of
acne vulgaris. Remember, inflammatory process plays a major role in
pathogenesis of acne breakouts and blackheads. Although exercise is very
good, taking a cold shower after exercising your muscles is much more
important. Why? Because after exercise your skin is in best condition for
invasion of opportunistic microorganisms especially staphylococcus and

6
propionobacterium acnes. Aside from that during exercise your skin pores
more open up to allow sweating. After exercise while your skin becomes
colder the pores start to close, this is the time all the bacteria on your skin
can get inside the closing pores.

2. Is this true that an acne-prone skin must use oil-free products?

Being oil free does not make a product good. At the same time an oily
product is not necessarily a bad product. Drying an acne producing skin could
be very stimulating for sebaceous glands and their overreaction can make
the skin even oilier. This is the scenario when you use a soap to wash your
face and body. It is right that high pH of a soap causes overreaction of
sebaceous glands, but another stimulation is a dry skin. So the skin should
not be over dried. Now, another factor we have to consider is that we have
good oils and bad oils. We have pore clogging oils and some other oils which
benefit the skin in many skin and resemble skin 's own natural sebum.
Among these oils are jojoba, grape seed oils, rosehip oil, borage oil and many
others, These help the skin in one way or another and are not pore-clogging.
What we try to achieve is to treat acne lesions in oily skin is to maintain
epidermal natural secretions. This maintenance has a regulatory effect on
sebaceous gland whose over secretion plays a major part in pathology of
acne.

3. My breakouts become worse during my exam time, anything I can do to

help this?

As you all heard stress makes acne worse. But why? Remember,
inflammatory process is involved in formation of blackheads and skin
breakouts. Any imbalance in your hormonal system aggravate the situation.
The best thing to do is to keep exercising your muscles, 20 minutes a day, try
doing something that let your skin sweat. This helps with regulation of your
hormonal system. Take a cold shower afterward. Do not wash with soap, use
a pH-balanced shampoo instead.

4. I hear about blackhead removal, should I actually remove a blackhead?

Does that damage my skin?

The truth is each time you use one of those tweezers to remove a blackhead,
you are making an small incision in your skin. It would be very likely to leave
a scar on your skin. The blackhead will be back in a very short time and
sometime you might lead a blackhead to a cystic acne, a very serious form of
acne, which is hard to treat. So what would we do with the blackheads? As
you know whiteheads and blackhedas are precursors of more inflammatory
acne. The same treatment could be used for blackheads. In addition,
regulating clay based masks could be particularly helpful to get rid of various
acne lesions among them are comedones. An example is Hippocrates
Clarifying Mask. This clears the pores from inside and balance secretions. It
maintains skin oxygenation and regulate inflammation.

7
5. How about my diet, does it have any importance what I eat? Should I avoid
certain foods?

Role of diet has been very controversial. Not

Are you making these mistakes each time you spot a little white little bump
on your face? Fixing those little white bumps starts with a small dose of
education and ends with a big dose of prevention. After understanding the
five reasons below, your little bumps should give way to clearer skin.

Reason #1: You have no clue what those little white bumps are
anyway.

Little white bumps, or milia, are keratin-filled cysts, or simply little globs of
protein under the skin. There are generally two types of milia. Primary milia
may result from oil glands that have not fully or properly developed.
Secondary milia result from trauma to the skin.

Reason #2: You think all little white bumps are acne, and treat them
that way.

Just because you have little white bumps on your face does not necessarily
mean that you have acne. Milia, are little balls of protein beneath the skin
that do not have a pore, or hole in the skin through which to escape.

Comedones or whiteheads are excess fats and wastes that are trapped in a
hair follicle and so they clog up the pore. In short, milia are proteins trapped
within the skin, while comedones are fats and skin debris trapped within the
pore.

Exfoliating the skin, or removing the dead skin cells from your skin with an
abrasive product or chemical, is beneficial. But brutally scrubbing your face
with soaps and chemicals too frequently may actually create milia. To avoid
this, remember that gentle exfoliation helps prevent excess dead skin cell
build-up that could clog your pores and cause whiteheads, not milia.

This gentle exfoliation helps make eventual removal of the milia easier
because the skin layer around the milia becomes thinner, with frequent, yet
gentle exfoliation. In short, Exfoliate your skin to prevent milia, not to cure
them.

8
Reason # 3 You have no idea what causes those little white bumps
anyway.

When you were a baby, you were probably covered with milia that disappear
after a few days. Or, you may have inherited milia from your parents.

On the other hand, you may develop milia after excessive exposure to the
sun. The reasons for developing milia after sun exposure are debatable.
According to some studies, the active ingredients sunscreens like Parsol 1789
may cause sun allergies and later lead to a milia breakout. Other studies
blame the sun itself for “damaging” the skin can thus causing little white
bumps.

Some people experience milia around the mouth. This could be the result of
fluoride irritation from toothpaste.

Reason # 4: No one ever told you how to prevent milia.

The best way to prevent milia is to avoid treating your skin with excessively
harsh chemicals and to limit sun exposure.

To reduce creating milia around the eyes, use eye creams with the least
amount of ingredients possible to avoid irritating the delicately thin eye area.
Also, gently touch the eyes and avoid rubbing the eyes vigorously so as not
to damage the skin.

When brushing you teeth, try to keep the pasty foam from staying around
your mouth too long. This limits possible fluoride irritation to the skin.

Use a sunscreen with the least amount of ingredients. Extraneous ingredients

like fragrances may irritate your skin. Additionally, purchase sunscreens that
offer physical sun blockage that contain active ingredients like titanium oxide
or zinc oxide.

Reason #5: You still want to know what you can do right now to get
rid of milia.

The key to getting rid of milia is realizing that they have no escape route,
those little bumps are trapped under the skin. So, to get them out, you’ll
need to have a professional like a dermatologist or aesthetician extract them.
You can extract the milia yourself, but this involves risks.

Precautions You need to ensure that you milia are not symptoms of some
underlying disease or illness. Also, if you extract the milia yourself, you may
have trouble completely pulling out the cysts, as the removable process may
prove too painful.

Otherwise, if you are confident with your health and courage, you can
cleanse your hands and face. Then wet a cloth with warm water and apply it

9
to your face for a few minutes. Gently apply a sterile needle to the center of
the little white bump to create a tiny opening in the skin.

Wrap your thumbs in a clean tissue and, using your thumbs, proceed to
gently squeeze the contents of the little white bump out. Finally, cleanse the
area of the extracted little white bump with an astringent.

Now, you have no reason to walk around with little white bumps on your face.
If you still think you do, please consider the possibility that you’re just telling
yourself little white bumpy lies.

one very easy home remedy for getting the milia out of your skin is, mix a
pinch of tumeric (avoid this if you are very pale) and a teaspoon on Besan
(Bengal gram flour) you can get it from a indian store. Add little raw milk
make a pasted and massage gently for 20 minutes, leave it for a hour or so
and then wash off with warm water. Do this every day. Gradually the milia
will start coming to surface and form a white head, you can pick this
whitehead or you can leave it and it will automatically go when you wash face
once it is "ripe". Source: personal experience

Whiteheads are also known as closed comedones. They are sebaceous

follicles that are filled with sebum, dead skin cell and bacteria. They have
only a microscopic opening to the skin surface. Since the air cannot reach the
follicle, the material is not oxidized, and remains white. A light yellow lump is
formed. Another term for this is milium or milia for plural.

CAUSE OF WHITEHEADS

» Excessive exfoliation of skin cells contributes to the growth of milia. The

dead skin cells quickly clog up the sebaceous follicles.

» Some skin specialists believe some individuals produce sebum that is drier
than normal. This creates an environment conducive to the formation of firm
plugs. Such individuals would be more prone and have frequent and multiple
blackheads and whiteheads. Sebum contributes to skin oils and people with

10
dry sebum may have dry skin and this may be especially true of people with
chronic whiteheads.

» Linoleic acid is an essential fatty acid that is normally produced together

with sebum in the sebaceous glands. The combination of sebum and lineleic
acid gives the liquid viscosity. It is soothing to the skin. Follicular irritation will
promote plugs. In the absence of linoleic acid, the sebaceous glands replace
it with oleic acid. The combination of oleic acid and sebum is less viscous and
firmer compared to linoleic sebum. It irritates the skin, thus promotes the
formation of plugs. The plug formed is hard and does flow out of the follicle
easily. This promotes the formation of blackheads and whiteheads. Acne
infections could be the result.

HOW TO PREVENT AND GET RID OF WHITEHEADS?

Looking for ways to get rid of or remove whiteheads?

An OTC topical medication is usually recommended for those people with

whiteheads or mild acne. Apply the topical medicine directly onto the
whiteheds and any other affected area of the skin.

You can’t get rid of whiteheads or blackheads overnight. It takes time. If used
regularly, OTC topical medicines can be reasonably effective. Be patient. It
might take 8 weeks or more before you will notice any difference in your skin.
Most treatments would several weeks or even months before you can see any
noticeable change.

Common OTC acne medicines used to treat acne include benzoyl peroxide,
salicylic acid, resorcinol and sulfur. Each of this works differently and has
different effects on the acne.

Benzoyl peroxide is useful for a mild case of comedones. It can also help to
prevent formation of more whiteheads.

The effects of benzoyl peroxide are:

• Antibacterial – Destroys and inhibits the growth of acne bacteria

• Decreases the chemical reaction that cause changes to the lining of
the hair follicle. This may help reduce the plugging that causes
comedones.

Resorcinol and sulfur help to break down comedones like whiteheads and
blackheads.

In addition to breaking down whiteheads and blackheads, salicylic acid also

helps to reduce the shedding of cells lining the follicles of the sebaceous
glands.

11
Topical OTC acne medicines come in various forms. It could be in the form of
a gel, a lotion, a cream, a soap or pads.

Tretinoin (Retin-A, Avita, Renova) is the chief ingredient used in treatment of

whiteheads and blackheads. Tretinoin is a derivative of vitamin A.

The effects of tretinoin are:

• Increases skin cell renewal

• Reduces the "stickiness" of the sloughed cells
• Causes expulsion of plugged material
• Converts closed comedones into open comedones. The material in
these newly converted open comedones can be easily extruded.

Extraction may be used by a health care provider on open comedones or

blackheads. 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.

http://index.healthboards.com/acne/get-rid-closed-comedones/1/

Milia are small white spots or white heads which are commonly found on the
face. Oftentimes they also cluster around the eyes and cheeks. Oily skin
types are more prone to milia than others, however, they can effect even
combination or dry skin from time to time. The good news is that there are
ways to lower your risk of outbreaks.

Milia derive from a few different sources. Do you tend to smother your skin in
heavy skin care products? Do you over expose your skin to the sun without
using proper SPF? These nagging white pimples are skin cells that become
trapped under the skin's surface. This is why they are so difficult to clear up.

Exfoliating frequently at home is essential. This will hep to clean your face as
well as prevent any of these skin cells from clogging. Do not abrasively scrub
layers of skin off your face, simply use a gently exfoliating cleanser one to
three times as week. When you are out in the sun, remember to use oil free
sunscreens and protect your face from the sun as much as you can.

12
Picking at milia on your own can cause them to come back, so steer clear of
the magnifying mirror. Consult your dermatologist if the at home solutions do
not help; they can administer microdermabrasion and glycolic peels, a
stronger method than the at home remedies.

http://www.google.ca/search?
q=how+get+rid+of+milia&btnG=Search&hl=en&client=firefox-
a&rls=org.mozilla%3Aen-US%3Aofficial&sa=2

13