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Comedones and treating them with hyfrecation and cautery

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What are comedones?

Comedones are very important as they are the first lesions to occur in acne and many of them will become inflamed red spots. Two types of comedones are seen in acne. Open comedones – also called blackheads, and closed comedones – also called white heads.
Controlling comedones will mean that fewer inflamed papules and pustules will develop.

How do comedones occur?

Comedones are when pores (hair follicles) become clogged. The cells that line the fine hair follicles (‘pores’) on the face become very sticky in acne, and stick to each other and eventually block a pore. Grease produced by sebaceous glands builds up behind the clogged pore and causes the comedone to form.

The development of a comedone is actually quite a complex process and is not fully understood. The following factors are thought to be of relevance:

  1. The cells that line the hair follicle increase in number – this is called pilo-sebaceous ductal hyperproliferation
  2. These cells are abnormally sticky and stick to each other – this is called excessive corneal adhesion

Types of comedones

If you have acne then you probably have one or more types of comedones on your skin. The common types of comedones are :

Microcomedones

These can not be seen with the naked eye and can only be seen under the microscope – they are minor clogging of the hair follicles from the reasons given above. These types of comedones can progressing acne spots and by topical medications.

Macrocomedones

Macrocomedones are more than 1mm in diameter and look like white or skin coloured bumps that are just under the skin. The best way to see them is to stretch the skin and use a side light.

Sandpaper comedones

Tiny closed comedones occurring close together in sheets on the forehead and cheeks.

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Why do comedones occur?

The sebaceous glands in acne patients may produce abnormal lipids which may stimulate comedones formation. Male hormones (androgens) also play an important role in stimulating comedones to be formed and those who are sensitive to androgens or have a hormonal acne may have more comedones. It is also possible that cells in the duct produce chemicals called cytokines that drive up comedone numbers.

How long does a comedone last?

A closed comedone will usually last 1 to 3 weeks but can last longer at times.

How are comedones treated?

Comedones can be treated with prescription topical therapies.
A prescription strength retinoid is the strongest remedy for condones and studies show that 3 months of treatment can reduce comedones by 60%. Examples of prescription retinoids that reduce comedones are Tretinoin and Adapalene.
Benzoyl peroxide, especially when combined with a topical antibiotic can also reduce comedones by 30% at 3 months.
Chemical peels that contain salicylic acid are also very effective at improving comedones in acne.

How are macrocomedones treated?

Macrocomedones need to be treated with physical remedies as topical treatments do not work so well. Hyfrecation works extremely well for macrcomedones. The macrcomedones are gently touched with a fine metal probe that has a light electrical current running through it. This heats the skin around the micrcomedones for a fraction of second. The heat disrupts the cells that are clogging the pore and allows the comedone to clear. Hyfrecation is very similar to cautery of comedones which is another technique that has the same effect.

What are the benefits of hyfrecation or radiofrequency of comedones?

Hyfrecation of comedones reduces macrcomedones by over 80%. A treatment every 2 weeks is required. A course of 2 or 3 treatments is usually enough for most people.

What are the risks of hyfrecation or radiofrequency of comedones?

Hyfrecation is a safe treatment when done correctly with low energies. As the energy is low and directly on a comedone, the risks of a scar forming or discolouration is very low. However, these would be the two most important risk to be away of. Very occasionally acne may flare after hyfrecation though this is not very common either.

How is hyfrecation or radiofrequency of comedones treatment done?

The skin is cleansed and the treatment is carried out. It takes about 10 to 15 minutes to complete. A warm pinch like sensation is felt each time. There may a tiny scab at each location. There may also be some temporary redness where the treatments was carried out. You are able to cleanse the skin later that day with a gentle cleanser, and apply makeup as normal the following day.

References

  • Cunliffe WJ et al. Comedone formation: etiology, clinical prsentation, and treatment. Clin Derm 2004; 22: 367-74.

Author information

Author: Dr Sajjad Rajpar

Date last reviewed: 10 Jan 2023

Conflict of interest and disclaimer

This information is based on the views of a UK Consultant Dermatologist (a doctor who is on the specialist register for Dermatology, the equivalent of which is ‘Board certified’ in the USA).  This information is intended for patients of this Clinic and under our care only. Practices vary nationally and internationally and we do not wish to contravene advice you have been provided by your own Physician.

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