Closed Comedones: What They Are and How to Get Rid of Them

On this page

1. Closed comedones vs fungal acne vs milia at a glance
2. What are closed comedones?
3. What causes closed comedones?
4. How do you tell closed comedones from fungal acne?
5. Closed comedones vs milia: what’s the difference?
6. How do you get rid of closed comedones?
7. Does salicylic acid work on closed comedones?
8. Which is better for closed comedones: adapalene, tretinoin or azelaic acid?
9. Should you extract closed comedones at home?
10. How long do closed comedones take to go away?
11. Your next step

Quick answer: Closed comedones are small, skin-colored or white bumps that form when a pore fills with oil and dead skin cells and a thin layer of skin seals over the top. They are a mild, non-inflamed type of acne, often called whiteheads. Adapalene 0.1% gel, salicylic acid and azelaic acid clear most closed comedones in 8 to 12 weeks.

We read 17 studies and sources, from a 1989 azelaic acid trial to a 2025 review of fungal acne, so every claim below links to where it came from. (I also wrote myself a sticky note that says DON’T TOUCH IT and stuck it on the bathroom cabinet. It’s there right now. It’s doing its best.)

Closed comedones vs fungal acne vs milia at a glance

	Closed comedone	Fungal acne	Milium
What it is	A pore plugged with oil and dead skin, sealed over by skin	Yeast overgrowth in the hair follicles (Malassezia folliculitis)	A tiny cyst of keratin, a skin protein, just under the surface
What it looks like	Skin-colored or white bumps in mixed sizes	Small bumps and pustules, all the same size	Hard, pearly-white dot
Itchy?	Rarely	Often	No
Where it shows	Forehead, chin, cheeks, sometimes back and chest	Upper back, chest, shoulders, hairline	Around the eyes, cheeks, nose
What clears it	Retinoids, salicylic acid, azelaic acid	Antifungal treatment	Often clears on its own, or a dermatologist removes it
Squeeze it?	No. Only a professional should extract	No. It won’t help	No. It needs a sterile needle or blade

Sources: DermNet on comedonal acne, DermNet on Malassezia folliculitis, Chalupczak and Lipner 2025, DermNet on milia, Cleveland Clinic on milia, Cleveland Clinic on comedonal acne.

What are closed comedones?

Closed comedones are pores plugged with oil (sebum) and dead skin cells, where a thin layer of skin has closed over the top. The plug stays hidden, so you see a tiny skin-colored or white bump instead of a dark dot. They are a mild, non-inflamed type of acne, most common on the forehead, chin and cheeks.

“If the pore closes up, you’ll see a tiny bump that looks white or flesh colored. These are whiteheads.”

American Academy of Dermatology, How to treat different types of acne

One of them on its own is a closed comedo, which sounds like a very small Italian car, and I will not be taking questions. If the pore stays open, the same plug turns dark at the top and becomes a blackhead, or open comedo. Cleveland Clinic says that dark tip happens because the plug meets the air and “oxidizes” (Cleveland Clinic). So a whitehead is basically a blackhead that kept its lid on. [Nods respectfully at the lid.]

Board-certified dermatologist Mona Gohara, MD, has the best picture of it I’ve found.

“Unlike blackheads, the pore opening remains covered by a thin layer of skin, trapping oil and dead skin cells underneath. Think of them as tiny traffic jams beneath the skin’s surface.”

Mona Gohara, MD, in Marie Claire

Most are small. DermNet says the bigger ones, over 2 to 3 mm across, are called macrocomedones (DermNet), a word I have now said out loud four times just to enjoy it.

Flat gray dots on your nose are a different thing. If the dots are flat, gray or tan, and sit in the pores on your nose, they’re probably sebaceous filaments, which are normal pore linings and not acne at all. Our guide to sebaceous filaments and what shrinks them covers those.

What causes closed comedones?

Closed comedones form when the pore lining sheds too many sticky skin cells while the oil gland makes extra oil, so the two jam into a plug. Hormones called androgens push oil up, which is why they flare in the teens, before periods and in pregnancy. Heavy products, humidity, smoking and picking all make them more likely.

DermNet’s list of triggers is longer than my list of excuses for skipping the gym, and more useful (DermNet):

• Skin that’s too wet for too long: before a period, from heavy moisturizers, or in humid weather.
• Certain ingredients: isopropyl myristate, propylene glycol, oily hair pomades and some cosmetic dyes.
• Damage to the pore: squeezing, abrasive washing, peels or laser treatments.
• Smoking: comedonal acne is more common in smokers.
• Diet: milk products and high-sugar foods “may contribute”, which is a hedge, not a verdict.

Cleveland Clinic adds a family history of acne and “using oily or greasy personal care products” (Cleveland Clinic). I read that list with my rich night cream open on the counter, looking very innocent. It was not innocent.

The squeezing one is the cruel twist. Popping a bump can damage the pore and cause more comedones, which is why the sticky note exists. (It has survived two Sundays. That’s a personal record.)

How do you tell closed comedones from fungal acne?

Fungal acne, properly called Malassezia folliculitis, is a yeast overgrowth in the hair follicles, not a clogged pore. The tells are itching, bumps that are all the same small size, and a spot on the chest, upper back, shoulders or hairline. Closed comedones rarely itch, come in mixed sizes, and don’t clear with antifungal treatment.

“Malassezia folliculitis presents as small, uniform, itchy papules and pustules particularly on the upper back and chest.”

DermNet, the New Zealand dermatology reference

“Uniform” is the key word. A 2025 review describes the bumps as 1 to 2 mm, all alike, and “devoid of comedones” (Chalupczak and Lipner 2025). So if you can spot real comedones in the mix, acne becomes the more likely answer, which makes this the only skin question I know where finding more of something is good news for the diagnosis.

The same review says fungal acne is often mistaken for acne, which leads to “inappropriate antibiotic use”. That’s a problem twice over, because DermNet lists antibiotics, heavy sweating, hot humid weather and thick creams or sunscreens as things that feed the yeast (DermNet). I, too, have made a problem worse by throwing the wrong product at it, although mine involved a toaster.

[Takes off the funny hat.] A dermatologist can confirm fungal acne with a quick skin scraping under a microscope, and antifungal treatment works well, though it often comes back. If your bumps itch, look identical, and ignored six weeks of acne products, get it checked before you buy anything else.

Closed comedones vs milia: what’s the difference?

Milia are tiny, hard, pearly-white cysts filled with keratin, a skin protein, sitting just under the surface with no pore opening at all. Closed comedones are softer plugs of oil and skin cells inside a pore. In adults, milia often clear by themselves within weeks to a couple of months. Closed comedones usually need a retinoid or an acid.

DermNet defines a milium, one of milia, as “a small cyst containing keratin (the skin protein)” (DermNet). Cleveland Clinic says adults “can have milia for a few weeks to a couple of months before they clear up on their own” (Cleveland Clinic). Milia are the house guests who leave without being asked. Rare, and precious.

The removal method is the giveaway that they’re a different animal. DermNet says a milium “may be de-roofed using a sterile needle or blade and the contents squeezed or pricked out”, a job for a dermatologist and absolutely not for me and a sewing kit. [Returns the sewing kit to the drawer. Closes the drawer. Moves the sticky note onto the drawer.]

How do you get rid of closed comedones?

Use one pore-clearing ingredient every day for 8 to 12 weeks: adapalene 0.1% gel (sold without a prescription in the US), a 2% salicylic acid leave-on, or azelaic acid. Add a gentle cleanser and non-comedogenic products, skip scrubbing and squeezing, and see a dermatologist if nothing has changed after three months.

Cleveland Clinic explains why this takes a while.

“Comedonal acne is typically the mildest form of acne. But it can be difficult to treat because the comedones are “stuck” within the follicles.”

Cleveland Clinic

Here’s the honest scorecard. (I wanted a row called “one night, zero effort”. I looked everywhere. It’s not in the literature.)

Option	What the evidence shows	Worth knowing
Adapalene 0.1% gel	Cut non-inflamed lesions 46% vs 33% for tretinoin 0.025% at 12 weeks (323 people)	Over the counter in the US from age 12. Most experts say stop in pregnancy
Tretinoin (prescription)	Cut non-inflamed lesions 54% at 12 weeks, similar to adapalene’s 57% (297 people)	Prescription only. Most experts say stop in pregnancy
Azelaic acid 20% cream	As effective as tretinoin 0.05% on comedones over 6 months, with fewer side effects (289 people)	Thought to be safe in pregnancy
Salicylic acid 2%	No significant difference from adapalene gel at 12 weeks: 51% vs 43% much improved (500 people)	One brand, one trial in China. Drugstore limit is 2%
Professional extraction	Clears the bumps you have now	Doesn’t stop new ones forming

Sources: Shalita 1996, Ellis 1998, Katsambas 1989, Ye 2024, AAD on acne treatment in pregnancy, FDA acne ingredient rules, Galderma.

The American Academy of Dermatology’s advice for whiteheads is short: use a retinoid, and add a benzoyl peroxide wash (AAD). Short, clear, and somehow still harder to follow than it looks, because I have the attention span of a golden retriever at a picnic.

Does salicylic acid work on closed comedones?

Yes, salicylic acid can help closed comedones. It is oil-soluble, so it can work inside the oily pore and loosen the dead skin cells that form the plug. In a 500-person trial, a 2% salicylic acid gel did about as well as adapalene over 12 weeks. Drugstore products in the US top out at 2%.

That trial is the best head-to-head we found: 51.01% of people on the salicylic acid gel were much improved or clear at 12 weeks, against 43.10% on adapalene, and the gap wasn’t statistically significant (Ye 2024). The honest catch: it tested one brand’s “supramolecular” formula in China, so your drugstore toner is a cousin of that product, not a twin. I have cousins like that. Lovely at weddings, not interchangeable.

Leave-on products get more time on the skin than a wash you rinse off after 30 seconds, so a toner or serum makes more sense for clogged pores. That’s practitioner consensus, not something a trial has tested on closed comedones. Start a few nights a week, since dry, irritated skin just gives you a new problem to google at 1 a.m.

Which is better for closed comedones: adapalene, tretinoin or azelaic acid?

For most people, adapalene 0.1% is the easiest place to start: it’s sold without a prescription in the US, and in a 323-person trial it cleared more comedones than a mild tretinoin gel while causing less irritation. Tretinoin needs a prescription. Azelaic acid matched tretinoin on comedones and is the pregnancy-friendly pick.

Adapalene went over the counter in July 2016, for people 12 and older, as the first new over-the-counter acne ingredient in more than 30 years (Galderma). The AAD puts it simply: “You can buy one retinoid, adapalene, without a prescription” (AAD). Thirty years for one new ingredient. My phone updates more often than that, and it has never once cleared a pore.

Tretinoin is the prescription option, and in a 297-person trial the two cut non-inflamed lesions by similar amounts, 57% and 54% (Ellis 1998). It’s the same retinoid behind the best-studied cream for new red stretch marks, which makes it the most overqualified ingredient in my bathroom.

Azelaic acid is the gentle one. In 289 people with comedonal acne, a 20% cream was “equally effective as 0.05% tretinoin cream in reducing the number of comedones”, and caused fewer side effects (Katsambas 1989). It’s the quiet kid in class who turns out to have the best grades. Note that the trials used 20%, which is stronger than many drugstore versions, so read the label (the one piece of homework I reliably do).

If you’re pregnant or trying to be, the AAD says most experts recommend stopping both adapalene and tretinoin, while azelaic acid “is thought to be safe to use during pregnancy” and salicylic acid is generally considered safe for a limited time (AAD). Check with your obstetrician or dermatologist first. No jokes in this paragraph. It’s the one place I behave.

Should you extract closed comedones at home?

No. Closed comedones are sealed under a layer of skin, so squeezing them means forcing the plug sideways or tearing the skin, which can leave scars, infection and more clogged pores. A dermatologist or licensed esthetician can extract them with sterile tools, but extraction doesn’t stop new ones from forming.

“Try not to pick, squeeze or pop comedones. Only a professional should do extractions.”

Cleveland Clinic

Cleveland Clinic lists what DIY extraction can lead to: acne scars, damaged pores that make more comedones, infection, inflamed acne and “more noticeable blemishes”. So the sticky note on my cabinet isn’t nagging. It’s quoting Cleveland Clinic. [Straightens sticky note. Feels supervised.]

Even a professional extraction is a reset, not a fix. Verywell Health says extractions “don’t keep closed comedones from forming” (Verywell Health), so you still need the daily ingredient. Clinic options for stubborn cases include chemical peels, microdermabrasion and prescription pills (Cleveland Clinic). None of them, sadly, is a sticky note.

How long do closed comedones take to go away?

Plan on 8 to 12 weeks of daily use before you judge any treatment, and a few months for a full clear. Cleveland Clinic says you may notice a difference in 8 to 12 weeks, and the American Academy of Dermatology says to give treatment six to eight weeks before seeing a dermatologist. Closed comedones can also come back.

Cleveland Clinic says comedonal acne “can be a long-term condition that comes back repeatedly over many years” (Cleveland Clinic), so the ingredient that clears them usually stays on as upkeep. Think of it less as a cure and more as a gym membership, except this one you’ll actually use. Many people also notice a few extra bumps in the first weeks of a retinoid, often called purging. That’s widely reported, but the trials above didn’t measure it separately, so treat it as practitioner consensus.

Here’s the sticky note’s final form. It no longer says DON’T TOUCH IT. It now says WEEK 8, THEN DECIDE, which is both better advice and, frankly, much better handwriting. [Sticks it back on the cabinet. Walks away. Does not look back. Looks back once.]

Frequently asked questions

Sources

• American Academy of Dermatology: How to treat different types of acne
• American Academy of Dermatology: Acne treatment during pregnancy
• Cleveland Clinic: Comedonal acne
• DermNet: Comedonal acne
• DermNet: Malassezia folliculitis
• DermNet: Milium
• Shalita et al. 1996, adapalene 0.1% vs tretinoin 0.025% (Journal of the American Academy of Dermatology)
• Ellis et al. 1998, adapalene solution vs tretinoin gel (British Journal of Dermatology)
• Katsambas et al. 1989, 20% azelaic acid vs vehicle and tretinoin
• Ye et al. 2024, 2% salicylic acid gel vs adapalene gel (Journal of Cosmetic Dermatology)
• Chalupczak and Lipner 2025, Malassezia folliculitis review (Journal of Fungi)
• Galderma: FDA approves Differin Gel 0.1% for over-the-counter use