Blackheads and whiteheads are non-inflammatory clogged pores driven by excess sebum and slowed cell turnover. They clear with the right approach — and recur without consistent maintenance.
get startedBlackheads (open comedones) and whiteheads (closed comedones) are non-inflammatory clogged pores — the earliest stage of the acne cycle before bacterial colonization and the immune response produce inflammation. They're extremely common, driven primarily by genetics and sebaceous gland activity, and found most frequently in the T-zone (forehead, nose, chin). They can exist in isolation without progressing to inflammatory acne, or they can precede and coexist with more inflammatory forms of acne.
Patients come in about blackheads when they've tried multiple products and the congestion keeps coming back, or when in-office extraction is the only thing that gives them the clearance they're looking for.
Comedones form from two converging processes inside the hair follicle.
Excess sebum production: Androgen-driven sebaceous glands produce more oil than the follicle can clear. This creates the saturated environment in which comedones form.
Abnormal follicular keratinization: Dead skin cells inside the follicle don't shed normally, accumulating and combining with sebum to form the plug. This is the most targetable part of the comedone cycle — retinoids normalize it directly.
In blackheads, the pore opening remains open and the top of the plug oxidizes, producing the characteristic dark color. In whiteheads, the pore seals over, trapping the material beneath.
Patients with blackhead and whitehead concerns typically describe:
Comedone formation typically peaks during adolescence as androgen levels surge. Many patients see improvement in their 20s and 30s, but hormonal fluctuation — menstrual cycles, perimenopause, stress-driven androgen elevation — can maintain significant comedone formation well into adulthood.
As skin ages, the sebum production that drives comedone formation typically decreases — which is why significant blackhead concerns are less common in patients over 50 than in younger adults.
Blackhead and whitehead management requires both clearing existing congestion and slowing new formation.
At CAMI, comedone treatment is practical and maintenance-oriented. In-office peels and extraction produce the most immediate improvement. The at-home routine — BHA exfoliation and retinoids — determines how quickly congestion returns. Both matter. Patients who maintain the routine between treatment sessions see significantly better long-term results than those who rely on in-office treatment alone.

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