May 23, 2011 Did you know there are many different types of acne breakouts? Debris in the pore leads to some form of a comedo, or blemish. But not all blemishes are alike. Four basic types of non-inflamed breakouts are often found on acne-prone skin. With non-inflamed comedones, there is no redness or swelling of the lesion. However, non-inflamed comedones may turn into a “typical” pimple if bacteria invade. While not everyone who has acne experiences inflamed breakouts, all acne sufferers have some form of non-inflamed comedones. Soft Closed Comedones Appearance: Soft closed comedones present as bumpiness on the skin’s surface. They are not painful or red. Development: Soft closed comedones develop when a plug of cellular debris and oil becomes trapped within the pore and are covered by a layer of dead skin cells. The oil plug itself remains liquid or soft. Treatment: Treatment involves reducing excess oil and dead cells. Estheticians and dermatologists often extract comedones by exerting gentle pressure, coaxing the trapped oil plug to the surface. Keeping the skin clear of soft closed comedones can drastically reduce the development of inflamed acne breakouts. Hard Closed Comedones Appearance: Hard closed comedones, called milia, have very obvious white heads. Unlike pustules, milia are not red or painful. They are especially common in the eye area. Development: Hard closed comedones develop just as their soft counterparts, however, the impaction has hardened and is similar to a grain of sand. The white head is not pus, but rather a mass of dead cells and sebum. Treatment: Dermatologists and estheticians (in some states) extract milia by making a tiny incision on the lesion and carefully removing the sebaceous plug. Even without treatment, milia can work their way to the surface over time. Open Comedones Appearance: An open comedo, or blackhead, is easy to identify by its dark brown to black surface coloring. Development: A blackhead is an accumulation of dead skin cells and sebaceous matter within the follicle. Its top is not covered by a layer of dead skin cells, but instead is exposed to air. The black coloring is not dirt. Air causes the oil to darken, much like a sliced apple turns brown when exposed to air. Treatment: Blackheads can usually be extracted by applying gentle pressure to the breakout. Consistent, thorough cleansing reduces oiliness, which can help prevent the development of blackheads. Microcomedones Appearance: Although most acne sufferers have many microcomedones, they are too small to be seen with the naked eye. Development: A microcomedo is the very beginning of an acne lesion. It occurs when the sebaceous duct and pore opening becomes blocked by excess sebum and dead skin cells. Every blemish begins as a microcomedo. Treatment: Treatment is similar to that of soft closed comedones and involves reducing excess oil on the skin. Regular exfoliation helps avoid buildup of dead skin cells. Treating comedones at this level helps prevent larger acne breakouts from occurring. Dr. Lawrence Jaeger of New York is an expert in the diagnosis and treatment of skin conditions and is board certified in dermatology and dermatologic surgery.