comedonal

Comedonal is a dermatology term used to describe skin lesions or a pattern dominated by comedones, which are clogged hair follicles filled with keratin and sebum. Comedones can be open (blackheads) with a visible pore, or closed (whiteheads) with no visible opening.

Comedonal patterns are most commonly seen in comedonal acne, a non-inflammatory form of acne in which comedones predominate and inflammatory lesions are minimal or absent. The term can also describe sun-damaged or other skin conditions that feature numerous open comedones, such as Favre-Racouchot syndrome, which may occur on the face of older adults exposed to chronic sun exposure.

Pathophysiology involves abnormal keratinization within the follicular canal and excess sebum production, leading to blockage of the follicle. Hormonal factors, genetics, and environmental influences (including occlusive cosmetics or skincare products that are comedogenic) can raise the risk of developing a comedonal pattern. Certain medications and stress can also influence sebum production and keratinization.

Diagnosis is clinical, based on the appearance of comedones and the absence or relative paucity of inflammatory lesions. Dermatoscopic examination can aid assessment in uncertain cases. It is important to distinguish comedonal acne from inflammatory acne, rosacea, or other follicular disorders.

Management focuses on reducing follicular plugging and sebum production. First-line treatments typically include topical retinoids to normalize keratinization, often combined with benzoyl peroxide or salicylic acid. Regular cleansing, non-comedogenic moisturizers, and sun protection are advised. Severe or persistent cases may require professional interventions such as automated extraction or adjunctive therapies under supervision. Prognosis is generally favorable with appropriate treatment and skincare.