Open Comedones (Blackheads) ICD-10: L70.0

Acne / Non-inflammatory skin lesion

Often searched as: blackheads on nose, dark spots in pores, clogged pores on face, blackheads that won't go away, blackheads on forehead, black dots on skin, how to get rid of blackheads, pores that look black…

Clinical urgency level

lowmediumhigh

Systems Affected

skinhair folliclessebaceous glands

Severity Levels

mild

A few blackheads on the nose or forehead, stable, no irritation — manageable with regular cleansing and over-the-counter topical retinoids or salicylic acid.

moderate

Numerous blackheads across the face, back, or chest, mixed with other acne lesions (papules, pustules) — benefits from consistent skincare routine and possibly prescription treatment.

severe

Extensive comedonal acne with deep, persistent blockages across large areas, often evolving into inflammatory acne or cystic lesions — requires dermatologist-guided treatment.

Red Flags

Blackheads becoming inflamed, red, and painful (transition to papules or pustules)
Scarring or post-inflammatory hyperpigmentation after picking or squeezing
Very large, dilated pores that don't respond to treatment (possible dilated pore of Winer)
Sudden widespread comedonal eruption in an adult not previously prone to acne (could signal medication side effect or hormonal imbalance)

Clinical Presentation

Open comedones (blackheads) on the nose — close-up clinical view

Source: Wikimedia Commons (CC BY-SA 3.0 )

Comedonal acne image gallery — DermNet NZ

View gallery on DermNet NZ (image gallery reference)

When to See a Doctor

Open comedones are benign and usually manageable at home. See a dermatologist if blackheads are extensive, keep coming back despite regular skincare, or are accompanied by inflamed acne lesions, scarring, or significant emotional distress. A dermatologist can prescribe retinoids or other treatments that work more effectively than over-the-counter options.

Differential Diagnosis

Closed comedones (whiteheads — pore is closed)
Sebaceous hyperplasia (enlarged oil glands — yellowish, not dark)
Dilated pore of Winer (single, very large open comedone)
Trichostasis spinulosa (multiple hairs in one follicle — dark pore-like)
Favre-Racouchot syndrome (solar comedones in elderly on sun-damaged skin)
Milia (tiny white cysts — closed, not dark)

Comorbidities

Acne vulgaris (papules, pustules, nodules)
Seborrheic skin type (excess oil production)
Hormonal acne (PCOS, puberty, menstrual cycle fluctuations)
Occupational acne (exposure to oils, grease, or comedogenic substances)

Prognosis

Blackheads are chronic but highly manageable. With consistent use of topical retinoids (tretinoin, adapalene) and salicylic acid-based products, significant improvement is seen within 8–12 weeks. They frequently recur if skincare is discontinued. Extraction by a professional aesthetician or dermatologist provides short-term clearance. Long-term control requires ongoing skincare. No risk of malignant transformation — purely a cosmetic and comfort concern.

Detailed Overview

Causes, Symptoms, and When to Take Action Open comedones, commonly called blackheads, are non-inflammatory lesions of acne. They form when hair follicles become blocked and the follicular opening remains open to air. How It Looks Texture: Slightly raised bumps; central pore appears dilated Color: Dark or black-brown at the opening, due to oxidation of skin pigments Shape: Papules with a visible dark 'head' at the follicular opening Location: Common on the face, forehead, nose, and chin; can also occur on back and other oily skin areas Why Does It Appear? Blockage of hair follicles by excess sebum and dead skin cells Poor shedding of keratin within the follicles Pigment in follicular opening oxidizes when exposed to air, causing dark coloration Influencing factors include oiliness, humidity, and skin care habits Should You Be Concerned? Open comedones are benign and not dangerous. However, concern is justified if: They become numerous or widespread They lead to skin texture issues or dissatisfaction with appearance There is risk of secondary irritation or spread Can You Prevent It? Maintain regular skin cleansing, especially in oily zones Avoid heavy or pore-clogging skin care or cosmetic products Don't squeeze or pick comedones, to reduce risk of skin damage 👉 How Piel AI Can Help Piel AI enables you to track open comedones over time via photographs. While not a diagnostic tool, it helps you notice changes in number, size, or appearance and decide when to seek evaluation. Summary Open comedones are blackheads: non-inflamed acne lesions with visible dark openings. They result from blocked follicles and pigment oxidation. Though benign, they affect appearance and may lead to complications if manipulated. Good hygiene and monitoring are key.

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