Comedones that won't clear — why exfoliating misses them

You have used the peeling gel, the exfoliating pads and the scrub, and the small bumps across the forehead and cheeks are exactly where they were.

Closed comedones start in the wall inside the pore, not in the surface layer of dead skin. What does have evidence is dissolving rather than scrubbing, and even that works over three months rather than three weeks.

Which layer of skin do closed comedones start in

Small bumps of this kind are called comedones. In a study comparing skin tissue from people with acne against healthy controls, comedone walls were thicker and more differentiated than normal upper follicle walls (Oulès et al., 2020).

When the surface of clear-looking skin from 23 people with acne was lifted with adhesive, microcomedones came away with it (Fontao et al., 2020).

Scrubbing works on the skin surface. Washing more often did not help comedones either. In a single-blind randomised trial comparing washing once, twice and four times a day over six weeks, there was no significant difference between the three groups (Choi et al., 2006). With 27 people split three ways, that is about nine per arm — too thin to read as a settled negative.

When acne-bearing skin was sealed under adhesive for two weeks, new inflammatory lesions appeared regularly, and the authors traced them to microcomedones rupturing out of sight (Mills & Kligman, 1975).

What does reduce closed comedones

Dissolving has evidence behind it. In a split-face trial comparing a 2% salicylic acid product against 5% benzoyl peroxide with 0.1% adapalene over 28 days, non-inflammatory lesions fell by 43.1% and 42.7% respectively (Zheng et al., 2019). The gap was not statistically significant.

In a 12-week phase III trial with 1,617 participants, non-inflammatory lesions fell 46.93% in the adapalene-only arm (Luan et al., 2024). There was no vehicle arm — all three groups were on active treatment — so that figure is not a difference from applying nothing.

Can you buy 2% salicylic acid where you live

Not as a product you leave on the skin. In Korea a leave-on cosmetic cannot carry it above 0.5%, and the 2% ceiling applies only to rinse-off cleansing products. What the trial above used was a 2% cream applied to one side of the face for 28 days; the paper does not record rinsing it off.

A cleansing gel with 2% salicylic acid plus zinc and LHA, massaged for thirty seconds twice daily and rinsed, reduced non-inflammatory lesions by 64.0% over 84 days in 35 people (Towersey et al., 2023). There was no control arm, the site was the trunk rather than the face, and six of the authors work for the company that funded it.

Could these bumps not be comedones at all?

They could.

Keratosis pilaris is common on the outer arms but appears on the face too. Comparing tissue from 20 patients against 20 controls, affected skin showed blocked follicular openings, a marked reduction in sebaceous glands, and hair shafts that failed to emerge properly (Gruber et al., 2015).

Plane warts also look like small bumps. Five cases have been reported of plane warts spreading after cosmetic hair removal (Sonthalia et al., 2015). It is a record of spread following friction or plucking, and five cases cannot establish cause.

Why weeks of effort leave comedones unchanged

No trial cleared comedones completely. If it is the pores themselves that stand out, see Large pores and blackheads — why do they keep coming back?

Where to start today

• If you have been using a scrub or peeling gel, put it down for two weeks. Comedones start in the wall inside the pore (Oulès et al., 2020), and what scrubbing reaches is the surface. If no more are appearing after two weeks, carry on.
• Swap the evening cleanser for one with salicylic acid, and rinse after thirty seconds. A 2% salicylic acid product reduced non-inflammatory lesions by 43.1% over 28 days (Zheng et al., 2019). Judge it at 12 weeks by the number of comedones.
• If three months brings no change or the count rises, see a dermatologist. Bumps that are not comedones do not change with exfoliating, and keratosis pilaris starts by a different mechanism (Gruber et al., 2015). In Korea adapalene requires a prescription.