Dr. Thomas P. Habif, MD discusses Blackhead and Whitehead Comedone Acne. See more at www.dermnet.com PLEASE RATE AND COMMENT!!! Acne Comedone Acne begins with the development of comedones. These appear before other signs of puberty at about age 10. The first event is the increase in production of oil by the sebaceous glands. The face and scalp become oily. Black heads or white heads first appear on the nose. Latter they form on the forehead, cheeks and finally to the chin. The chest and back may or may not be involved but these are the last areas affected. Comedones also form in and behind the ears. Closed comedones are the first to appear. The pores of some may dilate and become open comedones or blackheads. Lesion may be few or numerous giving the surface a studded appearance. The disease may then progress with some closed comedones evolving into papules, pustules and cysts. It is common to see patients with all of these lesions present in a single area. White round micros cysts called milia look like closed comedones. These are commonly found about the eyes or anywhere on the face. They are more common in older patients who have photodamaged skin. Large or small blackheads and whiteheads may be found lateral to the eyes in older people. Sun damage destroys the structural integrity of the collagen and the follicles expand to form large unsightly blackheads.