What are comedones caused by?

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Thank you for your query. I reviewed your pictures (attachment removed to protect the patient's identity). It is micro-comedonal acne. Acne is a disorder of the pilosebaceous unit, pilo-hair, and sebaceous-oil-producing gland. These pilosebaceous glands are densely distributed over the face, neck, chest, back, shoulder, and arms. It also has a genetic component, meaning the appearance and severity of acne depends on the parents' genes. The sebaceous gland produces oil expelled through the duct, opening on the skin's surface. Our skin has a harmless commensal bacteria called Propionibacterium (P. acne). This bacteria acts on the oil collected inside and causes inflammation leading to red bumps, pustules, cysts, or nodules as it progresses. If acne is not treated on time, they lead to scar formation. Hormones strongly affect acne; increased androgen hormone can cause thickening of the duct wall, leading to its blockage and causing comedones (black and white heads). PCOD or PCOS - Polycystic Ovarian Disease or syndrome is the most frequent hormonal disease causing acne in teenagers and adult women. I suggest you to follow a few things mentioned below. Wash your face with Salicylic acid face wash thrice daily. Apply Clindamycin and Benzoyl Peroxide combination cream. Apply a thin layer to the forehead at night. Initially, use it on alternate nights, and gradually increase the frequency of application as there can be mild irritation initially. Use sunscreen with SPF (sun protection factor) 50. Apply it to the whole face before you step out, irrespective of the presence of sunlight. Always use non-comedogenic sunscreen. Do not prick or squeeze your acne, as it will leave scars. Exercise for at least 40 minutes a day. Avoid oil massage to scalp, it will aggravate dandruff. If there is oil flow on the facial skin, it can clog the pores leading to comedones. Eat vitamin A-rich fruits and vegetables like papaya, mango, muskmelon, pumpkin, carrot, and beetroot. These foods have beta carotene, an antioxidant, and are very helpful for healthy skin. Also, drink two to three liters of water per day; this keeps the skin hydrated. Always use water based cosmetics, which are non-comedogenic. Avoid stress. Do not wax the face for facial hair removal. Avoid the use of steroid creams. Kindly consult a specialist, talk to them and take medications with their consent. I hope this has helped you. Thank you.