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Blackheads are regarded as the mildest and least inflammatory form of acne. However, these tiny dark spots are extremely hard to get rid of.
Although blackheads can appear anywhere on the skin where hair follicles are present, they are usually concentrated at the center of your face, that is, on the nose, forehead, cheeks, and chin.
The bridge and the sides of your nose are especially prone to blackheads because the pores in these areas are relatively larger. The larger the skin pore, the more likely it is to get plugged and form a blackhead.
You cannot expect to look your best when your skin is speckled with tiny blackheads. Sadly, even the most stringent skin care routine can be ineffective in both preventing and removing blackheads.
Scrubbing or squeezing blackheads only makes the condition worse. People who struggle with blackheads find it hard not to pick at these pesky little dots, only to regret it later.
If you squeeze a blackhead, the congested pore can develop into a full-blown acne lesion. Moreover, you run the risk of scarring your skin or transferring the infected sebum to other areas of the skin.
Difference Between Blackheads and Whiteheads
There are two types of comedones, namely, blackheads (open comedones) and whiteheads (closed comedones).
Unlike inflammatory acne, comedones do not form a head but manifest as tiny bumps that can be flesh colored, white, or black.
If the mouth of the plugged hair follicle remains closed, the mixture of oil, bacteria, and debris within it remains unexposed to the outside environment.
In such a case, the congested pore acquires a white top due to the gunk trapped within it. This is called a whitehead or closed comedone.
If the content of the clogged pore comes in contact with air, it oxidizes and turns black. This oxidization happens when the top opening of the blocked pore splits open. Thus, blackheads are also known as open comedones.
Causes and Formation of Blackheads
Your epidermal skin is covered with tiny pores that have a hair growing within it and a sebaceous gland underneath it.
When the oil glands become overactive, they start to produce excess sebum. This overactivity is made worse by the increased shedding of dead skin cells that further crowd the follicle cavity.
Both the oil and the skin cells along with the hair inside the follicle form a clumped mass that plugs the pore. This allows bacterial overgrowth in the follicle.
When this hair follicle becomes congested with excess sebum, dead skin cells, and acne-causing bacteria, it is referred to as a comedo.
The buildup of this gunk causes the hair follicle to expand and sometimes develop a wider opening. Thus, the congested pore sitting on the skin appears larger than usual.
In the case of open comedones, their content becomes exposed to the oxygen in the environment and undergoes a chemical reaction called oxidation.
This process causes the sebaceous mix within the hair follicle to acquire a darker hue, which makes the center of the pore look almost black.
Additional Contributing Factors for Blackhead Formation
The following factors can also contribute to the development of blackheads:
- If you have naturally oily skin
- If the acne-causing bacteria (Propionibacterium acnes) react with the excess sebum within the plugged pores to produce increased amounts of free fatty acids
- If your skin becomes excessively hydrated due to the overuse of skin moisturizers, increased atmospheric humidity, or natural changes before the onset of menstruation
- If you expose your skin to certain chemicals such as isopropyl myristate, oily pomades, propylene glycol, and some dyes that are commonly found in cosmetic products
- If the male sex hormone 5-testosterone (DHT), which is present in your skin cells, becomes overactive
- If you always wear tight-fitting clothes
- If you are an active or passive smoker
- If you spend too much time in the sun without proper skin protection
- If you are on certain steroid-based medications such as cortisone, including over-the-counter cortisone
- If you sweat profusely
- If you are suffering from PCOS
- If you are prone to excessive stress
- If you use excessive cosmetics on your skin for extended periods or go to sleep with makeup on
- If people in your family are prone to blackheads
- If you use comedogenic makeup products
How to Identify a Blackhead?
Unlike most acne lesions, blackheads are typically painless and headless. They become visible on the skin as slightly raised black bumps that are flatter than an inflammatory acne pimple or pustule.
Although blackheads can develop anywhere on the body where there is a hair follicle, they usually affect the facial skin, more specifically the nose.
While it is common to have blackheads on the top and sides of the nose, the forehead, and the chin, some people may get them in other places too. These areas include the ears, shoulders, arms, chest, and back.
The affected areas can become red and inflamed, especially if picked or scratched, resulting in a painful inflammation.
Scratching, scrubbing, or picking the congested pore to unclog it can be counterproductive as doing so can leave you with unnecessary skin scarring. But if left untreated, these blackheads can trigger a full-blown acne breakout.
How Are Blackheads Treated?
Your dermatologist will take into account your skin type and condition as well as the extent or severity of your blackheads before suggesting the appropriate treatment for you.
1. Topical ointment for blackheads
Your skin specialist may recommend “comedolytic” medications, which have to be applied topically to the affected skin once or twice a day.
The topical creams, ointments, or gels for the treatment of comedonal acne usually have a strong chemical composition. Therefore, they should be applied in minuscule amounts to avoid skin irritation.
Make sure that your skin is squeaky clean and devoid of any trace of moisture before applying a thin layer of the dermatologist-recommended skin product.
The treatment will only bear fruit if you follow the application guidelines and dosage stipulated by your doctor and if you have a long-term commitment to the regimen (usually 8-12 weeks or up to a year).
It can take anywhere between a few weeks to months before you can notice any visible improvement in your condition. Moreover, you may have to continue the topical application for years before the condition resolves completely.
Besides, the primary aim of this kind of basic topical therapy is to prevent future breakouts rather than cure the condition for good.
Some of the commonly prescribed topical agents for comedonal acne include:
- Topical Retinoids: tretinoin, isotretinoin, adapalene (doctor’s prescription needed)
- Salicylic acid (+/- sulfur and resorcinol)
- Benzoyl peroxide (helps certain skin types)
- Azelaic acid
- Glycolic acid
Some of these topical ointments may be available over the counter, but it is strongly advised to consult your doctor before using them to prevent any adverse skin reaction.
2. Clinical procedures for blackhead removal
If the condition of your skin does not improve despite preliminary topical treatment, your dermatologist may consider other measures to physically remove the blackheads.
a. Acne extraction
Acne extraction is a relatively invasive but safe clinical procedure for blackhead removal, provided it is performed by a trained dermatologist.
As the name suggests, this treatment involves the use of sterile instruments to pull out the contents of a clogged pore.
For best results, you may have to go through a round of skin exfoliation prior to the treatment.
Acne extraction is useful for cleaning out the plugged comedones. However, it does not offer a permanent solution to the problem of blackheads.
The unclogged pore can become congested again if you do not take proper care of your skin post treatment.
Your dermatologist will specify a customized skin care plan to prevent new blackheads from occurring. If you wish to prolong the effect of this treatment, you must adhere to this skin care regimen.
Acne extraction is usually not the first choice of treatment as it can be quite time-taking and expensive.
b. Chemical peel
Yet another cosmetic treatment for the removal of blackheads involves the application of peeling agents that dissolve the dead skin cells and facilitate speedy skin regeneration.
Chemical peels are acid-containing exfoliants used to improve and smooth the texture of your blackhead-ridden skin.
The procedure involves the application of a chemical solution to the affected skin to remove the surface layer. Once the dead and damaged skin is shed, new layers of skin form in its place.
Thus, by accelerating the cell turnover in your skin, chemical peels help to clear out the clogged pores. The freshly formed skin tends to have tighter pores that are less likely to turn into blackheads.
According to a 2015 study published in the International Journal of Cosmetic Science, chemical peels that contain 4% AHA (alpha hydroxy acid) solution may help reduce the pore size and the total comedone count in the treated skin when used in conjunction with appropriate physical therapy. (1)
Microdermabrasion is a popular skin exfoliation technique for correcting problems such as blackheads, whiteheads, and premature signs of skin aging.
This procedure uses the mild abrasive action of medical crystals to slough off the aging or damaged skin cells. It also stimulates the growth of fresh layers of skin at the surface.
This form of mechanical but gentle exfoliation helps improve the overall skin quality and appearance.
Microdermabrasion is suitable for both genders and all skin types.
d. Photopneumatic therapy
Your dermatologist may recommend a specific form of laser treatment called photopneumatic therapy to remove deep-rooted blackheads.
This procedure uses an intense pulsed light (IPL) laser in combination with a gentle suction pull to draw out the excess sebum and skin debris from the clogged pores.
Photopneumatic therapy is a safe, FDA-approved technique for the elimination of blackheads, whiteheads, and some types of pimples. However, it is not suitable for the treatment of acne nodules or cysts.
Self-Care and Home Remedies for Blackheads
1. Self-Care and Preventive Tips
Here are a few basic rules of skin care that you must stick to if you wish to clear your skin of blackheads.
- Do not touch your face: A lot of skin problems result from and are made worse by unnecessary facial touching.
Thus, you must resist the urge to touch your face the best you can, especially if your hands are unclean or unwashed. If you need to touch your face, you must wash your hands with clean water and soap first.
Also, sanitize your hands after treating or touching a blackhead to keep it from spreading.
Touching the bacteria-containing blackhead and using the same fingers to touch an unaffected area of the skin thereafter can spread the condition to other parts.
Facial blackheads, once formed, can be hard to ignore. Picking and popping these clogged pores in an attempt to clear your skin faster will further damage your skin tissue and may leave scars on your face.
Additionally, if you put pressure on the blackheads or scratch them with your nails or any sharp object, the pore can become inflamed and break out into an acne lesion.
- Also, avoid resting your phone on your face.
- Avoid over-cleansing: Frequently washing your face throughout the day can leave your skin very dry.
In an effort to keep their skin free of dirt, dust, and germs, a lot of acne-prone people make the mistake of washing their face every few hours.
You may think that this type of rigorous cleansing will keep your skin pores from getting clogged.
The truth is it can aggravate the condition by stripping away the moisture from your skin.
Skin dryness will cause your sebaceous glands to go into overdrive and produce excessive amounts of sebum, which will eventually lead to further clogging of your skin pores.
It is recommended to wash your face no more than two or three times a day with a mild antiseptic cleanser. Gently pat your face dry afterward instead of rubbing it. You can even let your face air-dry if you are not in a hurry.
- Moisturize your skin: If your skin is dry, the subcutaneous oil glands will secrete extra amounts of sebum to make up for the lack of skin moisture.
This overactivity of the sebaceous glands often leads to the accumulation of excess oil within the hair follicle, resulting in clogged pores.
To maintain a healthy oil balance in your skin, follow a regular moisturizing routine.
Note that every skin type is different and has different skin care requirements. It is important to use a hydrating cream or lotion that is suitable for your particular skin type.
Water-based moisturizers are usually the best option for people who frequently get blackheads, whiteheads, or other forms of acne.
- Apply nose strips: Nose strips are often used to pull out the sebum, debris, and dirt settled in the pores over your nose.
- Choose your makeup wisely: When buying makeup, skin care products, or facial cream, look for noncomedogenic brands that are specifically designed for acne-prone skin.
Noncomedogenic makeup does not have a greasy composition and is essentially water-based. Hence, it is light on the skin.
Oil-free cosmetics are less likely to cause clogged pores or acne, but do not eliminate the threat completely. It is still possible to get blackheads, whiteheads, or a full-blown acne flare-up even after the application of noncomedogenic makeup.
You should be mindful of what you put on your face. Exclude any product from your makeup or skin care kit that is suspected to irritate or clog your skin. Choose 100% mineral-based makeup whenever possible.
- Follow a healthy makeup-cleansing routine: If you have sensitive, dry, or acne-prone skin, avoid putting on too much makeup for prolonged periods.
Makeup can seep into your pores and leave them clogged. If you must use makeup, always opt for lightweight noncomedogenic products that allow your skin to breathe by not clogging your pores.
Make it a point to remove every trace of makeup from your skin before you go to sleep. Letting the product sit on your skin overnight will only invite new blackheads, whiteheads, and pimples to form on your face.
- Watch what you eat: An unhealthy diet that lacks enough fiber, nutrients, and minerals will have a bearing on the condition of your overall health. Poor food choices reflect badly on your skin.
Deep-fried foods and junk food are among the prime contributors to the development of clogged pores. Thus, you must replace your greasy diet with a wholesome, nutritionally balanced one.
- Change your pillowcase at least weekly.
- Often, comedones worsen when you start a treatment and before it gets better, so hang in there!
Steaming is perhaps the most commonly used home treatment for deep cleaning clogged pores.
Your facial skin is more sensitive than that of the rest of the body and needs to be treated accordingly. So, it is essential that you check the temperature of the steam before exposing your face to it.
Steaming renders your skin extremely soft by activating the underlying blood vessels and increasing blood flow to the area.
The vapors help dilate your skin pores, making it easier for you to extract the debris trapped inside them.
Instead of manually squeezing the blackheads, you should use a small tool called a comedone extractor. This tool is specifically designed for this purpose.
Picking at the pores with your sharp nails can damage and even scar your facial skin.
This kind of gentle heat therapy can be done twice a week for a deep-level facial cleansing.
Here’s how you can do it:
- Boil a pot of water. Preferably, add a few therapeutic herbs to it such as peppermint, chamomile, rosemary, and lemon.
- Once the water comes to a boil, turn off the heat and let it cool down for a bit.
- Make sure that the steam is comfortably warm to avoid any burning accidents.
- Place your face above the steam. Cover your head with a towel while doing so to keep the steam from escaping.
- To open the clogged pores, 10-15 minutes of steaming should be enough. Then, use a sterile comedone extractor to squeeze out the skin impurities.
- Rinse your face with lukewarm water.
Exfoliating the epidermal layer of the skin to remove dead skin cells is necessary for timely skin renewal. No skin care routine is complete without exfoliation.
When you remove the surface layer of dead skin, it gets replaced by freshly formed skin.
The cell turnover of your skin can be accelerated through numerous ways, both chemical and mechanical.
However, one must realize that one exfoliation technique may not suit all skin types. You must consult a board-certified dermatologist to determine the best exfoliation method for your particular skin type.
Chemical exfoliation involves applying an acid-containing peeling agent to your skin to remove the dead cells and speed up skin regeneration.
Some chemical exfoliants, such as 2% salicylic acid wash, can be purchased without a prescription. But it is still recommended to consult a skin specialist before trying out any topical treatment.
Mechanical exfoliation uses motorized devices such as brushes or topical exfoliants such as scrubs to physically remove the dead skin cells.
Skin exfoliation can help enhance the absorption of your skin care products as well as other topical treatments, but you must not overdo it.
Excessive peeling can thin your skin over time, whereas rigorous or excessive scrubbing of the skin can damage it further.
People with preexisting skin issues such as warts, herpes simplex, and molluscum contagiosum need to be extra-cautious when it comes to skin exfoliation.
All these conditions are characterized by raised skin lesions that can get irritated, ruptured, or infected due to the exfoliating action.
Here are two easy-to-make homemade scrubs that can help remove blackheads from your skin:
Oatmeal and yogurt scrub
- Take 1 teaspoon each of honey, oatmeal, and tomato juice in a bowl and mix them to make a paste.
- Apply the paste to your face.
- Use gentle circular motions of the hand to scrub your skin in an upward direction, with a special focus on the blackhead-prone areas.
- Rinse off the paste after 10 minutes of scrubbing.
- Mix a few drops of honey with a few drops of lemon in a bowl.
- Add granulated sugar to make a scrub.
- Take some of this mixture on your fingertips and gently rub it on your face, especially on the blackhead-ridden areas.
- After 10 minutes of scrubbing, wash your face with clean water.
- Use this gentle scrub once or twice a week.
Are DIY Remedies Helpful in Removing Blackheads?
A dermatologist or a skin specialist is best equipped to remove the deep-rooted blackheads. However, superficial ones can be easily addressed through proper skin care at home.
The following remedies may help in cleansing the impurities settled in the pores of your skin and thereby diminish the appearance of blackheads.
Moreover, certain ingredients used in these scrubs and masks may help tighten your pores to prevent blackheads from occurring in the future.
None of these methods are backed by any scientific evidence and may or may not yield successful results. Also, you may have to try different techniques before you find the one that suits your skin the most.
Egg white mask
- Break open a few eggs and separate the yolk from the egg whites.
- Take a few egg whites in a clean bowl and whisk them together.
- Use a clean makeup brush to apply the whisked whites all over your face.
- It is best to leave the skin around your eyes, as it is particularly thin and sensitive.
- Take a long piece of paper towel and tear it into small strips.
- Gently press or pat the strips on to your face so that they adhere to the sticky layer of egg whites.
- Once the entire face is covered with a single layer of paper towel strips, brush another layer of egg white on top of it.
- Now, sit back and relax as the multilayered mask dries on its own.
- When the mask feels completely dry, it is time to peel it off.
- Stripping off the layers of paper towel will pull out the impurities from your pores as well.
- Once you have removed the dried mask, rinse your face with clean water to wash off any impurities or egg residue on your face.
Egg whites are known to tighten skin pores. This means that this face mask, if used regularly, may not only remove blackheads but may also keep them from forming again. It is safe to apply this mask two times a week.
Activated charcoal-gelatin mask
- Mix 1/2 teaspoon of gelatin powder with 1/2 teaspoon of activated charcoal in a bowl.
- Put 1 tablespoon of hot distilled water into the mix and stir the ingredients together with a skewer to form a thick paste.
- Wash your face with warm water and let it air dry. You can also dab your face with a clean towel that has been soaked in warm water. This heat therapy helps open up the pores on your face.
- Apply a thin layer of the charcoal paste all over your face, except the soft skin around your eyes, your brows, and your lips. You can use an old makeup brush for ease of application, but make sure it is clean.
- Thicken the mask by applying a double or triple coat of the paste.
- Wait for the mask to dry completely, which can take a while.
- Once dried, you can peel off the charcoal mask with a swift upward pull.
- You can wash the bits that you are unable to get off with warm water later.
- Applying a light water-based moisturizer to help soothe the skin, especially if you experience a little irritation after the procedure.
It is best to use this facial mask once a week.
Myths and Facts About Blackheads
- If you think that you will stop getting blackheads after a certain age, you are wrong. Although more common among teenagers, blackheads can affect people of all ages.
Those who struggled with this skin issue during their adolescence may continue to face it well into their adulthood.
- It is a common misconception that blackheads are caused by the accumulation of dirt in your skin’s pores.
Keeping your skin free of environmental impurities is important for the sake of hygiene and health.
However, the lack of cleanliness is not directly responsible for the occurrence of blackheads. The occurrence of blackheads does not reflect poorly on your hygiene or skin care.
In fact, people who maintain the highest standard of personal cleanliness can get comedones as well. Blackheads are caused by a buildup of excess sebum and dead skin cells within the pores of your skin.
This buildup eventually turns black when exposed to air. The dark color of the blackheads is due to the oxidization of the impurities trapped inside it, rather than the accumulation of external grime.
Thus, anyone can get a blackhead, regardless of how clean they are.
- A lot of people avoid using a moisturizer due to the misguided fear that it will clog their pores.
But moisturizing is one of the cardinal steps for proper skin care as it helps to maintain a healthy lipid balance in your skin.
However, people who are prone to blackheads, whiteheads, and other forms of acne are advised to use noncomedogenic moisturizers that are especially suited for their skin.
Ask your skin specialist to recommend the best product for your skin type and condition. Choose a moisturizer that contains acne-fighting ingredients such as glycolic or salicylic acid.
When to See a Doctor
Everyone tends to get blackheads from time to time, some more than the others. This skin issue does not pose any threat to your health and rarely warrants a visit to the doctor.
You may need the help of a professional skin specialist/dermatologist:
- If proper skin care and home treatment fail to remove the blackheads
- If the blackheads keep recurring
- If the blackheads cause a lot of itchiness
- If the blackheads are so noticeable that they make you extremely conscious of your appearance and negatively impact your confidence
Questions your dermatologist may ask you:
- Can you identify any triggers that may lead to the outbreak of blackheads in your case?
- What is your skin care regimen and how often do you follow it?
- How often do you wear makeup?
- Are you currently using any OTC topical treatment for blackheads, or have you used one in the recent past?
Questions you may ask your dermatologist:
- Is the appearance of blackheads linked to any specific cause?
- Can blackheads be removed surgically?
- How safe are these surgical procedures for my skin type?
- What should I do to keep my skin free of blackheads?
- Do I have to take any precautionary measures before a surgical procedure?
Expert Answers (Q&A)
Answered by Dr. Niyati Sharma, MBBS (Dermatology)
You can do that. However, I would advise that it is best to use a topical retinoid to help in the long term. It aids in the reduction of the overall amount of blackheads.
No, you cannot do that physically.
Baking soda is a great ingredient to help with exfoliation (I mix it with coconut oil), but it will not get rid of blackheads. Once again, I advocate topical retinoids.
I have not heard of this, but I would advise against applying lemon juice. If you go out in the sun, you may get a photosensitive reaction on your skin.
It should reduce because our skin becomes less oily as we get older. Older people get more giant ones, though (frequently on the back).
As mentioned earlier, go and get yourself some vitamin A, retinoid cream. Your dermatologist can prescribe you the strongest ones but start first with adapalene.
About Dr. Niyati Sharma, MBBS: Dr. Sharma completed her MBBS from the University of Adelaide, Australia, in 2007. She completed her Pediatrics Dermatology Fellowship in 2018 from Ann & Robert Lurie Children’s Hospital, USA.
Dr. Sharma currently sees patients at Monash Health, Victoria, Australia.