‘Blackheads’ is a skin term meant to refer to pores that are open and filled with keratin or sebum exposed to the air. Read more...
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What are blackheads?
‘Blackheads’ is a skin term meant to refer to pores that are open and filled with keratin or sebum exposed to the air. Excess keratin, sebum, and oil build up in our pores while the pore is still open. The keratin in these pores oxidizes with exposure to the air and turns black in color. The medical term for blackheads is open comedones. Whiteheads, on the contrary, are closed pores, also clogged, but not open or exposed to the air. The keratin inside still has a “cheesy” or “whitish-yellow” appearance when extracted as it has not been exposed to air as yet. They tend to appear as an expanded pore that feels like a goosebump or sandpaper-like with a discolored plug or core inside. When you run your finger over the top, there is often a slight textural change to the skin based around a pore. This is distinct from a freckle that tends to be flush with the skin, slightly pigmented, and not necessarily associated with a pore.
What causes blackheads?
Blackheads (open comedones) and whiteheads (closed comedones) are considered the first stage of acne. This is the comedonal stage. Pores are open or closed and filled with excess keratin, oil, and sebum. These alone do not tend to be inflamed. The skin usually has more of a bumpy or sandpaper feel to it. There is little redness. Some people erroneously refer to pustules or pus bumps as whiteheads. Whiteheads technically do not have inflammation or pus associated with them. The next stage of acne is when bacteria in our pores start to work on the excess buildup and inflame the pores. The name of this bacteria is Cutibacterium acnes (formerly known as Propionibacterium acnes or P. acnes for short). This is when redness and the possibility of pus bumps develop as well. There can be tenderness or sensitivity associated with these breakouts. The next stage of acne is nodulocystic acne when the acne starts to become swollen and tender while developing pockets of keratin or pus under the surface and has the potential for scarring. Up until this point, the risk of scarring is low. Comedones do not tend to scar unless the skin is physically damaged from the extraction of the pore. Inflammatory acne can leave behind temporary pigment or pink inflamed skin while resolving, but this is usually not permanent. The triggers for blackheads are similar to the triggers for acne.
Are there other factors that can cause or contribute to blackheads?
If you are holding your phone against your face for long periods of time and allowing sweat and dirt to build up between your face and your phone then you do have some potential to develop a type of acne called acne mechanica. This similarly occurs with chin straps from helmets and baseball hats over the forehead. This type of acne can be reduced by being mindful of frictional forces that trigger breakouts in addition to the regular use of products designed for acne-prone skin such as salicylic acid, benzoyl peroxide, and retinoid-containing products. Pomade acne can be triggered by the use of hair products, often concentrated around the hairline. Recognizing patterns for acne distribution can often help focus on a cause or trigger to avoid aggravating more flares. Most acne is primarily hormonal, however. Recognizing that many factors are outside our control in this regard, focusing on optimal prevention and management of acne is important.
How to remove blackheads | A step-by-step guide to “popping blackheads”
It’s reasonable to remove blackheads at home gently.
2 Cotton tips or Q Tips
Topical retinol or retinoid
In preparation, for a few days prior to extracting a blackhead, apply retinol or retinoid to the skin nightly to help “loosen up” the keratin buildup in the pore
Gently cleanse the skin using a mild cleanser and lukewarm water.
Blot the skin dry with a soft towel.
Take two cotton tips or Q tips, one in each hand.
Anchor each on either side of the pore to be extracted a few millimeters away from the pore opening. (see figure below)
Gently roll while pushing into the skin the cotton tips across the skin towards each other and towards the central pore.
Another strategy is to anchor a cotton tip on one side of the pore while applying gentle pressure. Then take the other and start a few millimeters away from the pore opening and roll towards the anchored cotton tip
The keratin will start to extrude through the pore.
Reposition in the opposite plane of the pore and gently roll and push the cotton tips towards each again at a different angle.
More keratin will extrude through the pore.
Gently wipe this away and move on to a different pore.
Follow up by applying retinol or retinoid to help reduce the keratin and sebum from building up again.
Figure | How to extract a blackhead (made with Canva)
This process will be far less traumatizing to your skin than using your fingernails! For retinols, over-the-counter, this is found most commonly in anti-aging preparations. Retinoids can be found over the counter as an ingredient called adapalene (brand name Differin). Prescription-strength versions include tretinoin and tazarotene. These products loosen up and break apart the keratin and dead skin cells making them easier to extract.
Blackheads on the nose | How to get rid of blackheads on the nose
Remember, the ‘black dots’ on the nose are actually not always blackheads. There is a common genetic trait called trichostasis that results in the appearance of blackheads on the nose and chin. These are actually wider open pores filled with wax and sebum along with a small hair follicle giving them a dark appearance. These can be extracted like a blackhead but they are likely to recur very quickly. These are best managed with adhesive nasal strips such as Biore.
Are there any products or treatments meant for blackheads?
“Tried and true solutions to treat blackheads once and for all” would technically be Accutane or isotretinoin. This oral medication works to provide long-lasting results by acting on the oil or sebaceous gland to shrink it long-term and reduce the amount of oil produced. This is an oral medication with its own ‘baggage’ of side effects but worthy of mention simply because it’s the only potentially "once and for all" option for acne. Every other treatment option only suppresses acne to control it or buy time until we outgrow it. When a patient indicates to me that they are looking for a long-term option and do not want to have to deal with regimens this is important to discuss to give them the ability to make a decision that is best for them.
Topical retinoids. Over the counter, we now have adapalene available under the tradename Differin. Prescription options include tretinoin (Retin A) and tazarotene (Tazorac). Retinoids work by preventing the formation of clogged pores and promoting cell turnover. These have been the mainstay of acne treatments for decades. Although for some there can be excess dryness, these are overall well-tolerated and work as long as you continue to use them!
Benzoyl peroxide. Benzoyl peroxide can clear dead skin cells from the surface of the skin. In addition, it is able to kill acne-causing bacteria on the skin that lead to the inflammation found with acne. By gently exfoliating and treating bacteria on the skin, benzoyl peroxide can be very useful in people that have inflammatory acne. Benzoyl peroxide can reduce the buildup of dead skin cells in our pores which leads to blackheads developing. These products can be a bit more irritating. I would use caution in some instances. These are the ones where the next day you may find your skin a little flaky. It’s also important to remember to use white towels, bath mats, and pillowcases. Benzoyl peroxide will bleach these products. Panoxl has a 10 % concentration of benzoyl peroxide. The reason why Panoxyl is nice for the body too, however, is because it’s foaming. For larger surface areas like the chest and back, it tends to spread easier. This has been a go-to recommendation for years. Salicylic acid. If your acne is mostly clogged pores: salicylic acid-containing cleansers can be helpful to achieve some exfoliation to help open these pores and unclog them. These work as ‘keratolytic’ that break apart dead skin cells to encourage them to exfoliate and not stay attached to the skin to accumulate in our pores and result in blackheads.
Adhesive nasal strips. Products such as Biore nasal strips are very effective at ‘unclogging’ blackheads containing pores manually. A tip to make blackhead removal easier is to use a topical retinoid for several days before extracting. Over the counter, you will find Differin. Prescription-strength versions include tretinoin and tazarotene. These products loosen up and break apart the keratin and dead skin cells making them easier to extract. It’s good to get into the routine of using these weekly to maintain the effect.
Are there any devices that can be used to extract pores?
Most acne is primarily hormonal, however. Recognizing that many factors are outside our control in this regard, focusing on optimal prevention and management of acne is important.
What are some professional blackhead removal options?
I usually extract these using a lancet or the assistance of a vacuum device such as a microdermabrasion machine. It allows the advantage of treating larger areas to start patients with a ‘cleaner slate’ for deeply embedded pores that are difficult to get one step ahead of!