Blackheads: What You should know

Blackheads are small , dark lesions that often appear on the face and neck. They are a feature of mild acne, but they may appear without there being other signs of acne.

They contain an oxidized version of melanin, which is the dark pigment made by skin cells.

Acne is a skin infection which affects up to 50 million people in the United States (U.S.) Handling blackheads in the right way can help prevent the development of more severe acne.

Important facts about blackheads

  • Blackheads are made of oxidized melanin and not trapped dirt.
  • Squeezing or scrubbing at blackheads can make them worse.
  • To reduce blackheads, avoid oil-based skin care products, humid environments, tight clothes, and skin products that contain alcohol.
  • They tend to appear when hormones lead to the increased production of sebum, an oily substance, by the glands under the skin.

What are blackheads?

Blackheads are pockets of oxidized melanin on the surface of the skin.
Blackheads are pockets of oxidized melanin on the surface of the skin.

Blackheads are a type of comedo. Comedones occur when the skin pores get plugged with dead skin cells and an oily, protective substance called sebum.

The blackhead top that is noticeable on the skin’s surface has a dark colour.

Normally, hair develops in the pores from hair follicles, and underneath lie the sebum-producing sebaceous glands.

When these pores are plugged, the dead skin cells in the open pore react with oxygen in the air and turn black, forming a blackhead.

This is often confused with trapped dirt but blackhead development is not related to skin cleanliness.

Other acne lesions are usually closed, but the skin around the blocked pore opens in blackheads, causing air to oxidize the collected sebum oil or dead skin cells, turning black or sometimes yellowish.

The most common blackheads appear on the face, back , neck, chest , arms, and shoulders. Those areas have more hair follicles.

Causes

Some factors can make blackheads more likely to develop.

An important factor is age, and hormonal changes. As with other acne signs, blackheads are most common during puberty when hormone levels increase triggers a spike in sebum production. They may appear at any age however.

Androgen, the male sex hormone, triggers increased sebum secretion, and increased skin cell turnover around puberty. During adolescence both boys and girls experience higher rates of androgens.

Hormonal changes associated with menstruation , pregnancy and the use of birth control pills can also bring blackheads in women after puberty.

Body overproduction of skin cells can cause blackheads.

Other factors include:

  • the blocking or covering pores by cosmetics and clothing
  • heavy sweating
  • shaving and other activities that open the hair follicles
  • high humidity and grease in the immediate environment
  • some health conditions, such as stress, polycystic ovarian syndrome (PCOS) and premenstrual syndrome (PMS)
  • medications that encourage rapid skin cell turnover
  • use of some steroid-based drugs, such as corticosteroids

Contrary to common opinion, blackheads are not caused directly by bad hygiene. Excessive scrubbing may make them worse in an attempt to remove these.

Symptoms

The main symptom is the small, dark lesion which gives its name to blackheads.

Blackheads are a symptom of acne, but they differ from other acne lesions in some ways, being caused by open pores.

Blackheads are non-inflammatory. This means they are not infected, and in the same way as pimples and pustules, they will not cause pain and discomfort.

Blackheads have a texture that is elevated but they are flatter than pimples.

The change in appearance caused by blackheads can lead to some patients being embarrassed and having social or psychological difficulties.

Sebaceous filaments

Sebaceous filaments look like blackheads, but they are different. They can show up on the nose. They tend to be smaller, they appear in groups and they feel flat on the touch. Sebaceous filaments are glands which channel sebum flow through the pores. These are not a form of acne, unlike blackheads.

Diagnosis

Blackheads rarely lead to a visit to a doctor unless there is already severe acne. Their appearance makes them easy to identify and diagnose.

Treatment: Do’s and don’ts

Most people at home treat their blackheads without having to see a doctor but certain practices can make them worse or cause a more serious form of acne.

There are many myths and contradictions about how blackheads can be treated so it might be best to see what works for you.

Do’s for blackheads

cleansing the skin can help blackheads
Gently cleansing the skin can help blackheads, so long as the cream used does not excessively dry the skin.

Cleansing: Special scrubs that can help to gently exfoliate the face. Look for those that are fragrance-free and for sensitive skin, and avoid anything that makes your skin overly dry.

While drying out the skin by decreasing excessive oil production is important, drying it too much can make matters worse because the glands stimulate extra oil production.

Make-up and cosmetics: Use non-comedogenic products that do not clog pores instead should keep the pores clear and open and reduce dead skin buildup.

Prescription treatments: Azelaic acid, salicylic acid, and benzoyl peroxide are also available for non-inflammatory acne in both prescription and counter ( OTC) types. Such procedures are topical, applied directly to the skin.

Prescription medicines containing vitamin A, such as tretinoin, tazarotene, and adapalene, may be prescribed to prevent plugs from forming in the hair follicles and to foster more rapid skin cell turnover.

Most people, however, do not look for such remedies until their acne has progressed to become an infected or more serious form, such as pimples. It may be best to have the blackheads removed by a skin care specialist if they become botherful.

Underlying conditions: Any other skin problems, such as eczema or rosacea, can make blackheads a bit more difficult to treat. Before the acne the condition should be treated as successful treatment can lead to blackheads improvement.

Rest and relaxation: Having enough rest and avoiding stress, as stress can cause sebum development, can help too. Exercising can help to lower stress.

Food: Research has not established that cutting out fries or chocolate would either reduce acne or not reduce it, but a good, nutritious diet with plenty of fresh fruits and vegetables is beneficial for skin. It may reduce the risk of being infected with skin lesions.

Don’ts for blackheads

Hormonal causes can make blackheads possible, but there are factors that can raise the likelihood or make it worse.

Squeezing: Avoid squeezing blackheads, even with a metal blackhead remover, because this can irritate the skin and make the problem worse.

Steaming: A steam bath has long been suggested as a blackhead remedy, as it “opens the pores.” However, research has not verified this. Some people think that’s making the problem worse.

Scrubbing: That could make the problem worse. Scrubbing removes sebum. Then, the sebaceous glands work harder to remove the sebum, resulting in more blockages and the possibility of inflammatory acne.

Removers: Removal strips, masks, and vacuums should be used with care, as these can irritate and harm the skin if misused.

Makeup and cosmetics: Avoid oil-based makeups and skin care products.

Other environmental triggers to avoid are:

  • humid environments
  • tight clothes that close off the skin
  • skin products with alcohol, as these can also tighten and dry out the skin

Hydrogen peroxide: For acne, this has been recommended. It can reduce outbreak severity but it is also a harsh product that can dry and irritate the skin. Researchers remain undecided as to whether or not it should be used, due to its adverse effects.

Plant-based treatments

Plant-based therapies for acne are often prescribed and some research is under way. Tea tree, thyme, aloe vera, and rose oils all seem to provide antibacterial properties to prevent acne disease. Further research is needed.

Blackheads appear to resolve themselves as a type of mild acne, as the body controls hormones more effectively after puberty. Self-resolving blackheads may take a long time, and they can remain for several years.

A patient with the appearance of blackheads experiencing psychological problems can find it beneficial to see a therapist.

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