Acne comes in a variety of shapes, sizes, and colors—and in some cases, the skin condition does not appear at all like a blemish.
Consider blackheads, those vexing dark-colored spots filled with gunk. If you’ve ever attempted to squeeze one, you’re likely to have ended up facing an angry bump and immediately regretted it.
Thus, what is the most effective way to rid your skin of this type of acne?
To begin, let’s examine the causes and who is most susceptible to developing blackheads.
What Are the Causes of Blackheads?
“Blackheads are caused by an accumulation of sebum, oil, dead skin cells, and possibly C. acnes (the acne-causing bacteria) in the hair follicle,” explains Nazanin Saedi, MD, director of Jefferson Laser Surgery and Cosmetic Dermatology Center in Philadelphia. “When these substances oxidize in the air, they turn the opening black,” Dr. Saedi explains.
Kathleen Cook Suozzi, MD, director of Yale Medicine’s aesthetic dermatology program and assistant professor of dermatology at Yale School of Medicine in New Haven, Connecticut, explains that blackheads are referred to medically as comedones. “Comedones are the pre-acne stage,” the physician explains. “As the follicle dilates further, it has the potential to rupture and spill its contents into the surrounding skin layer, called the dermis, triggering an inflammatory response.” This results in an inflammatory papule — more commonly referred to as a pimple — which is a far more serious condition than a blackhead.
Although acne-prone individuals are more prone to blackheads, there is also a genetic component, Saedi explains. Dr. Suozzi adds, “Hormonal influences also play a role in stimulating sebum (skin oil) production.”
“Extended pores may also be present in individuals who have sustained significant sun damage,” Suozzi explains. “A decrease in the collagen support of the dermis surrounding the hair follicle can result in the appearance of larger and more dilated ostia (small openings). An extreme case of this is the condition Favre-Racouchot, which causes patients to develop large blackheads in areas of sun-damaged skin, particularly around the eyes, “she explains.
How to Prevent the Formation of Blackheads on Your Skin
Suozzi recommends using topical or oral retinoids to prevent blackheads, including prescription medications such as tretinoin or Retin-A. Recently, a prescription-strength retinoid called adapalene or Differin became available over the counter in the United States for the treatment of comedonal acne, she explains. “For patients with more severe comedonal acne, oral retinoids such as isotretinoin or Accutane may be required.” Saedi adds that chemical exfoliants can be effective as well, but she is not a fan of scrubs due to their potential for irritation.
The Most Effective Methods for Getting Rid of Blackheads
If you already have blackheads, there are several dermatologist-recommended methods for removing them — and several of them are also preventative.
Utilize Salicylic Acid-Containing Products
Salicylic acid is a popular ingredient for removing blackheads because it is a beta hydroxy acid that promotes cell turnover and unclogs pores, according to Saedi. Suozzi adds that because the acne treatment is a mild chemical irritant, it can aid in the drying of active acne lesions.
Numerous studies indicate that salicylic acid is effective in treating acne. This includes a small double-blind, placebo-controlled study that discovered that using a 2% salicylic acid wash for two weeks reduced acne lesions in 30 people.
Saedi recommends two inexpensive but effective drugstore salicylic acid products: Neutrogena Pink Grapefruit Oil-Free Acne Wash ($7.97, Amazon.com) and Neutrogena Gel Cleanser Acne Proofing ($8.29, Amazon.com).
If you’re willing to spend a little more money on a more powerful, multitasking product, Suozzi recommends Skinceuticals Blemish + Age Defense ($92, Dermstore.com), a combination of 2% dioic acid and optimal alpha and beta hydroxy acids that not only helps with acne by reducing sebum production, but also has anti-aging properties. Additionally, she recommends DCL Multi Action Penta Peel pads ($65, Dermstore.com), a highly concentrated chemical peel.
Include a Retinoid in Your Daily Routine
Prescription retinoids (such as Retin-A) and over-the-counter retinoids (such as Differin) are an effective method for removing blackheads from the skin. “Retinoids work by increasing skin turnover and decreasing the’stickiness’ of skin cells, thereby preventing the follicular ostia from becoming blocked,” Suozzi explains.
She notes that when you begin retinoid treatment, comedones may worsen as cell turnover increases in the presence of a clogged opening, resulting in further dilatation. However, with continued treatment, the plugged ostia improve, and with increased skin turnover, they are less likely to become blocked again, she explains.
Not only does retinoid help with acne, but it is also excellent for anti-aging and skin regeneration. A study published in March 2016 in the Journal of Cosmetic Dermatology discovered that subjects experienced an increase in collagen production and epidermal thickness after only four weeks of retinol (a lower-concentration retinoid) use, as well as a “significant reduction in facial wrinkles” after 12 weeks. Saedi recommends first attempting an OTC product such as Differin ($12.88, Amazon.com), but if that does not work, “then consult a doctor for prescription strength.”
Consider the case of Alpha Hydroxy Acids
While alpha hydroxy acids such as glycolic acid and lactic acid are beneficial, Saedi maintains that salicylic acid is superior for unclogging pores. Two highly rated AHAs on the web are Drunk Elephant T.L.C. Framboos Glycolic Resurfacing Night Serum ($90, Sephora.com) and Sunday Riley Good Genes Glycolic Acid Treatment ($48, SundayRiley.com).
Make an In-Office Appointment
A dermatologist can assist you with removing blackheads from your skin. “There are in-office treatments available that can assist in reducing the appearance of pores,” Suozzi notes. These include nonablative resurfacing (also referred to as laser treatments) with the Fraxel or Clear + Brilliant lasers, as well as microneedling. According to dermatologists, prices vary and can range from a few hundred dollars to $1,500 or more. While some people are satisfied with the results of a single treatment, others may require multiple sessions.
The Worst Methods for Removing Blackheads
Using Abrasive Scrubbers
It can be alluring to slough off all your dead skin with the aid of an exfoliating scrub. While chemical exfoliants (such as AHAs) can be beneficial, Saedi advises against over-exfoliating with a granule scrub, as you may have been taught as a teen, when you manually scrubbed granules into your skin until it turned red. “Harsh scrubs can deplete your natural oils and stimulate the production of new oils,” she notes. Dermatologists recommend exfoliating up to three times per week, depending on the product being used and the type of skin being treated.
Manual Extraction Procedures
Suozzi advises against popping any pimples. “Squeezing your blackheads can rupture the follicle and result in the formation of an inflammatory lesion or cyst,” she explains. In other words, a blackhead can develop into a much more serious skin condition. Bear in mind that the closer a blackhead is to the skin’s surface, the easier it is to squeeze.
While technology that claims to sucking sebum from pores may sound appealing, Suozzi warns that these products may do more harm than good. “This suction can be detrimental to delicate facial skin and can result in the appearance of telangiectasias, or ‘broken blood vessels,’ most commonly on and around the nose,” Suozzi explains.
The Takeaway on Blackhead Prevention and Treatment
While it may be nearly impossible to resist the urge to extract that blackhead with your two fingers, make a conscious effort to leave it alone.
Suozzi asserts that the best treatment is prevention. Enlist the assistance of a few effective ingredients, such as retinoids, which act as dual-taskers, assisting in the treatment of the skin condition while also preventing the formation of new blackheads. Alternatively, schedule an appointment with a dermatologist to receive professional treatment.