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Table of Contents

1. What are Blackheads?

2. How to Get Rid of Blackheads

3. Why are Blackheads Black?

4. Acne Classification

5. Where do Blackheads Appear?

6. What Causes Blackheads?

7. What’s the Deal with Sebaceous Filaments?

8. How to Prevent Blackheads

9. Key Takeaways

Acne affects teens and adults alike, with the American Academy of Dermatology reporting that 40 to 50 million Americans are affected by acne each year in the United States. There are many different types of acne. One of the most common acne symptoms reported is blackheads. From mild to severe cases, blackheads are almost always present in the skin of acne patients and their dark color makes them easily noticed and diagnosed.

So what's the best way to treat blackheads? First, it's important to understand how these dark marks develop.

What are Blackheads?

Blackheads are minuscule bumps found on the skin that appear when a hair follicle becomes clogged with sebum and debris. Blackheads are a mild form of acne lesion that can appear all over the body. Generally you’ll find blackheads on the face, but they can also be seen on the back, shoulders, neck, chest, and arms.

What is a Blackhead and Why do Blackheads Occur?  

Blackheads occur when pores become clogged. Each pore on your skin—referred to medically as pilosebaceous units—contains a hair follicle and sebaceous (oil) gland. This sebaceous gland is tasked with producing sebum, an oily substance designed to keep the skin hydrated and soft. An excess of sebum production can result in a plug at the top of the pore, and when a plug is formed, sebum will build up, catching and collecting dead skin cells and bacteria on its way. This can result in a comedo, which refers to single acne lesion, and this comedo can either be open or closed.

Blackheads are one of two types of comedones. A blackhead refers to an open comedone, in which the plug of a clogged pore is open to the air on the surface of the skin. Unlike pimples, blackheads are not painful because there is less inflammation involved with this type of comedo blockage.

 

 How to Get Rid of Blackheads

Learning how to get rid of blackheads on your nose, chin, or forehead may mean trying a variety of treatment options. There are a wide array of treatments for getting rid of blackheads that have proven effective, including:

  • Topical Application
  • Manual Removal
  • Light Therapy
  • Laser Therapy
  • Chemical Peels
  • Microdermabrasion

Read more in the Blackhead Prevention and Treatment section below. 

 

Why are Blackheads Black?

Blackheads get their name from the dark hue that characterizes the top of the comedo. The name can be deceiving however, blackheads can develop in a range of colors, including gray, yellow, brown, and black. Many mistakenly attribute these colors to the presence of dirt in the pore, but it’s actually a case of oxidation. When melanin pigment—found in the sebum produced by our oil glands—makes contact with the air at the top of the open comedo, it is oxidized. This turns the blackhead dark. If it is not oxidized, the blackhead will appear more yellow in color.

What are Blackheads - Types of Blackheads

While blackheads are common and found in a large number of acne cases, there are particular observations of blackheads that are more rare, particularly the giant comedo, and a condition known as Nevus Comedonicus.

What Causes Blackheads Giant Comedo

A giant comedo is an abnormally large blackhead that is easily visible. According to Primary Care Dermatology Society, the size of these blackheads could be a result of an increased production of corneocytes that line the sebaceous duct. It’s also associated with the decreased rate at which ductal corneocytes separate. No real data or research has been able to confirm these suggestions, however. These giant comedones can be found on various parts of the body but are most common on the face, chest, and back. They have also been occasionally found in areas that contain apocrine glands, like the groin and scrotum. These occur more frequently in middle-aged and older populations.

Nevus Comedonicus

Also known as spreading blackheads and super blackheads, Nevus Comedonicus is a rare condition that was first observed back in 1895. This skin condition manifests in groups of dilated follicular openings that are characterized by dark keratin plugs—they essentially look like massive comedones, or blackheads. While most cases are isolated, the condition may be related to central nervous system anomalies, cutaneous defects, and ocular abnormalities. According to Medscape.com, this condition may indicate the presence of follicular structures that are unable to form sebaceous glands and terminal hair, thus leaving them only able to produce soft keratin.

This keratin builds up in the pore and results in dark, comedo-looking lesions. While there’s not yet sufficient research to indicate the rarity or frequency of this condition, one study found 12 cases of Nevus Comedonicus in a set of 100,000 skin biopsies, while another observed just one case in every 45,000 dermatology appointments. It seems to affect men and women equally, and mostly occurs in the early stages of life, although cases have been observed in elderly people.

 

Acne Classification

Acne is diagnosed in terms of severity, and can range from mild to moderate to severe. Blackheads are classified as the mildest type of acne, but are present in moderate and severe cases of Acne Vulgaris, as well. Some dermatologists use the Merck Manual to help assess the severity of acne, which goes as such:

Mild Acne

Those with mild acne will exhibit less than 20 comedones, which could be blackheads or whiteheads and less than 15 inflammatory lesions, which could appear in the form of papules, pustules, and rarely, nodules and cysts.

Moderate Acne

In cases of moderate acne, more than 20 to 100 comedones are present, and 15 to 50 inflammatory lesions, or the skin may exhibit a total lesion count of 30 to 135 lesions.

Severe Acne

Severe acne sees more than 100 comedones, and over 50 cases of inflammatory lesions, or the skin may exhibit a total count of over 125 acne lesions.

Dermatologists may classify acne on various scales, examining a patient’s skin against standard photographs to help determine the appropriate grade of severity, which allows them to better prescribe effective treatment.

Just as the severity of acne varies, so too do its causes. Do genetics cause acne? In some cases, yes. Does diet affect your skin? Certain foods can serve as a breakout trigger. Does birth control cause acne? Some women find that contraceptives make their acne worse. Understanding the causes behind your lesions will help you better treat them, whether you have only blackheads or you've developed cystic acne.

Where do Blackheads Appear?

Blackheads are often prevalent on the face because the skin found there contains a higher concentration of oil glands. Many find blackheads populate their T-Zone, which refers to the forehead, nose, and chin. However, these open comedones can appear on various parts of the body, including the chest, neck, back, buttocks, and other areas that feature a saturation of pilosebaceous units.

Difference between a Blackhead and a Whitehead

A comedo might be open or closed on the surface of the skin, and this distinguishes blackheads from whiteheads. Blackheads are pores that are exposed to the air with a stretched opening area, while whiteheads are covered by a thin layer of skin. Both are pores clogged with sebum, dead skin cells, and bacteria, but whiteheads do not expose the tip of the plug and their contents may not harden in the way that the contents of a blackhead’s pore does. Both blackheads and whiteheads are considered types of non-inflammatory acne. While these types of breakouts can generally clear up on their own with regular care, it is important to arm yourself with important information from blackhead and whitehead guides.

 

What Causes Blackheads?

How do blackheads form? Blackheads can be caused and exacerbated by a number of factors, including hormones, genetics, stress, sweat, and lifestyle.

Hormones

The simple answer to the question of blackhead causation: hormones. The most common cause of blackheads and other types of acne lesions is excess sebum production, which comes about as a result of hormonal changes. While the bulk of acne-causing hormonal changes occurs during puberty, there are other life events that may catalyze the production of excess sebum.

Puberty

The hormonal changes experienced during puberty are the most common trigger for an excessive production of sebum (the oil found in the oil glands beneath the surface of the skin). When children reach puberty, the body begins to pump out higher levels of hormones. This change in hormones can lead to an increase in sebum production in the oil gland. If excessive sebum combines with dead skin cells and bacteria in the pore, a plug can be formed. Should sebum production continue, the pore can enlarge and form a visible comedo, whether that be in the form of a blackhead or whiteheads. These types of lesions can worsen and become papules, pustules, nodes, and cysts depending on the bacteria present.

Menstruation

Many women may find their acne and prevalence of blackheads worsens during or before their period. This is because the body experiences many hormonal fluctuations at this time. When estrogen levels decrease, progesterone levels increase. When progesterone increases, the oil glands in the skin produce more sebum. Menstruation-related acne usually begins between two and seven days before a woman’s period and ends once the period starts as progesterone levels readjust.

Birth Control Pills

While some women find that their acne clears up after beginning birth control, some of these prescriptions can actually promote acne. Some birth control pills have been proven to clear acne.  In 2012, one study took a look at 31 trials involving upwards of 12,000 participants to examine whether oral contraceptives might help decrease the incidence of acne. It was found that some brands helped clear open and closed comedones, pustules, papules, and nodules. However, while some women find that their acne clears up after beginning birth control, some of these prescriptions can actually promote acne. While most birth control pills help lower androgen levels, lowering sebum production and clearing the skin, some brands have the opposite effect. Birth control pills that contain androgen-based progestin can actually result in the promotion of acne, and a higher incidence of blackheads, along with other lesions.

Pregnancy

Many women discover that their acne worsens, or appears for the first time, during pregnancy. This generally occurs around six weeks into a pregnancy. Changing hormones during pregnancy can cause an increase in androgen, which is the oil that signals the production of sebum.  According to WhatToExpect.com, the body also retains more fluids during this time, which can contain toxins that manifest as pimples.

Keep Hair Out of Your Face

As blackheads are formed inside hair follicles, the more hair follicles an individual has, the more blackheads and other types of acne they are susceptible to. It’s also important to keep your hair off of your face and back when possible. Greasy hair that touches the skin can spread P. acnes bacteria and encourage the growth of blackheads. Tie up hair when working out and in other sweaty conditions, and keep it off of your face as often as possible.

Excessive Sweating and Heat

Sweat does not necessarily cause Acne Vulgaris, but it can result in a subtype of acne that may lead to an increase in skin irritation.  This type of acne is known as Pityrosporum Folliculitis and is caused by the production of yeast that occurs when sweating. This type of acne can be found across the chest and back, and is characterized by pinhead sized acne lesions and small, white bumps that might itch. This condition is most commonly observed in people who have an intense workout regimen or perform hard manual labor.

Stress

While there has been no significant research that states whether stress does cause acne, researchers and dermatologists alike have seen a correlation between high stress and the incidence of acne breakouts in various studies and patients. Stress is not a cause, but it does seem to exacerbate its prevalence. As more cortisol and androgens are released during times of stress, the body responds by increasing oil production. As women produce a higher percentage of androgens, stress acne tends to affect women more often than men. 

Diet

We’ve long been regaled with tales that point the finger at greasy foods, and with scientists and doctors telling us to stay away from the fast food joints and potato chips. There is actually no solid evidence to support the claim that diet directly affects acne, however there are those who do practice an acne fighting diet to take preventative measures as well as for general health. While there have been connections noted between diet choices and the prevalence of acne, research is insufficient to claim a significant link. Popular questions like "does eating chocolate cause acne?" or "does alcohol consumption worsen acne conditions?" have indeed been explored, but are inconclusive.

Smoking

According to FacingAcne.com, there is a noted connection between smoking and a type of acne known as Acne Inversa. Acne Inversa develops differently than Acne Vulgaris; the pore is blocked from the top down, caused by an overproduction of skin at the top of a skin follicle. One study found that in a group of 100 participants, 87 percent who smoked experienced symptoms of Acne Inversa. This condition can result in a higher number of comedones, and shows a link between smoking and the presence of blackheads.  

 

What’s the Deal with Sebaceous Filaments?

It’s important to differentiate blackheads from sebaceous filaments. Many mistakenly believe they are dealing with blackheads; sebaceous filaments appear similar to this acne symptom, but are normal and actually very prevalent. These are merely the exposed tip of a pore. In every follicle, sebum is created and pushed out through the pore. This is healthy, as this sebum lubricates the skin and keeps it feeling and looking its best. Sebum actually controls the size of your pores. The more sebum created, the larger the pore appears as it stretches to expel it from the skin. What differentiates sebaceous filaments from blackheads is the lack of a plug that would cause the pore to fill with dead skin cells and bacteria that would result in a comedo.

Determining whether those spots on your nose, forehead, or chin are blackheads or sebaceous filaments requires knowledge of a few characteristics. Blackheads tend to be darker, while sebaceous filaments almost always appear to be the color of the surrounding skin or gray. Sebaceous filaments are evenly distributed and you’ll find many in one area; blackheads are most commonly single lesions that appear sporadically. Unfortunately, there’s no way to permanently rid the skin of sebaceous filaments. Even when expelled, the glands will usually fill up within a matter of 20 to 30 days. Squeezing them out of the skin can cause damage to the cells, resulting in larger pores and infection that can lead to acne.

 

How to Prevent Blackheads

Blackheads are easy to self-diagnose, and on their own, not usually a cause for concern or reason enough for an individual to pursue help from a dermatologist. Many are tempted to remove blackheads, but the real trick for how to have clear skin is prevention. Preventing blackheads are as easy as maintaining a regular washing regimen with BioClarity products. Washing your face once in the morning and evening, as well as after a workout, can help your skin prevent oil buildup that results in clogged pores. This will help kill off P. Acnes bacteria, and ensure pores stay as clear as possible. If your blackheads have been impossible to prevent, or continue to come back, there are treatment options available.

What Doesn’t Work - Blackhead Treatment

Before we get into treating blackheads, it’s important to take a look at the products that claim to help but are really just a temporary fix.

Self Extraction

The first and most important blackhead treatment route to avoid is self extraction. It can be tempting to squeeze the substance out of those pores, but this can wreak havoc on your skin. This can leave your skin inflamed, open it to infection, and result in scarring.

Pore Strips

Pore strips are also a popular method, but these strips actually don’t do much in the form of treating blackheads. While they can remove the tip of the plug found in the comedone, all of the oil, skin, and bacteria built up in the rest of the pore is left intact, meaning a new plug will easily form. While they can temporarily make pores appear smaller, they do nothing to stop the recurrence of blackheads.

Over Washing

Many mistakenly believe that blackheads can be cured through rigorous washing and cleansing, but this can actually aggravate the skin and worsen acne symptoms. Washing your face twice a day is adequate to slough of dead skin cells and keep pores clean.

What Works

Of course, there are also many treatments which have been proven effective.

Blackhead Treatment - Topical Application

While daily washing of the skin can do wonders for blackhead prevention and treatment, there are also topical ointments that help the persistence of this pesky skin condition. BioClarity's Treatment gel has the exfoliating power to clear pores of oil, dirt and bacteria so acne is significantly reduced with continued usage and future outbreaks are prevented.

Blackhead Treatment - Manual Removal

Dermatologists sometimes use a special instrument called a round loop extractor (sometimes referred to as a comedo extractor) to remove blackheads. This extractor is applied around the comedo, essentially pushing the skin surrounding the pore. This forces the contents of the pore up, causing the plug to pop out of the skin. They will push from various angles to ensure all of the clogged material is removed from the skin. Never attempt to remove blackheads at home with your fingers. Improper removal could result in ruptured skin cell walls, which can lead to inflammation and infection and result in more severe pimples and acne symptoms. Squeezing these lesions can lead to larger pores that are more easily clogged and more visible, and push the infection deeper into the surface of the skin.

Blackhead Treatment - Light and Laser Therapy

According to SkinInc.com, IPL and LED therapies can minimize the appearance of pores and reduce the incidence of blackheads. The light is designed to reach deep into the skin’s surface and stimulate the production of collagen and meant to kill acne-causing bacteria that resides on the skin. These treatments can be very expensive, and require multiple sessions, but for some with excessively large pores and/or severe acne, it can be a beneficial route.

Blackhead Treatment - Chemical Peels

Chemical peels involve the application of a strong chemical solution to the skin. The top layers of skin are stripped from the area, revealing smoother, regenerated skin cells underneath. This can help unclog pores and rid the skin of blackheads. There are some mild, over the counter peels, and dermatologists and certified professionals can provide stronger chemical peels.

Blackhead Treatment - Microdermabrasion

Microdermabrasion is gentler than chemical peels and other forms of blackhead treatment. This is a skin resurfacing treatment that uses abrasive material and tools to gently remove the top layer of skin in combination with suction tools. This helps with treatment of blackheads as it often dislodges blackhead plugs, opening up the pore and removing the contents of the blackhead.

 

Key Takeaways

  • Blackheads are a mild form of acne and are also known as open comedones.
  • Never attempt to squeeze your own blackheads; it can cause more damage and worsen your acne.
  • Blackheads are clogged pores that are open to the surface of the skin, while whiteheads are covered by a thin layer of skin.
  • Hormonal fluctuations caused by puberty, menstruation, and prescription medications can result in higher incidences of acne, including blackheads.
  • Blackheads are dark in color because of the melanin found in sebum; once this melanin is exposed to the air at the opening of a pore, it oxidizes and turns gray or black.
  • Blackheads are not painful, as they are a non-inflammatory type of acne.
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