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Symptoms of blackheads
Acne mainly affects the face, but can also affect the upper trunk and upper arms.1 Pilosebaceous units - the hair follicle and sebaceous gland units - are nine times more numerous, in terms of area concentration, on the face, upper neck and chest than on the rest of our skin.6
Blackheads are a feature of noninflammatory acne - in which the comedones are not infected.
When comedones do become infected and inflamed, it is inflammatory acne. While the skin may be infected with any number of organisms, the most common culprit is a bacterium called Propionibacterium acnes. This type of infection typically leads to papules, pustules, nodules or cysts. Cystic acne is a severe form of inflammatory acne.1,8
Blackheads may not produce direct symptoms - their existence may only be indicated by the appearance of black pimples on the skin.
Symptoms such as irritation and pain may be present with blackheads, but these are more common with development into more severe forms of acne.9
Blackheads often lead to a range of psychosocial symptoms, however, including these examples:9-11
- Adolescents (and adults) affected by acne can experience reduced quality of life, often for psychological and social reasons.
- Although psychosocial effects of mild forms of acne involving only uninfected blackheads are typically milder than with severe acne, there are still implications for self-esteem, body image and relationships.
- Studies have been carried out which ask, "Do you believe that your acne affects negatively the way that others (relationships, parents, friends, teachers, the opposite sex) treat you?" Results show that people with acne report experiencing peer pressure.
- Embarrassment and reduced self-esteem may affect as many as half of adolescents with blackheads, although these problems are usually greater with whiteheads, and greater still with pustules and cysts.
- Adolescents with acne may experience other people avoiding them, calling them names, teasing, bullying and asking questions
- Feelings resulting from acne can lead to social problems such as avoidance of activities
- Being noticed for choosing different clothing as a result of acne also affects young people
- Skin irritation and/or pain resulting from blackheads can lead to problems with sleep.
Diagnosis of blackheads
Blackheads alone may not worry a person sufficiently to consult a doctor. Often, people manage blackheads themselves, sometimes resorting to misguided interventions that remain popular despite no evidence of efficacy or safety. See below for preferred treatments.12
While blackheads alone may be diagnosed as "mild acne," physicians and dermatologists should acknowledge that the psychological effects deserve recognition and assurance.12
A doctor's confirmation of the problem comes simply through examination - acne is obvious for a doctor to see on close inspection. With some types of acne, the doctor may be looking to differentiate it from other skin conditions.1
The doctor may take a history - ask questions - to confirm, for example, that a case of acne is not due to the use of drugs such as corticosteroids.1
Diagnosis may involve characterizing the blackheads as part of mild, moderate or severe acne. This helps determine the likelihood of psychosocial effects (although these effects are most associated with severe acne that causes scars), and whether treatment is needed.12
Cystic acne, for example, is a severe form that is typically diagnosed when there are five or more cysts in addition to over 100 comedones.1
Blackheads alone constitute mild acne, and the numerous inflamed lesions also visible here form part of moderate and severe forms of acne.
The three levels of severity of acne are broadly defined by the existence and number of three types of lesion - comedone (blackhead or whitehead), inflammatory lesion (papule, pustule or nodule), and cyst.1 A number of diagnostic guides and grading scales take similar approaches.9,11,12
The US Food and Drug Administration (FDA) notes that there are inconsistencies in the assessment of acne severity, and only offers vague guidance to the dermatological industry about lesion counts and diagnosis. However, the regulator is more consistent in regard to descriptions of the types of lesion.13,14
The following example is of a guide used by doctors who follow the Merck Manual to assess acne:1
- Mild acne is fewer than a total of: 20 comedones; or 15 inflammatory lesions; or 30 lesions
- Moderate acne is: more than 20 and up to 100 comedones; or between 15 and 50 inflammatory lesions; or 30 to 125 lesions in total
- Severe acne is characterized by: more than five cysts; or over 100 total comedones; or over 50 total inflammatory lesions; or more than 125 lesions.
Recent developments on blackheads and acne from MNT news
The prescription of only one medication may be most effective for helping patients stick to the acne treatment, found a March 2015 study in the journal JAMA Dermatology.
First issued in mid-2014 and remaining active in late 2015, there is a US government warning that products containing benzoyl peroxide or salicylic acid can - in rare cases - cause potentially life-threatening allergic reactions or severe irritation.
On the final page, we look at the available treatments for blackheads and how they can be prevented.