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Treatments for blackheads
Having a limited number of blackheads on their own is classed as mild acne. Acne is treated according to severity, so blackheads may not call for treatment and the problem will usually resolve by itself - albeit often after a long time. More severe acne should always be treated, to control its worst effects and prevent scarring7).1,4,5,7
It is important that patients with acne know that even treatments offered by a doctor do not rapidly clear acne. Many products for acne are available without prescription and are heavily advertised as offering a "miracle cure." It is sensible to approach such products with realistic expectations as many have no grounding in science.1,4,5,7
Normal daily cleansing of the skin is part of managing acne. No further improvement is seen, however, with scrubbing or a greater frequency of washing. In fact, excessive face-washing can cause irritation and increase the risk of infection.4,6,7
People with blackheads and no other acne lesions may find it helpful to use a gel, cream or wash that contains benzoyl peroxide. These products are available at pharmacies and have comedolytic and antibacterial properties, meaning that they help to break down the plugs of sebum and prevent inflammation caused by bacteria.1,4,6
It may be tempting to squeeze a blackhead, but this can worsen the problem. Sometimes extraction with a sterile tool at the clinic can be appropriate, however.
Prescription treatments for non-inflammatory acne (whiteheads as well as blackheads) tend to be more effective than consumer products.7 These include gels or lotions containing retinoids (vitamin A), antibiotics, benzoyl peroxide (antibacterial) or azelaic acid. These options are also prescribed as combination treatments.1,4,6,15
These products do pose a risk of adverse effects, especially in pregnancy, and should only be used as advised by a qualified health care practitioner.
Oral antibiotics may be used to treat mild acne, although these are not a specific treatment for noninflammatory blackheads. Hormonal agents, such as the oral contraceptive pill, can help with the problem of sebum production.1,4,6,15
Isotretinoin (brand named Accutane) is a drug reserved for treating severe acne, such as cystic acne. Drugs containing high levels of vitamin A should not be used by those who are pregnant or who are trying to conceive as they can cause serious birth defects.1,4,15
Myths about blackhead treatment
There are two major, and easily debunked, myths about how best to treat blackheads at home:1,4,6,7
- Picking, squeezing and popping blackheads and other acne lesions - these actions, while perhaps providing some initial satisfaction, in fact worsen lesions by causing inflammation and potential scarring
- Abrasive scrubs for washing acne - these do not improve the condition and may cause irritation.
Severe inflammatory lesions can be individually treated by dermatologists. Where other treatment has not helped, simple comedones, including blackheads, may be treated using a specially designed tool to extract the material plugging a pore.1 Such mechanical attempts risk making the problem worse or causing scarring, especially if attempted by the person with acne themselves.4,6,7
Prevention of blackheads
The main risk factors leading to blackheads and other acne are largely unavoidable - the hormone changes during puberty, for example, certainly cannot be prevented.1-6 There are, however, ways to prevent a worsening of the effects of excessive sebum production:1,5
- Avoid following the myths about dealing with a blackhead, as described immediately above
- Avoid tight clothing that does not allow the skin to breathe, and avoid cosmetics that block the skin
- Avoid highly humid air conditions and heavy sweating.