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Blackheads are small, dark lesions that appear on the skin, often on the face and neck. They are a feature of mild acne, but they can appear without other signs of acne being present.
They contain an oxidized version of melanin, the dark pigment made by cells in the skin.
Blackheads are a type of comedo. Comedones occur when the pores in the skin become plugged with dead skin cells and an oily, protective substance known as sebum.
The top of the blackhead, which is visible on the surface of the skin, has a dark color.
Normally, hair grows from hair follicles in the pores, and the sebum-producing sebaceous glands lie underneath.
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 the development of blackheads is not related to the cleanliness of the skin.
Other acne lesions are usually closed, but in blackheads, the skin around the clogged pore opens, air gets in causing the collected sebum oil or dead skin cells to oxidize and turn black or sometimes yellowish.
Blackheads appear most frequently on the face, back, neck, chest, arms, and shoulders. There are more hair follicles in these areas.
Some factors can increase the chance of developing blackheads.
Age and hormonal changes are an important factor. Like other symptoms of acne, blackheads are most common during puberty, when the change in hormone levels triggers a spike in sebum production. However, they can appear at any age.
Androgen, the male sex hormone, triggers greater secretion of sebum and a higher turnover of skin cells around puberty. Both boys and girls experience higher levels of androgens during adolescence.
After puberty, hormonal changes related to menstruation, pregnancy, and the use of birth control pills can also bring on blackheads in women.
Overproduction of skin cells by the body 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 popular belief, poor hygiene does not directly cause blackheads. Excessive scrubbing in an attempt to remove them can make them worse.
The main symptom is the small, dark lesion that gives blackheads their name.
Blackheads are a symptom of acne, but, being caused by open pores, they differ in some ways from other acne lesions.
Blackheads are non-inflammatory. This means they are not infected, and they will not cause pain and discomfort in the same way as pimples and pustules.
Blackheads have a raised texture, but they are flatter than pimples.
The change in appearance caused by blackheads can lead to embarrassment and social or psychological difficulties in some patients.
Sebaceous filaments look like blackheads, but they are different. They can appear on the nose. They tend to be smaller, appear in groups, and feel flat to the touch. Sebaceous filaments are glands that channel the flow of sebum through the pores. Unlike blackheads, they are not a form of acne.
Blackheads will rarely lead to a doctor’s visit unless severe acne is already present. They are easy to identify and diagnose from their appearance.
Most people manage their blackheads at home without needing to see a doctor, but some activities can make them worse or trigger a more severe type of acne.
There are many myths and contradictions about how to treat blackheads, so it may be best to see what works for you.
Do’s for blackheads
Cleansing: Special scrubs for gently exfoliating the face can help. Look for those that are fragrance-free and for sensitive skin, and avoid anything that makes your skin overly dry. Various products are available to purchase online.
While it is important to dry up the skin by decreasing excessive oil production, drying it too much may make matters worse due to stimulating the extra production of oil by the glands.
Make-up and cosmetics: Use non-comedogenic products that do not clog pores instead should keep the pores clear and open and reduce the buildup of dead skin. Non-comedogenic makeup is available to purchase online from various brands.
Prescription treatments: Azelaic acid, salicylic acid, and benzoyl peroxide are also available in both prescription and over the counter (OTC) forms for non-inflammatory acne. These are topical treatments, applied directly to the skin.
Prescription medications that contain vitamin A, such as tretinoin, tazarotene, and adapalene, may be prescribed to keep plugs from forming in the hair follicles and promote the more rapid turnover of skin cells.
However, most people do not seek these treatments until their acne has worsened to become an infected or more severe form, such as pimples. It might be best to have a skin care specialist remove the blackheads if they become bothersome.
Underlying conditions: Any other skin problems, such as eczema or rosacea, can make treating blackheads a little harder. The condition should be treated before the acne, as successful treatment may lead to improvements in the blackheads.
Rest and relaxation: Getting enough rest and avoiding stress can also help, as stress can trigger sebum production. Exercise can help reduce stress.
Food: Research has not confirmed that cutting out fries or chocolate either will or will not reduce acne, but a healthful, balanced diet with plenty of fresh fruit and vegetables is beneficial for overall health. It may reduce the risk of skin lesions becoming infected.
Don’ts for blackheads
Hormonal triggers can make blackheads unavoidable, but some factors can increase the risk or make them worse.
Squeezing: Avoid squeezing blackheads, even with a metal blackhead remover, as this can irritate the skin and make the problem worse.
Steaming: A steam bath has long been recommended as a treatment for blackheads, on the basis that it “opens the pores.” However, this has not been confirmed by research. Some people find it makes the problem worse.
Scrubbing: This can worsen the problem. Scrubbing removes sebum. The sebaceous glands then work harder to replace the sebum, leading to more blockages and the risk of inflammatory acne.
Removers: Removal strips, masks, and vacuums should be used with caution, as these can irritate and damage 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: This has been recommended for acne. It can reduce the severity of outbreaks, but it is also a harsh product that can dry and irritate the skin. Researchers remain undecided about whether it should be used or not, because of its adverse effects.
Plant-based treatments are often recommended for acne, and some research is under way. Tea tree, thyme, aloe vera, and rose oils all appear to offer antibacterial benefits to prevent acne from becoming infected. Further research is needed.
As a form of mild acne, blackheads tend to resolve on their own when the body more successfully regulates hormones after puberty. It can take a long time for blackheads to self-resolve, and they may persist for many years.
A patient who is experiencing psychological difficulties with the appearance of blackheads may find it helpful to see a counselor.