Blackheads

Blackheads are a very common skin condition that mostly affects your face, neck, back and chest. There are a variety of causes, including too much oil on your skin and hair follicle irritation. Blackheads commonly affect adolescents, but they can occur at any age.

What are blackheads?

Blackheads are a type of acne (acne vulgaris). They’re open bumps on the skin that fill with excess oil and dead skin. They look as if dirt is in the bump, but an irregular light reflection off the clogged follicle actually causes the dark spots.

Blackheads aren’t pimples. Pimples are small, painful, discolored bumps with a thick, white-yellow fluid (pus) at the tip.

Who do blackheads affect?

Blackheads typically affect teenagers and young adults undergoing hormonal changes. However, many adults continue to have acne into their 20s, 30s and beyond. Some even develop blackheads for the first time as adults.

How common is this condition?

Blackheads are very common. Some researchers suggest that blackheads affect nearly everyone during their lives. They’re most common among adolescents, but up to 10% to 20% of adults have blackheads too.

How do blackheads affect my body?

Your face (especially your nose and chin, sometimes your cheeks), neck, back and chest are most likely to develop blackheads. However, oil (sebaceous) glands are all over your body. They release an oily lubricant called sebum that helps keep your skin and hair hydrated and shiny. As a result, though it isn’t common, blackheads sometimes appear on your butt, thighs, ears and armpits.

Blackheads don’t seriously affect your physical health, but they can affect you psychosocially (how society and social groups affect your mind) and psychologically (your self-perception and behavior). Blackheads can cause anxiety, depression, mood disorders and suicidal thoughts.

Symptoms and Causes

What are the symptoms of blackheads?

Blackheads are a milder form of acne. Dark, open bumps in your skin are the main characteristic of blackheads. They don’t hurt or feel uncomfortable like whiteheads.

What causes blackheads?

Sebaceous glands are located all over your body, and most of them connect to hair follicles. Blackheads and whiteheads are comedones (singular comedo). Blackheads are open comedones, and whiteheads are closed comedones. Comedones occur when a hair follicle/sebaceous gland becomes inflamed. Inflammation can occur as a result of:

Increased sebum (oily material produced by the sebaceous gland) production.
Abnormal formation of keratin (the protein that helps make your hair, skin and nails).
Increased hormones (androgen).
An increased presence of bacteria on skin that causes acne.

Are blackheads contagious?

Blackheads aren’t contagious. You can’t spread blackheads to another person through skin-to-skin contact.

Diagnosis and Tests

How are blackheads diagnosed?

Blackheads are easy to recognize, so you don’t necessarily need a healthcare professional to diagnose them. If you have blackheads along with other severe forms of acne, see a dermatologist for treatment. Dermatologists are doctors who specialize in conditions that affect your skin, hair and nails.

Management and Treatment

How are blackheads treated?

Nonprescription medications can treat blackheads. These may include:

Salicylic acid: This is available over-the-counter for blackheads as a cleanser or lotion. It helps remove the top layer of damaged skin. Salicylic acid dissolves dead skin cells to prevent your hair follicles from clogging.
Azelaic acid: Barley, wheat, rye and other various grains naturally contain azelaic acid. It kills microorganisms on your skin and reduces swelling.
Benzoyl peroxide: This is available as an over-the-counter product (such as Clearasil®, Stridex® and PanOxyl®) as a leave-on gel or wash. It targets surface bacteria, which often aggravates acne. Lower concentrations and wash formulations are less irritating to your skin. Irritation (dryness) is a common side effect.
Retinoids (vitamin A derivatives): Retinoids, such as Retin-A®, Tazorac® and Differin® (which is now available without a prescription), break up blackheads and whiteheads and help to prevent clogged pores. You may notice a change in skin color or peeling. Using retinoids every other day or using them at the same time as a moisturizer can reduce these side effects.

If your blackheads don’t go away with nonprescription medications, your healthcare provider may recommend:

Prescription-strength retinoids: Prescription-strength retinoids are stronger than nonprescription retinoids.
Oral antibiotics: Oral antibiotics reduce the bacteria that cause blackheads.
Microdermabrasion: A dermatologist uses a specialized instrument to “sand” your skin. Removing the top layers of your skin frees the clogs that cause blackheads.
Chemical peels: Chemical peels use a mild chemical solution to remove layers of skin and reduce blackheads.
Laser skin resurfacing: Laser skin resurfacing directs short, concentrated pulsating beams of light at your blackheads. The light beams reduce the amount of oil that your sebaceous glands produce.

Are there any home remedies for blackheads?

There are a few home remedies that may help treat blackheads:

Tea tree oil: Tea tree oil can prevent or stop the growth of bacteria. Apply a small amount of tea tree oil to a cotton applicator and rub it on your blackheads.
Sugar or salt scrubs: Sugar and salt scrubs scratch away (exfoliate) dead cells on the surface of your skin. Wet your face, apply a salt or sugar scrub to your affected areas and massage your skin in small, circular motions for up to 30 seconds. Rinse your face with water when you’re finished.
Green tea: Wet green tea leaves can help reduce oil production in your skin. Green tea is also an antioxidant. Mix dry green tea leaves with water and massage the wet leaves into your skin in small, circular motions for up to 30 seconds. Rinse your face with water when you’re finished.

Do blackheads go away on their own?

Blackheads can sometimes go away on their own — it depends on how deep blackheads are in your skin. If a blackhead is close to the surface of your skin, it’s more likely to go away on its own. However, some blackheads can be deeply embedded in your skin. Deep, embedded blackheads are less likely to go away on their own. If you have embedded blackheads, a dermatologist or medical aesthetician can remove them.

Is it okay to squeeze out blackheads?

It can be very tempting — and satisfying — to squeeze out or pop blackheads. However, squeezing out blackheads can create several problems:

You may not remove the entire blackhead. You may even push the blackhead further into your skin, which can cause painful irritation.
You may introduce bacteria or more oil into the blackhead opening. Your blackheads could get bigger or even spread.
Inflammation or scarring. Your skin is sensitive, and your nails are much stronger than your skin. When you use your nails to apply a lot of pressure to your skin to remove a blackhead, you can irritate or seriously damage your skin.

How do you get rid of deep blackheads?

Deep blackheads should be removed by a medical professional — usually a dermatologist or medical aesthetician. They use a small tool with rigid metal loops on the ends (blackhead or comedo extractor) to apply even pressure to your blackheads. They can safely remove the entire blackhead and reduce the risk of it returning.

Prevention

How do you prevent blackheads?

Preventing blackheads is difficult, if not impossible, during normal hormonal changes. But some things can help:

Wash your face daily with warm water and a mild facial cleanser.
Routinely use moisturizer.
You don’t have to stop using makeup, but try to use “noncomedogenic” products and remove makeup at the end of each day.
Keep your hands away from your face.

Outlook / Prognosis

What can I expect if I have blackheads?

Blackheads often go away in early adulthood, though some people will continue to experience them throughout their lives. Your healthcare provider, medical aesthetician or dermatologist can help you manage your blackheads.

Living With

When should I see my healthcare provider about my blackheads?

See your healthcare provider as soon as you notice blackheads to start treatment immediately.

What questions should I ask my healthcare provider?

How severe are my blackheads?
Do I need to see a medical aesthetician or dermatologist?
What over-the-counter medications do you recommend?
Do I need more serious treatment?

A note from Cleveland Clinic

Blackheads are a common skin condition that affects the majority of people, especially adolescents. Because it mainly affects adolescents, many people attribute blackheads as part of the transition from childhood to adulthood and don’t see a healthcare provider about them. However, despite how common they are, they can have a severe effect on your mental health. If you notice symptoms of anxiety or depression due to the presence of blackheads, talk to your healthcare provider.

Acne comes in many shapes, sizes, and colors — and sometimes, the skin condition doesn’t look like an obvious blemish at all.

Take blackheads, those pesky dark-colored gunk-filled spots. If you’ve ever tried squeezing one, you’ve probably found yourself facing down an angry bump instead, and immediately regretted it.

So what is the best way to clear your skin from this type of acne?

First, let’s take a look at the causes and who is most prone to developing blackheads.

What Causes Blackheads?

“Blackheads are caused by a buildup of sebum, oil, dead skin cells and possibly C. acnes (the bacteria that causes acne) that are stuck in the hair follicle,” says Nazanin Saedi, MD, clinical associate professor at Thomas Jefferson University and the department co-chair of the Laser and Aesthetics Surgery Center at Dermatology Associates of Plymouth Meeting. “When these substances oxidize in the air, the opening turns black,” says Dr. Saedi.

Acne-prone individuals are most susceptible to blackheads, but there is a genetic predisposition as well, explains Saedi.

“Hormonal influences also play a role, stimulating the production of sebum (skin oil),” says Kathleen Cook Suozzi, MD, the director of the aesthetic dermatology program at Yale Medicine and an assistant professor of dermatology at Yale School of Medicine in New Haven, Connecticut.

“Enlarged pores can also be present in individuals with severe sun damage,” Dr. Suozzi says. ”A decrease in the collagen support of the dermis surrounding the hair follicle can make the ostia (small openings) appear larger and more dilated. An extreme example of this is in the condition Favre-Racouchot, in which patients have large blackheads in areas of sun damaged skin, particularly around the eyes,” she says.

How to Prevent Blackheads on Your Skin

To keep blackheads at bay, Suozzi recommends topical or oral retinoids, including prescription medications like tretinoin or Retin-A.

“Recently, a prescription strength retinoid, called adapalene or Differin, became available over the counter for the treatment of comedonal acne,” she says. “In cases of more severe comedonal acne, patients may require treatment with oral retinoids, such as isotretinoin, or Accutane.”

Saedi adds that chemical exfoliants can also be effective, but she isn’t in favor of scrubs because they can cause irritation.

The Best Ways to Get Rid of Blackheads

If you already have blackheads, there are a few dermatologist-endorsed methods to get rid of them — and a few of them are preventive as well.

Use Products With Salicylic Acid

One go-to ingredient for eliminating blackheads is salicylic acid, a beta hydroxy acid that increases cell turnover and unclogs pores, says Saedi. Suozzi adds that the acne treatment can help dry active acne lesions because it is a mild chemical irritant.

A wealth of research suggests salicylic acid helps treat acne. That includes one study that found that using a 2 percent salicylic acid wash for two weeks led to a reduction in acne lesions.

Saedi recommends two thrifty but effective drugstore products with salicylic acid: Neutrogena Pink Grapefruit Oil Free Acne Wash and Neutrogena Gel Cleanser Acne Proofing.

If you are willing to invest a little more money for a more potent, multitasking product, Suozzi recommends Skinceuticals Blemish + Age Defense, a combination of 2 percent dioic acid with an optimal alpha and beta hydroxy acid formulation that will not only help with acne, because it reduces sebum, but also has anti-aging properties. Additionally, she is a fan of DCL Multi Action Penta Peel pads, a highly concentrated peel or chemical exfoliant.

Add a Retinoid to Your Routine

Retinoids, which are available by prescription (such as Retin-A) and over-the-counter (Differin) are a reliable method for ridding the skin of blackheads. “Retinoids work by promoting skin turnover and decreasing the ‘stickiness’ of the skin cells to prevent blockage of the follicular ostia,” Suozzi explains.

She notes that when you start retinoid treatment, blackheads, also known as comedones, may worsen as cell turnover increases against a clogged opening, causing further dilatation. This will improve with continued treatment, she says.

Saedi suggests trying an OTC product like Differin first, but if it isn’t helping, “then see a doctor for prescription strength.”

Consider Alpha Hydroxy Acids

Alpha hydroxy acids, such as glycolic acid and lactic acid, are helpful for getting rid of blackheads as well, says Saedi, but she says that salicylic acid is better for helping unclog pores. Drunk Elephant T.L.C. Framboos Glycolic Resurfacing Night Serum and Sunday Riley Good Genes Glycolic Acid Treatment are two highly rated AHAs on the web.

Opt for an In-Office Treatment

A dermatologist can help rid your skin of blackheads. “There are in-office treatments that can help diminish the appearance of pores,” Suozzi points out. These include nonablative resurfacing (aka laser treatments) such as Fraxel laser or Clear + Brilliant laser or microneedling.

Prices vary and can range from a few hundred dollars to $1,500 or more, dermatologists say. While some people are happy with the results of a single treatment, others may need multiple sessions to achieve desired results.

The Worst Ways to Get Rid of Blackheads

Using Harsh Scrubs

It can be tempting to slough away all your dead skin in instant gratification via the help of an exfoliating scrub. While chemical exfoliators (like AHAs) can be helpful, Saedi suggests that you avoid overexfoliating with a granule scrub.

“Harsh scrubs can strip your natural oils and create more oil,” she points out. Dermatologists in general recommend exfoliating up to three times per week, depending on the product you are using and your skin type.

Doing Manual Extractions

Suozzi recommends fighting the urge to pop any pimples. “If you squeeze your blackheads, you can cause the follicle to rupture and induce the formation of an inflammatory lesion, or cyst,” she says. In other words, you can transform your blackhead into a much more serious skin condition. Keep in mind that the closer a blackhead is to the surface of your skin, the safer it is to squeeze.

Turning to Suction Devices

Tech that promises to suck sebum from pores may sound appealing, but these products may do more harm than good, Suozzi says. “This suction can be harmful to delicate facial skin and can induce telangiectasias, or ‘broken blood vessels’ to appear, particularly on and around the nose,” Suozzi explains.

The Takeaway on Preventing and Treating Blackheads

While it might be almost impossible to resist attempting to extract that blackhead with your own two fingers, try your hardest to leave it alone.

“The best treatment is prevention,” says Suozzi. Enlist the help of a few effective ingredients — for example retinoids, double-taskers that will not only help treat the skin condition but also prevent new blackheads from forming. Or, make an appointment with your dermatologist for a professional treatment.