Advice by Jenna C. Lester, MD November 7, 2022 at 5:58 a.m. ES
Jenna C. Lester is a dermatologist and the director of the Skin of Color Program at the University of California at San Francisco.
Q: I have blackheads on my nose, chin and chest. Should I squeeze them? Does applying a moisturizer make them better or worse?
A: Although it’s tempting, squeezing blackheads with your fingers is a bad idea. That can cause trauma to the skin and lead to hyperpigmentation or scarring.
Instead, I suggest you try getting rid of them in one of two ways: You can visit a dermatologist or an aesthetician for an extraction, which is the process of removing blackheads with special tools that minimize damage to the surrounding skin. This is a great option if you want to get rid of them fast. But it can be expensive, costing around $100 to $200 per session.
Or you can try topical treatments, which will take longer to work but are cost-effective and will do the most for you in the long run, since they can prevent future blackheads from forming. They’re also readily available at most drugstores and at a variety of price points, so you can find the best option for your budget and skin.
Salicylic acid chemical peels can also be helpful in treating comedonal acne. Be sure to see a practitioner who is experienced in administering peels, particularly if you have deeply pigmented skin, as peels can be irritating and cause discoloration.
How blackheads form
To understand what treatments are effective, it helps to know how and where blackheads — technically a type of acne — form.
Blackheads form in an area of the skin called the follicle, commonly referred to as a pore, which is a channel that starts underneath the skin and opens at its surface. A hair protrudes from the pore’s opening but is usually so small that it isn’t visible.
There are millions of pores covering your body. Each pore has a gland that produces oil, which travels to the pore’s opening and functions as a moisturizer for the skin and hair. Dead skin material is also extruded through the pores, where it can be washed away.
But sometimes oil and dead skin can accumulate inside the pore and at its opening. This causes a blockage that leads to more oil buildup. When that oil and dead skin material are exposed to air, they turn black and create the appearance of blackheads.
Blackheads can develop anywhere but are most commonly found in areas with the most oil glands, such as your back, chest and face.
They can cause scarring, which usually appears as tiny “ice pick” scars in the skin and may be associated with a type of acne called comedonal acne. In this type of acne, you may see blackheads along with closed comedones — also known as whiteheads, which are small, skin-colored bumps. These are also plugged pores, but instead of being open to the air like blackheads, they’re closed off, so the material inside doesn’t turn black.
Some moisturizers may make blackheads worse
Blackheads usually start during puberty because of increased hormone production, particularly androgens. These hormones stimulate glands to produce more oil, in turn leading to clogged pores. Teens aren’t the only ones with acne. Hormonal changes that happen throughout life, such as those in pregnancy or menopause, can result in adult acne.
Many of my patients use oils in their hair, which can end up on their face and cause blackheads. Oils applied directly to the skin or through moisturizers can cause the same outcome. If you’re prone to developing blackheads, look for moisturizers that are designated as noncomedogenic (meaning they don’t clog pores) or oil free.
Topical treatments that actually work
Most acne and blackhead treatments require patience. It can take three months to see improvement, and consistency is key.
Retinoids: Retinoids can help address the oil production and dead skin buildup that cause blackheads. They’re also effective in treating the discoloration that can result from the formation of blackheads, which is more common for people with darkly pigmented skin.
If you opt for a prescription-only retinoid such as tretinoin, you should discuss the appropriate concentration with your dermatologist. Adapalene 0.1 percent gel is available over the counter.
Retinoids can be applied anywhere on the body where acne exists, but most are meant to be used on the face. They can cause irritation, so it’s important to use only a small amount and to start by using the product a few times a week. Use moisturizer for dryness, and wear sunscreen since they can also make your skin more sensitive to the sun.
Benzoyl peroxide and salicylic acid: Both benzoyl peroxide and salicylic acid can help with skin exfoliation and reduce oil production. They’re sold as a cream, gel or wash.
I usually recommend the wash preparations in a concentration of 4 to 10 percent — because they treat an entire area — but some patients prefer to use them as spot treatments to speed the resolution of a particular blemish.
Like retinoids, they can be drying to the skin, so they should be gradually introduced and paired with a moisturizer when needed.
Benzoyl peroxide can bleach your clothing or towels, so keep that in mind after applying it or choose products with salicylic acid instead.
Sunscreen: Sometimes blackheads can develop as a long-term consequence of unprotected sun exposure in a condition called Favre-Racouchot. It’s not known why this happens, but it’s thought that sun damage causes the pores to enlarge.
Protect your skin by wearing wide-brimmed hats if you’re outside for a prolonged period between 10 a.m. and 4 p.m. Wear sunscreen of at least SPF 30 daily, and reapply it regularly
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