Blackheads

Medically Reviewed By William C. Lloyd III, MD, FACS
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What are blackheads?

Blackheads are a form of comedonal acne, which is a type of acne vulgaris—or acne for short. Acne is a skin condition that can be either inflammatory or non-inflammatory. Comedonal acne, including blackheads, is non-inflammatory.

The name, comedonal, comes from the term, comedo, which means pore. Pores are openings in the skin that contain a hair follicle and a sebaceous gland. The gland secretes an oil called sebum. The oil travels up from the bottom of the pore and out through the pore opening to moisturize the skin. Along the way, it picks up dead skin cells and carries them out of the pore to keep it clean. In comedonal acne, the oil and dead skin cells get trapped and form a plug.

Blackheads are one of two types of comedonal acne blemishes. The other type is whiteheads. Whiteheads occur when the opening of the plugged pore is closed at the surface. With blackheads, the clogged pore remains open. This allows air to cause a chemical reaction called oxidation, which causes the black color. The black is not dirt. Oxidation is the same reaction that causes apples, avocados and potatoes to darken on exposure to air. Open comedo is the medical name for a blackhead.

Blackheads are extremely common. Almost everyone will have an acne breakout at one point or another. It is the most common skin condition in the United States. Acne is more likely to be a problem for people whose parents also had breakouts.

Blackheads can occur at any point during life, but they are more common in teenagers and young adults. The exact reason for this is unclear. Experts believe changing hormone levels likely play a role, as does excess oil production. It is a myth that poor hygiene causes acne.

Blackheads on the nose, cheeks and face are common. But they can also appear on the chest, back and shoulders. They usually heal slowly and resolve on their own. Self-treatment can help them heal quicker and prevent new ones from developing. For mild breakouts, over-the-counter products containing benzoyl peroxide or salicylic are often effective. See your doctor if you still have blackheads after eight weeks of use. Prescription medicines or blackhead extraction may be necessary. Removing blackheads yourself can lead to worsening acne problems and scarring.

What are the symptoms of blackheads?

Blackheads can occur anywhere, but they most often show up on body parts with a high concentration of oil glands. This includes the face, chest, upper back, and shoulders.

Common symptoms of blackheads

Blackheads look like dark, black or dirt-filled pores. This is the result of the pore remaining open at the skin surface, allowing oxidation of the plug. It is not actual dirt in the pore. The skin around blackheads can become red or inflamed due to irritation.

Seeing a doctor can be helpful when you have an ongoing problem with blackheads. Dermatologists have the expertise to diagnose and treat conditions that affect the skin, including acne.

What do blackheads look like?

Blackheads appear as small, dark blemishes that look like dirt in the pores. However, the dark color is actually the result of oxidation of the plugged pore caused by a small opening at the skin surface.

Closed up of pimple blackheads on face
Getty
Closed up of pimple blackheads on nose and lips
Getty

What causes blackheads?

Blackheads occur when skin pores become plugged with oil, dead skin cells, and sometimes bacteria. Experts do not know exactly why skin pores become clogged. There are several factors that could play a role. Hormonal changes are likely to be a key one. During puberty, rising hormone levels increase oil production and stimulate the turnover of new skin cells. Both of these effects may contribute to acne breakouts. Changing hormone levels may also trigger breakouts in women during menstruation, pregnancy and menopause. Other contributing factors may include genetics and sensitivity to bacteria that are normally present on the skin.

What are the risk factors for blackheads?

Several factors may trigger acne breakouts, including blackheads, or increase the risk of having breakouts. However, not everyone with risk factors will have a problem with blackheads and other types of acne. This contributes to the uncertainty about acne’s exact cause. Risk factors for comedonal acne and blackheads include:

  • Being a teenager or young adult
  • Eating high-carbohydrate or high-glycemic diets, which some research suggests could contribute to acne breakouts
  • Having a parent who had problems with acne, including blackheads 
  • Taking certain medications, such as corticosteroids, lithium and phenytoin
  • Using greasy or oily skin products, such as cleansers, cosmetics or creams, which may clog your pores 
  • Wearing tight or occlusive clothing or equipment, especially in humidity or during sweating, which can produce friction or pressure 

Some people with acne find that stress increases breakouts of blackheads and other blemishes. Smoking may also be a breakout trigger.

Reducing your risk of blackheads

You cannot always avoid a breakout of blackheads, but you may be able to minimize breakout triggers. Ways you can reduce the severity of blackheads and breakouts include:

  • Avoid squeezing or popping blackheads, as picking at them can cause more irritation, make it harder for your skin to heal, and lead to scarring.
  • Do not touch your face. 
  • Shampoo your hair on a regular basis, as often as every day if you have oily hair.
  • Stop smoking.
  • Use gentle, nonabrasive cleansers and avoid scrubbing your skin or using harsh or alcohol-based cleansers or products, which can cause irritation and make acne worse. 
  • Wash your face twice a day and after sweating with lukewarm water instead of hot water, which can contribute to skin irritation

Keeping a breakout diary may help you identify breakout triggers. Share the diary with your dermatologist and ask about strategies to deal with your blackheads.

What are the diet and nutrition tips for blackheads?

There is no specific diet that will clear up blackheads and other forms of acne for sure. However, some research suggests certain foods may act as triggers for breakouts. Scientists believe these foods lead to breakouts by stimulating inflammation in the body. While more research is needed, it may be worth avoiding the following foods:

  • Cow’s milk, regardless of the fat content
  • High-glycemic foods and beverages, such as white bread, white rice, potatoes, fries, chips, sweets, and sugary beverages

Interestingly, products made from cow’s milk, such as yogurt, do not seem to have the same link to acne as drinking the milk itself.

If you decide to eliminate these foods, talk with your doctor. It will be helpful to keep a diary and only eliminate one type of food at a time. Record what happens if you do not eat the food for a week or a month.

How do doctors diagnose blackheads?

Your doctor will likely be able to diagnose a blackhead breakout by looking at your skin. Your doctor may also ask you several questions related to your breakouts including:

  • How long have you had blackheads?
  • What, if anything, seems to trigger a blackhead breakout?
  • What medications do you take?
  • What skin and hair care products do you use, including soaps, cleansers, lotions, moisturizers, sunscreens cosmetics, and shampoo and conditioner?
  • How often do you wash your face and neck?
  • What treatments have you tried?
  • Is your acne affecting your social life or self-esteem?
  • Do you have a family history of acne?
  • For females, do you take oral contraceptives or use another form of hormonal birth control?
  • For females, are your menstrual periods regular and is there any chance you could be pregnant?

How are blackheads treated?

Mild blackhead breakouts may respond to over-the-counter (OTC) treatments with benzoyl peroxide or salicylic acid products. Benzoyl peroxide works by killing bacteria and drying up oil from the sebaceous glands. Salicylic acid is an exfoliant that increases skin cell turnover. This helps unclog your pores. You can also try an OTC topical retinoid, such as adapalene (Differin and others). Retinoids promote skin cell turnover and dry the skin as well.

If your breakouts persist after eight weeks of using OTC products, consult your doctor. A prescription-strength product may be necessary. Topical antibiotics may also be helpful, depending on what other types of blemishes you have. In general, doctors do not prescribe oral acne treatments for comedonal acne, including blackheads.

Women who have comedonal acne with blackheads may achieve breakout control by using oral contraceptives. “The pill,” as it is commonly called, balances hormone levels, which can stabilize acne and reduce breakouts.

Sometimes, doctors recommend extruding blackheads when medication alone does not eliminate them. This technique involves using special tools to gently unplug clogged pores. While effective, extrusion can lead to scarring. Chemical peels may be an alternative to extrusion. Typically, you need to repeat chemical peels to maintain their effects.

Alternative treatments for blackheads

If you are looking for an alternative to traditional medicine for acne, there are a couple of options to consider including:

  • Hansen CBS brewer’s yeast taken orally may decrease acne breakouts. Abdominal gas is a potential side effect of this supplement.
  • Tea tree oil in the form of a 5% gel may work as well as benzoyl peroxide 5%. This product will likely take longer to work than benzoyl peroxide and may cause skin redness, dryness and irritation.

Talk with your doctor before using alternative treatments to make sure there is no reason that you should not try them. For example, tea tree oil may not be the best choice for someone with other skin conditions, such as rosacea, due to its side effects.

What are the potential complications of blackheads?

Comedonal acne, including blackheads, can lead to complications that affect you both physically and mentally. Physical problems that can result from acne include scarring and skin color changes. As acne blemishes heal, the skin where they were may turn darker or lighter than the surrounding skin. Scarring and color changes may be temporary or permanent.

Emotional problems can also occur as a result of acne including:

  • Embarrassment
  • Low self-esteem
  • Social isolation

If you have blackheads or other forms of acne, work with a dermatologist. Together, you can find a skin care solution that works for you.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jun 2
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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