The Best Ways to Prevent & Remove Blackheads

Blackheads are dark pinpoint dots on the skin resulting from of a clogged pore that has oxidized with air exposure. They are a type of comedonal acne that usually form on the face but can appear on the chest, back, shoulders, and neck. If you regularly struggle with this type of acne, please read below for tips on how to prevent and safely remove blackheads.

About Blackheads

Comedonal acne of whiteheads and blackheads forms as a result of dead skin cells, sebum (skin oil) and acne-causing bacteria getting clogged inside pores. Closed comedones or whiteheads arise when the clog is deep within the pore and is covered by a thin layer of overlying skin. These lesions may be subtle and generally appear white or skin-colored. Open comedones or blackheads form when the clog extends superficially, dilating the follicular pore opening, and contacts with air. This results in the contents of the clog oxidizing and appearing gray or black on the surface. Thus, blackheads tend to be more cosmetically concerning, as they are more conspicuous than their whitehead counterpart.

Risk factors for comedonal acne such as blackheads include:

Oily Skin

All acne, including comedonal acne, is typically found in sites with well-developed sebaceous (oil) glands, most often the face and upper trunk. Blackheads commonly reside on the oiliest parts of these sites, including the T-zone face that consists of the forehead, nose and chin.

Familial Predisposition For Acne

Although the precise role of genetic predisposition is uncertain, it is understood that the number, size and activity of sebaceous glands is inherited and that oiliness is associated with blackhead formation. In addition, the concordance rate for the prevalence and severity of acne among identical twins is extremely high, supporting the role of genetics and blackheads.

How to Prevent Blackheads

Because blackheads are the result of clogged pores, the best way to prevent them is to keep skin clean, exfoliated, and moisturized with the following tips:

• Reduce oil build-up within pores by cleaning your face in the morning, before bedtime at night, and after you break a sweat
• Prevent excessive oil production by using gentle, non-abrasive cleansers
• Remove dead skin cells by exfoliating 1-3 times weekly with a chemical or physical exfoliant
• Prevent clogged pores by using non-comedogenic skincare products
• Avoid acne-causing foods like skim-milk derived dairy, and high-glycemic carbohydrates

The Best Methods to Remove Blackheads at Home

Blackheads are best addressed via gentle extraction or skincare. Above all else, they are not to be forcefully picked, popped, or squeezed, due to the risk of pushing the clog deeper in the pore. Aggressive removal of blackheads can also overly traumatize and scar the surrounding skin.

Instead, try the following methods:

Mild Blackheads? Use a Salicylic Acid Cleanser

Salicylic acid is a beta-hydroxy-acid (BHA) that exfoliates the top layer of skin by dissolving the bonds that keep dead skin cells tied together. Salicylic acid also dissolves excess oil, dirt, or makeup that can potentially clog pores.

Salicylic acid cleansers are available without prescription and come with varying concentrations of active ingredient. If you have sensitive skin that is prone to dryness, choose one with 2% salicylic acid or less. If you have oily skin, a cleanser with up to 5% active ingredient may be your best bet.

Salicylic acid cleanser works best for those with several small blackheads. Because BHAs are oil-soluble, they also work great for those with oily skin and help loosen the blackhead plug. After cleansing, it is sometimes appropriate to gently squeeze out loosened blackheads using clean hands.

Stubborn Blackheads? Use a Retinol Product

Retinol products are available over the counter. This vitamin A derivative treats blackheads by breaking keratin bonds to exfoliate skin and remove dead skin cells. This process also unclogs pores and increases the speed of skin cell turnover. Consistent use of over-the-counter retinols or prescription retinoids will maximize absorption and efficacy of your other skin care products.

Like salicylic acid, retinols can be drying to the skin, so should be used judiciously. When first beginning a new retinol product, choose a product with a low percentage of active ingredient or slowly phase them into your skincare routine. Begin using retinols every other night and gradually increase to every night.

Of note, most retinols make you more sensitive to the sun, so protect your skin during the day with a non-comedogenic broad-spectrum sunscreen.

When to See a Dermatologist

If your blackheads are not responding to over-the-counter methods, it may be time to see a dermatologist. Your doctor may suggest one or a combination of multiple of the following remedies for a blackhead-fighting regimen specifically designed for you.

Prescription-Strength Retinoids

Prescription-strength retinoids such as Retin-A (tretinoin), Differin (adapalene), and Tazorac (tazarotene), are more potent at addressing blackheads than over-the-counter retinols. Over-the-counter retinols must be converted by a two-step enzyme process in your skin before they can exert changes to the skin. Prescription retinoids are already in their active form and target your blackheads directly.

While retinoids such as Retin-A are extremely effective at dissolving blackheads, they are much more drying and irritating than over-the-counter options. Thus, it is important to introduce your retinoid slowly and protect your skin from the sun while using this topical.

Professional Extraction

Although mild blackheads may be removed with gentle extraction using clean hands, it is recommended to see a professional for extractions, especially for stubborn blackheads. A dermatologist can safely remove blackheads in-office using a comedone extractor. This device applies equal pressure to all sides of the pore, reducing skin irritation and ensuring a clean extraction.

Chemical Peels

Chemical peels effective for blackheads typically use salicylic acid or retinoic acid as the active ingredient. The duration of the treatment and the downtime required depends on the depth of the treatment. Peels offer deep exfoliation in order to dissolve dead skin cells, break up excess oil, and encourage new skin cell regeneration.

Dermabrasion

Dermabrasion is a method of physical exfoliation that uses a textured roller to remove the outer layers of the skin. Like other methods of exfoliation, dermabrasion can help clear pores. It may not be suitable if you have inflammatory acne or skin prone to post-inflammatory hyperpigmentation.

Oral Medication

If topical treatments are ineffective, certain oral medications can reduce oil production and limit acne-causing bacteria. This includes oral isotretinoin (Accutane), spironolactone, and birth control pills, all of which are effective for comedonal and inflammatory forms of acne.

Remember to Moisturize

Although excess oil can clog pores and cause blackheads, it is still important to moisturize. Moisturizing acne-prone areas keeps oil production low, fortifies skin’s natural lipid barrier and defense again acne-causing bacteria, and maintains the smoothness of skin’s outer layer. Moisturizing is also vital if you are exfoliating with salicylic acid, retinoid products, or a physical exfoliant, as these treatments can by drying and irritating to the skin. Choose a non-comedogenic moisturizer to keep skin hydrated while undergoing removal of your blackheads.

Quynh-Giao (QG) Sartor, MD is a Board Certified Dermatologist who obtained a Medical Doctorate and completed her internal medicine internship and dermatology residency at Baylor College of Medicine (BCM) in Houston. Dr. Sartor’s professional expertise includes medical dermatology as well as in-office cosmetic and surgical procedures. Dr. Sartor is passionate about connecting with patients, practicing open communication, and customizing a personalized plan for her patients.