Getting Rid of Blackheads

A lot of people are frustrated or confused about how to win the battle against blackheads (technically called comedones) or whiteheads (technically called milia). Why all the confusion? Primarily it's because the many products claiming they can rid the face of these black dots don't work. The problem persists and often these same products don't improve conditions, but make matters worse. In reality, aside from misleading marketing claims, the truth about blackheads (usually accompanied by oily skin) and whiteheads (accompanied by either dry or oily skin) is hard to accept. What is the truth? To put it plainly, they are just hard to get rid of. It is difficult to fight clogged pores but there are things you can do.

Here's how it works: A normal functioning pore produces a normal amount of sebum (oil). When a normal amount of oil is produced, it effortlessly moves through the pore and out onto the surface of skin, where it melts into an imperceptible film forming a protective, healthy barrier over the face. The amount of oil produced is regulated almost exclusively by hormones, specifically androgens, which are the hormones that create masculine human characteristics.

When hormones cause too much sebum (oil) to be produced, dead skin cells are in the way, and the pore is impaired or misshapen, the path for the oil is blocked, creating a clog—a perfect environment where blackheads or/and whiteheads can occur. Further exacerbating these conditions are the use of skin-care or makeup products containing ingredients similar to the composition of sebum (human sebum is a mixture of triglycerides, fatty acids, wax esters, squalene, cholesterol, and cholesterol esters). All these substances are typically found in thousands of cosmetic products and they can absorb into the pore, adding to the build up of sebum. Interestingly and contrary to popular belief, the ingredients mineral oil and petrolatum cannot absorb into the pore because their molecular size is too large. Both ingredients feel greasy, especially on oily skin, but neither has been proven to clog pores or contribute to blackheads. In short, when a combination of skin cells and too much sebum are trapped inside a pore and the pore is not covered over by skin, the clog is exposed to air, causing cells and sebum to oxidize and resulting in the dark color of a blackhead. When the sebum and skin cells are inside a pore that is covered by skin, they are not exposed to air and therefore stay clear, but form a slight white bump under the skin.

The never-ending questions are: Why do some people get whiteheads and not blackheads? Why does the problem occur in some areas of the face but not others? What causes some products to make people break out but not give them blackheads? And finally, what makes some products cause blackheads but not acne? Those questions have no specific answers. It seems to be primarily a genetic predisposition accompanied by the right conditions (mentioned above) randomly taking place in any one of the thousands of pores we have on our face. Not to mention an unknown reaction to the thousands and thousands of different cosmetic ingredients we may come in contact with from the various products we use.

Other than avoiding products that are too emollient (meaning thick or greasy creams) and not using moisturizers unless you truly need them, there are really only four essentials for dealing with whiteheads and blackheads:

1) Gentle, water-soluble cleansers (and avoiding bar soap). The ingredients that keep soap in its bar form can clog pores, and irritation can cause skin cells to flake off before they're ready and accumulate in the pore. The good news is that there are lots of gentle cleansers to consider. It's actually getting more and more difficult to find a cleanser that isn't gentle. Someone with dry skin would want to use a slightly more moisturizing cleanser—but be careful: cleansers that are too emollient can contain ingredients that add to the sebum in your skin causing further problems.

2) Gentle exfoliants that can both remove the excess skin cells on the surface of the face (so they don't build up in the pore) and exfoliate inside the pore (to improve the shape of the pore, allowing a more even flow of oil through it). Keep in mind that the pore itself is lined with skin cells that can build up, creating a narrowed shape that doesn't allow for natural oil flow out of the pore. But don't get carried away with this step. Overdoing it (removing too many skin cells) can cause problems and hurt skin. Exfoliation is essential for both dry and oily skin to eliminate blackheads or whiteheads. Again, someone with dry skin will want an exfoliant that has a more moisturizing base.

The best option for a good exfoliant is a 1% or 2% BHA gel, liquid, or lotion. There are still only limited options for this one, including Olay Total Effects Anti-Aging Anti-Blemish Daily Moisturizer, Paula's Choice 1% or 2% Beta Hydroxy Acid products, and Serious Skin Care Clarifying Treatment with 2% Salicylic Acid. If you cannot use a beta hydroxy acid, you might want to try an alpha hydroxy acid, but AHAs are not able to penetrate the pore lining and affect mostly the surface of skin. That can be helpful, but salicylic acid can absorb into the pore lining and improve conditions.

By the way, topical disinfectants such as benzoyl peroxide or topical antibiotics available by prescription do not help in the treatment of blackheads and milia because there is no bacterial involvement related to these conditions.

3) Deeper exfoliation treatments for stubborn blackheads and milia are options you may want to consider. Microdermabrasion, either from an at-home treatment (Neutrogena's At Home Microdermabrasion System) or the procedure performed at a doctor's office or spa are options. Also AHA or BHA peels and laser resurfacing may possibly have a positive impact on the appearance of blackheads and milia. However, the research on this is at best limited. Anecdotally, it appears to be an option. Keep in mind that none of these treatments alter hormone function or the structure of the pore, or improve pore functioning—rather, they temporarily get rid of the surface problem, making the skin look better in the short term.

4) Absorbing excess oil. This step is for those with oily skin and is not necessary for those with whiteheads and dry skin, because with dry skin the problem isn't about excess surface oil, it's only the oil trapped inside the pore. For those with oily skin, clay masks (that don't contain irritating ingredients of mint, peppermint, camphor or the like) are an option and oil-absorbing papers can also help.

5) Retinoids play an important role in successfully battling blackheads. Retinoids are forms of vitamin A that can actually help skin cells function normally and improve the shape of the pore so oil flow is normalized and clogs are far less apt to take place. The most typical and well-researched retinoids are tretinoin (found in prescription medications such as Retin-A, Renova, and Avita,), adapelene (found in the prescription drug Differin) and tazarotene (found in the prescription drug Tazorac). These can be used on their own or with a BHA product. Research has definitely established that tretinoin and adapelene have positive effects on how pores function, and these products should be a strong consideration for battling blackheads or breakouts in general.

6) Hormone blockers, birth control pills, and Accutane: For those with severe oily-skin conditions, prescription medications such as hormone blockers or certain low-dose birth-control pills can reduce hormone levels of androgens which are the cause of excess oil production. And, when all else fails, Accutane should definitely be considered. Though many doctors are reluctant to prescribe Accutane for "merely" oily skin and blackheads, for those with that kind of persistent skin problem, it does not feel like a "mere" problem in the least and Accutane can be a cure. Either way these are all options (albeit serious ones) you can talk over with your physician.

7) Removing blackheads: This isn't a pretty topic, but it is a fact of life and human nature that just leaving a blemish or blackhead alone is almost impossible. Fortunately, gently removing a blackhead or blemish with light-handed squeezing can actually help the skin. Removing the stuff inside a blackhead or especially a pimple relieves the pressure and reduces further damage. Yes, squeezing can be detrimental to the skin, but how you squeeze determines whether you inflict harm. If you oversqueeze, pinch, scrape the skin with your nails, or press too hard, you are absolutely doing more damage than good. Gentle is the key word and, when done right, squeezing with minimal pressure is the best, if not only, way to clean out a blackhead or blemish.

How not to over-squeeze? Although I never recommend steaming the face (heat can cause spider veins to surface and create irritation), a tepid to slightly warm compress over the face can help soften the blackhead or blemish, making removal easier. First, wash your face with a water-soluble cleanser. Pat the skin dry, then place a slightly warm, wet cloth over your face for about 10 to 15 minutes. Once that's done, pat the skin dry again, then using a tissue over each finger to keep you from slipping and tearing the skin, apply even, soft pressure to the sides of the blemish area, gently pressing down and then up around the lesion. Do this once or twice only. If nothing happens, that means the blemish cannot be removed, and continuing will bruise the skin, risk making the infection or lesion worse, and cause scarring. Again, only use gentle pressure, protect your skin by using tissue around your fingers, and do not over-squeeze.

What about pore strips? What has me most concerned about pore strips (which are not as widely available as they once were) is that most people don't pay attention to the warnings clearly printed on the side of the box. Pore strips are accompanied by strong warnings such as not to use them over any area other than the nose and not to use them over inflamed, swollen, sunburned, or excessively dry skin. It also states that if the strip is too painful to remove, you should wet it and then carefully remove it. What a warning! You may at first be impressed with what comes off your nose. (Well, if you have extremely superficial, noticeable black-looking blackheads, there is no question: you will be impressed.) Most people do have some oil sitting at the top of their oil glands (most of the face's oil glands are located on the nose), and whether you use these strips or a piece of tape, black dots and some skin will be removed. Is that helpful? Briefly, but if you use these repeatedly, they will not eliminate the problem and the ingredients on the strip can eventually irritate skin and potentially trigger further breakouts.

The way these strips adhere can absolutely injure or tear skin. They are especially unsafe if you've been using Retin-A, Renova, AHAs or BHA; having facial peels; taking Accutane; or if you have naturally thin skin or any skin disorder such as rosacea, psoriasis, or seborrhea.