OVERVIEW

What are blackheads? Why are they black?

Blackheads, commonly referred to as comedones, are a mild form of acne. They are open comedones caused by the continuous dilation and opening of hair follicles. When the contents inside come into contact with dust in the air, they form black, dot-like granular substances, hence the name "blackheads."

Blackheads mostly appear on the face, chest, and back. Mild blackheads primarily affect appearance, but if they become infected, they may develop into inflammatory papules with pustules at the tip, which can impact daily life^[1].

Squeezing blackheads is not recommended, as it can enlarge pores and increase the risk of skin infection. Choosing suitable facial cleansers can help reduce the formation of blackheads.

Are blackheads common?

This condition is common. In the United States, approximately 40 to 50 million people suffer from acne vulgaris each year^[2], though there are no specific statistics on the incidence of blackheads. Blackheads are most common in young men and women aged 15 to 30^[1].

SYMPTOMS

What are the manifestations of blackheads?

Black dotted granular substances can be seen on the skin, sometimes accompanied by oiliness. If the contents are squeezed out, they may emit an odor. They commonly occur on areas such as the cheeks and forehead.

CAUSES

How do blackheads form?

Blackheads are composed of sebum, dead skin cells (keratin), and bacteria (such as Propionibacterium acnes), which block the opening of hair follicles. When exposed to air and contaminated by dirt, they oxidize and turn black, forming blackheads^[2].

What factors contribute to the formation of blackheads?

The main factors contributing to blackhead formation include the following^[1,2]:

• **Genetic factors:** The number, size, and activity of sebaceous glands are hereditary. Pore size varies among individuals, and the extent of improvement also differs. Those whose parents had acne in their youth are more prone to blackheads.
• **Hormonal imbalance:** Since the growth and sebum secretion of sebaceous glands are influenced by androgens, increased androgen levels lead to excessive sebum production, raising the likelihood of blackheads.
• **Poor diet:** A diet high in greasy foods increases sebum secretion, promoting blackhead formation.
• **Medications:** Hormonal drugs such as androgens and glucocorticoids can affect the skin and contribute to blackheads.
• **Improper use of cosmetics:** Long-term use of heavy makeup, low-quality cosmetics (lacking production dates, quality certifications, or manufacturer details), or improper makeup removal can clog pores and increase sebum production, leading to blackheads.

DIAGNOSIS

How are blackheads diagnosed?

The diagnosis of blackheads is not difficult, and most doctors can confirm it through clinical manifestations. Some people also gain a certain understanding of blackheads through self-learning skincare knowledge.

It should be noted that there is another common issue on the nose called sebaceous filaments, which are often misdiagnosed as blackheads. Sebaceous filaments are normal metabolic products of hair follicles. They are more fluid, do not clog pores, and appear slightly lighter in color—often gray, brown, or dark gray. They do not affect pore size. Additionally, sebaceous filaments feel smooth to the touch, whereas blackheads, due to clogged pores and follicular plugs, feel rough and grainy.

TREATMENT

Can blackheads be permanently eradicated at once?

No, blackheads are difficult to cure completely. They can only be gradually reduced and recurrence minimized. It is almost impossible to achieve a permanent cure, as there is still a chance of recurrence even after improvement.

Which department should I visit for blackheads?

For severe blackheads accompanied by symptoms like papules, it is recommended to visit the dermatology or endocrinology department of a reputable hospital.

What are some incorrect methods for removing blackheads?

• Using pore strips: The violent pulling action can severely damage the skin. Not only does it fail to eliminate blackheads, but it can also loosen the skin, enlarge pores, and even make the skin more sensitive.
• Scrubbing the face with salt or sugar: Folk remedies often claim that scrubbing with salt or sugar can remove blackheads, shrink pores, and refine the skin. However, there is no scientific basis for this. The high-concentration liquid formed when salt or sugar dissolves can dehydrate the skin, disrupting the oil-water balance. Moreover, the coarse granules of table salt or sugar can damage the skin during scrubbing, eventually weakening the skin barrier and making it more sensitive.
• Squeezing blackheads with hands: Many people can't resist squeezing blackheads when they see them in the mirror. This crude method does not remove blackheads entirely. Improper handling may push blackheads deeper, enlarge pores, or increase the risk of skin infection.
• Using blackhead extraction solutions: The market for blackhead extraction solutions is poorly regulated, with varying product quality. Some solutions may significantly harm normal skin, so caution is advised. Always choose products with complete certifications and avoid those from small workshops.

Can "Korean micro-bubble" and "comedone extraction" remove blackheads?

Yes, but the effects are temporary.

"Korean micro-bubble":

This method uses negative pressure suction to remove oil and dirt from pores. It is relatively painless and non-irritating. However, it only removes superficial oxidized lipids and does not address the root cause of excess oil production or enlarged pores. Blackheads will reappear quickly, requiring regular treatments.

"Comedone extraction":

This involves a professional disinfecting the skin and using tools (e.g., a comedone extractor) to remove the top of the blackhead or widen its opening, then extracting the clogged sebum and other substances.

If opting for these physical methods, ensure they are performed at reputable facilities, such as hospitals offering medical aesthetic services.

What are effective methods for removing blackheads?

Fundamentally, blackheads are a mild form of acne.

The most reliable treatment is consulting a doctor for scientific and rational medication. Below are some medical treatment options^[1,2]:

Retinoids:

Retinoids regulate follicular keratinization and reduce sebum production, preventing new blackheads. Common oral medications include isotretinoin, while topical options include tretinoin cream, adapalene, or tazarotene. Side effects like dryness, peeling, stinging, and redness may occur. Initial use should involve spot application, gradually expanding as the skin adapts. If side effects are severe, reduce frequency or discontinue use temporarily. Important notes:

• Retinoids are teratogenic, so pregnant or breastfeeding women should avoid them.
• Women of childbearing age should use effective contraception during and for three months after oral retinoid treatment.
• Visible results take over eight weeks, so consistent use is necessary.
• Apply at night and avoid sunlight. If sun exposure is unavoidable, use sunscreen.

Benzoyl peroxide gel:

This non-antibiotic medication kills bacteria and dissolves keratin in blackheads. It can be used alone or combined with other treatments. Unlike retinoids, it is not photosensitive. However, it may irritate the skin, requiring similar precautions as retinoids.

Azelaic acid:

Azelaic acid treats blackheads and has anti-inflammatory effects. Common side effects include mild redness and stinging. Discontinue use and consult a doctor if allergic or severe reactions occur.

What other methods can remove blackheads?

Blackheads can also be extracted using a comedone extractor. A doctor uses the tool to expel the keratin contents, eliminating the blackhead and helping pores return to normal^[2].

DIET & LIFESTYLE

Do blackheads appear because the skin isn't thoroughly cleansed?

No.

Blackheads are primarily a combination of oil, bacteria, dust, and other particles that clog pores. Their formation can be attributed to various factors such as hormonal imbalances, poor sleep, and genetics. Therefore, simply not washing the face thoroughly does not necessarily lead to blackheads.

Are blackheads only a problem for young people?

No.

Everyone can develop blackheads. However, adolescents tend to experience them more frequently due to hormonal imbalances during puberty, frequent late nights, or a preference for fried foods and sweets.

What lifestyle precautions should people with blackheads take?

• Removing blackheads is relatively easy, but they often reappear and require timely treatment.
• Squeezing blackheads is not recommended, as it can enlarge pores and lead to skin infections.
• Blackheads are often a form of acne. If blackheads are numerous and accompanied by acne, they should be treated using acne management methods.
• Choose cleansing and toning products suitable for your skin type to minimize blackhead formation.
• Maintain a regular sleep schedule, avoid staying up late, and aim for early sleep and wake times to stabilize hormone levels.
• Keep a positive mood, learn stress-relief techniques, and engage in relaxing activities like yoga, meditation, or walking.

What dietary precautions should people with blackheads take?

• Limit fatty and sugary foods, such as fried items, pastries, and cakes.
• Eat more fresh vegetables and fruits, which are rich in vitamins.
• Avoid or reduce spicy and irritating foods^[3].
• Consider reducing or avoiding low-fat and skim milk, as studies suggest they may increase acne incidence^[4].

PREVENTION

How to Prevent Blackheads?

• Pay attention to skin cleanliness, choose suitable cleansing and care products to ensure clean and comfortable skin.
• Reduce or avoid low-fat and skim milk to minimize acne occurrence.
• Control intake of fatty and sugary foods, such as fried foods, pastries, and cakes.
• Maintain a regular sleep schedule, avoid staying up late, and keep a stable endocrine system.
• Stay in a good mood and avoid frequent anger.
• Quit alcohol. Eat fewer spicy and irritating foods.
• Eat more fresh vegetables, fruits, and vitamin-rich foods.
• Prevent constipation. Constipation may disrupt endocrine balance, worsen skin condition, and trigger blackheads. Maintain regular bowel movements, avoid reading or using phones during bowel movements, exercise regularly, and drink plenty of water.