Blackhead Symptoms, Causes & Treatment Options

Blackheads (also known as open comedones) are individual lesions of acne vulgaris. They are almost never life-threatening and many effective treatments exist for blackheads.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is A Blackhead?

Summary

Blackheads, also known as open comedones, are a defining lesion of acne vulgaris. They tend to affect the face and upper torso of adolescents and adults. Though they can negatively affect appearance and quality of life, blackheads are almost never life-threatening. Acne is caused by clogging of the pores, sometimes combined with mild infection of the skin. Treatments for acne include topical retinoids, topical antimicrobials, and in more severe cases, systemic retinoids and systemic antimicrobials. Acne can be prevented by maintaining good hygiene, good diet, and good adherence to appropriate acne medications.

Recommended care

Blackhead Symptoms

Main symptoms

Blackheads are the common term for open comedones – which are the central feature of the common skin disease called acne vulgaris, which is generally just called “acne.” Blackheads are most likely to occur on the face and upper trunk – sites with many sweat glands and hair follicles. Blackheads and acne can have any of the following appearances [1]:

  • Open comedones: These are commonly called “whiteheads.” They will look like small (1-2 millimeter) white or yellow bumps on the skin on a red, swollen base. Closed comedones may be tender, and may discharge the white-yellow pus within with physical irritation.
  • Inflammatory acne: Blackheads may progress into more severe, inflammatory acne. In this form of acne, larger nodules and cysts filled with pus or clear liquid may coalesce into big groups. Acne of this kind may be painful, with leakage of blood or clear fluid.
  • Scarring: Blackheads that have progressed to inflammatory acne with nodules and cysts are more likely to leave scars, that may look like small, healed pits in the skin or lasting dark spots in the skin.

Blackhead Causes

Blackheads and acne are very common: 85% of adolescents have had acne and the condition persists into adulthood in up to 35% of the population. A tendency for more severe acne may run in families.

Blackheads occur when pores get clogged, due to outside forces, or just as a part of the normal life cycle of the skin. When a pore becomes clogged, oils produced by glands in the skin will accumulate. This process may be especially bad during adolescence when hormones cause extra oils to form and may become worse with other hormonal changes. Clogged pores may additionally become infected with a bacteria, called P. acnes, which may lead to more severe acne.

The dark color of blackheads is caused by naturally occurring melanin in the skin and oxidized fatty acids that are exposed to the air.

Factors that may cause acne

Several factors are theorized to cause more acne or make acne worse.

  • Hormonal changes: As noted above, hormonal changes can cause increases in oil production in the skin leading to more and worse acne. This explains why teenagers, women during their menses, and certain infants may all be at risk for acne.
  • Mechanical occlusion: Occlusion of pores is a key step in the formation of blackheads. Mechanical occlusion, which can commonly occur from sports helmets or chinstraps may lead to blackhead formation.
  • Occlusion with cosmetics: Makeup, cosmetics, or hair products may also lead to occlusion that can cause blackhead formation.
  • Diet: Many people believe that diet is closely connected with acne and blackhead formation. Though there is no definitive proof of this, foods like skim milk may have some effect on blackhead formation [2].

Other causes of acne (special cases)

Below, rare and specialized causes of acne are listed.

  • Neonatal acne: Acne in newborn infants sometimes occurs. This is caused by Malassezia yeast (rather than P. acnes bacteria or pore-clogging).
  • Infantile acne: As noted above, certain infants aged 3 months to 2 years may have blackheads and acne due to hormonal changes that are a part of the normal development process.
  • Chemicals: Rarely, certain chemicals containing chlorine (found in herbicides and insecticides) may cause acne within months of exposure.
  • Medications: Other systemic medications (most commonly systemic steroids) can cause acne in individuals within weeks or months of starting the drug.

Other causes of blackheads

Occasionally blackheads can present as a part of a condition other than acne. Some of these cases are listed below [2]:

  • Solar comedones: Occasionally in older individuals, sun damage may present as blackheads.
  • Discoid lupus: Individuals suffering from discoid lupus may have open comedones in or around their lupus lesions.
  • Comedonal nevus: This is a type of birthmark consisting of one or many grouped blackheads that are not associated with acne.
  • Seborrheic keratosis with comedones: Seborrheic keratosis is a benign, common skin growth that can contain open comedones within it.
  • Giant comedone/comedone cyst: Sometimes skin cysts, which are not acne, will present as giant, open comedones that can be much larger than the standard 2-3 millimeters in diameter.

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Treatment Options, Relief, and Prevention for Blackheads

Treatment

Many treatment options are available for acne blackheads, and the level of treatment depends on the severity of the acne. Options are outlined below: For rare, single blackheads, not treating at all is an option. Blackheads are not dangerous and do not need treatment. If acne and blackheads are recurring and causing distress, or if you simply want to have fewer blackheads, treatment options are listed below [3].

  • Topical retinoids, like tretinoin (Retin-A), adapalene (Differin), and tazarotene, help to keep pores unclogged, but can cause some level of dryness or irritation of the skin. A mild retinoid is a good first step to treating acne.
  • Salicylic acid is found in many over the counter acne medications in the form of toners, pads, and creams. It is usually less effective on its own than retinoids, but can be added to retinoids for increased effect.
  • Benzoyl peroxide is a topical antimicrobial treatment that is found in many over the counter and prescription acne medications. It is often used as a face wash. It may be particularly helpful if acne appears to be of the inflammatory subtype.
  • Topical antimicrobials, like topical clindamycin, erythromycin, and topical sodium sulfacetamide (sulfur), are prescription creams and ointments that help to treat inflammatory acne by directly treating microbes on the skin. These medications can also be combined with retinoids.
  • Oral antibiotics: Oral antimicrobials. like doxycycline, minocycline, and Bactrim, may be used in more severe, inflammatory types of acne. Isotretinoin (Accutane) is a powerful oral agent that is highly effective for permanently curing acne, though it does require monitoring for certain severe side effects
  • Female patients: Adult women may have acne due to hormonal cycles and may benefit from beginning oral contraceptive pills or by using hormonal analogs like spironolactone.
  • Emergency blackhead removal: In special cases, a blackhead may be individually removed by a dermatologist with a comedone extraction procedure or by an intralesional corticosteroid injection.

Prevention

Many strategies have been devised for the prevention of blackheads. The simplest option is just to avoid triggers like mechanical occluding factors, cosmetics that occlude pores, and individual dietary triggers. A more involved regimen may include face washing and exfoliation. Some acne medications like retinoids and benzoyl peroxide can be used year-round to prevent blackhead formation. Finally, individuals on more powerful anti-acne medications need to focus on adherence to their regimens, even once skin is improving to prevent a recurrence of acne. These preventative measures are summarized below:

  • Avoid clogging: mechanical and cosmetic
  • Avoid dietary triggers: on an individual basis
  • Regular cleaning and exfoliation of the face
  • A preventative low dose topical retinoid plus benzoyl peroxide
  • Adherence to prescribed acne medications even when skin looks good

When to Seek Further Consultation for Blackheads

Though blackheads almost never life-threatening, acne can be disfiguring and can have a big impact on self-confidence and quality of life. You should seek further consultation with a dermatologist if your blackheads and acne bother you in any way – they are treatable and can be eliminated. You should seek out care as soon as possible if you have any of the following features of severe acne to prevent the possibility of scarring and to ensure that your diagnosis is acne and not something more serious [4]:

  • Nodules: large bumps beneath the surface of the skin
  • Sinus tracts: holes leaking fluid
  • Existing scarring
  • Fevers: Seek medical care immediately in case of a skin infection.
  • Acne in armpits, on scalp, or in buttocks region: This may be part of a more serious skin disease.
  • Acne that doesn’t resolve: Seek care to ensure that this is acne and not a more serious skin disease.