1 Blackheads Summary

Blackheads, also known as closed comedo, is a very common skin problem. Blackheads are one of the manifestations or symptoms of acne (acne vulgaris). Therefore, if you have blackheads, you have active acne that should be treated.

Many myths exist on why blackheads appear. Contrary to popular beliefs, blackheads are not caused by having dirty skin or eating too many greasy foods. Sticking to wrong beliefs and practices contributes to the problem. Another problem is the wide availability of over-the-counter products claiming to remove or erase blackheads, which often does not work. 

Blackheads can be easily seen and touched, especially when there are several of them. Blackheads occur only on the pores of the skin. Blackhead appears as a tiny blackish ‘plug’ covering the opening of a skin pore.

Blackheads are not serious and do not worsen or cause complications. If done correctly, removing blackheads do not harm the skin. However, blackheads are usually removed due to cosmetic reasons.

Almost anyone can get blackheads from time to time. It is more common in younger people, especially in adolescents although adults and elderly can still have them.

The pores in the skin serve as the opening for oil glands (sebaceaous glands). These pores are tiny and serve as a passageway for sebum, which is continuously produced by the oil glands. Sometimes, the oil glands produce too much sebum that clogs up the skin pore.

The oil glands can produce too much oil due to several reasons. Things like puberty, stress, diseases affecting the body’s hormones, or infection are just some of the causes. The things that make acne worse also worsens blackheads.

Initially, the blockage forms a plug called a whitehead. Whiteheads still remain inside the pore and appear whitish in color (hence the name). As more sebum collects, it makes the plug bigger and pushes outside the skin pore.

Once outside the pore, the plug somewhat hardens and turns dark in color, forming a blackhead. Blackheads are easily noticeable and having several of them can change the look and texture of the skin, which are reasons they are often removed. Because of their appearance and effect on appearance and body image, blackheads should be removed.

Doctors or dermatologists can easily diagnose and treat blackheads, as well as other symptoms of acne vulgaris. Few blackheads are not a cause for concern.

Although blackheads can be removed at home and removal are often offered by beauty shops, they are better handled by the doctors especially for severe cases. Skin ridden with blackheads, with a clear presence of redness, pus, pain or other symptoms should be seen by the doctor.

Blackheads are just a symptom that can be easily treated. There are several treatment options for acne vulgaris, and the condition itself is easily treated. Several procedures remove blackheads from the skin, and when done by doctors, the risk of side effects or complications are very minimal.

2 Causes

Blackheads are a symptom of and are caused by acne vulgaris. Anything that causes the oil glands to act up and cause increased production of sebum can cause blackheads.

The tendency to have acne or blackheads is often hereditary. Some people with acne problems or blackheads have parents that suffered the same problem.

Clothes or accessories we wear cause acne and blackheads. Tight clothing constantly rubs against the skin that clogs the pores with sloughed cells to cause acne or blackheads. Wearing tight and non-breathable clothing is a culprit of acne formation in the chest, shoulders, neck and back.

Certain facial cosmetics, particularly those that contain alcohols, industrial mineral oils, lanolins, lauric acid, cetyl acetates, and cocoa and coconut butter, worsens acne. Note that these ingredients are commonly used in cosmetics and skin creams, but they do eventually cause blackheads when applied on the face.

Fats or oils splashed or applied on the skin can also cause blackheads. Note that some cosmetics or face creams contain oils that can cause acne. This may be a problem to those who work with kitchen vat fryers.

Stress is long known to be associated with acne and blackheads. Individuals with acne tend to have high-stress levels. This is important because stress hormones have an effect on the activity of oil glands in the skin.

In some people, facing stressful moments or activities cause a breakout of acne or blackheads. Adolescents struggle with body image issues as they go through puberty and at this time the oil glands is at its peak producing sebum, so they tend to have acne and blackheads.

Medical conditions:

Conditions like pregnancy, menses, or polycystic ovary syndrome may worsen acne and cause more blackheads. These conditions cause fluctuation in hormones that cause the skin to become more oily or inflamed that makes it prone to acne and blackheads.

Taking certain drugs:

Blackheads and worsened acne can also be a side effect of taking certain drugs, especially corticosteroids, lithium, anticonvulsants, barbiturates, bromides, iodides, and androgenic steroids. Note that not everyone who takes these drugs will have acne.

Here are some of the drugs known to cause acne:

  • Oral corticosteroids such as Hydrocortisone, Dexamethasone or Prednisone
  • Birth control methods such as Depo-Provera, contraceptive implants (Jadelle or Implanon), or progesterones (Mirena), and birth control pills. Despite claims that birth control pills may help relieve acne, it may worsen outcomes in some users.
  • Testosterone and other steroids used to build muscle
  • Halogens used as contrast agents or anesthetics such as Halothane
  • Carbamazepine, Phenytoin, Phenobarbital, or other drugs used to treat convulsions
  • Ethionamide, Isoniazid, Rifampicin, and other drugs used to treat tuberculosis
  • Many antidepressants, including lithium and Amoxapine
  • Cyclosporine
  • Certain preparations of vitamin B6, B12 or Cyanocobalamin
  • Epidermal growth factor receptor inhibitors
  • Biologic agents such as TNF-alpha inhibitors, although rare
  • Azathioprine

3 Diagnosis and Treatment


Blackheads and other symptoms of acne are easily recognizable and diagnosed by the doctor or dermatologist. Doctors can diagnose acne vulgaris by simply looking at it.

It is important to share with your doctor your medical information when having treatment for acne. Your doctor will need to know if you have other medical problems that might cause acne or blackheads.

You may have to answer the following questions to help your doctor understand your condition better:

  • All the drugs or medications you are currently taking, including the use of birth control pills.
  • Any pre-existing health conditions or problems.
  • Vitamins and supplements you are taking.
  • Any recent life events or stresses you are currently facing, like losing or changing jobs, moving to a new place, having a divorce, marriage, deaths of loved ones, etc.
  • Creams, cosmetics, or other over-the-counter drugs you are using, including soaps, lotions, sunscreens, hair products, etc.
  • The regularity of menses, and pregnancy status.
  • Any problem with self-esteem or self-confidence, especially in social situations
  • Any treatments or self-care measures tried so far.

If blackheads have a noticeable effect on your appearance or self-esteem or keep on coming back, a dermatologist should treat it right away. Dermatologists are doctors specializing in treating skin problems, and they are the experts in the treatment of conditions such as acne or blackheads.


The dermatologist may first treat blackheads by prescribing topical preparations (to be applied on the skin). Note that these preparations have specific instructions for use, which must be followed for best effect and to reduce the risk of side effects.

These preparations may belong to any of the following:

  • Retinoids (Adapalene, Tazarotene, or Tretinoin)
  • Benzoyl peroxide
  • Azelaic acid
  • Antibiotics (Clindamycin or Erythromycin)
  • Anti-inflammatory agents

Procedures for treating blackheads:

The dermatologist may suggest procedures that will remove blackheads and treat acne. These procedures may be done along with the application of prescribed topical preparations.

Here are those procedures:

  • Manual extraction – the dermatologist physically removes blackheads in the skin using hand instruments. This is also known as a facial.
  • Light or laser therapies – reduces scarring and acne. Laser or light therapies are often performed after manual extraction of blackheads to reduce scarring.
  • Chemical peels – these peels work similar to those peels brought from drugstores. However, chemical peels used by dermatologists are different. Chemical peels work on clearing both blackheads and other acne lesions.
  • Acne or cyst removal – for blackheads with clear inflammation and pus collection (cyst), the dermatologist may perform a ‘drainage and extraction’. This removes the cyst, and sometimes, medicine is injected into the area to speed up healing and reduce scarring.

Note that acne tends to return. Therefore, dermatologist usually prescribes a skin care routine with an application of a prescribed topical preparation so acne or blackhead will not come back. Your dermatologist will tell you when can you stop treatment.

You can also reduce blackheads or acne by doing certain things every day. Make sure not to use over-the-counter peels, masks or solutions that irritate the skin. Choose cosmetics that are water-based or non-comedogenic, which are less irritating and have less tendency of causing blackheads.

Some people experienced worsened acne during sun exposure, so use a sunscreen. Make sure to choose water-based sunscreens, as oil-based products make acne worse. Never pick or squeeze acne or blackheads, or it may result in scarring.

To clean skin if you have acne or blackheads, wash your face twice a day and use a gentle face cleanser. Good cleansers do not dry the skin or cause irritation. Ask your doctor for acne products to cleanse excess oil and promote peeling of the skin to reduce acne and blackheads.

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