Acne : Navigate your options
Can you briefly explain what a blackhead actually is, what causes them?
'Blackheads’ is a term usually meant to refer to clogged pores that are open or exposed to the air. Excess keratin, sebum and oil builds up in our pores while the pore is still open. The keratin in these pores oxidizes and turns black in color. The medical term would be open comedones. The difference between these and ‘whiteheads’ or closed comedones is that with whiteheads the same keratin, oil and sebum builds up inside the pores but the pore stays closed. Because the keratin is not exposed to the air they do not turn black.
How are blackheads different from other types of breakouts? Please explain.
Blackheads and whiteheads are considered the first stage of acne. This is the comedonal stage. Pores are open or closed and filled with excess keratin, oil and sebum. These alone do not tend to be inflamed. The skin usually has more of a bumpy or sandpaper feel to it. There is little redness. The next stage of acne is when a bacteria in our pores starts to work on the excess buildup and inflames the pores. This is when redness and the possibility of pus bumps develops as well. The next stage is nodulocystic acne when the acne starts to become swollen, tender, and has the potential for scarring. Technically the blackheads stage does not tend to be scarring.
What are 5-7 tried-and-true solutions for treating blackheads once and for all?
“Tried and true solutions to treat blackheads once and for all” would technically be Accutane or isotretinoin. This oral medication works to provide long lasting results by acting on the oil or sebaceous gland to shrink it long term and reduce the amount of oil produced. This reduces the chances of ever developing blackheads again since the oil gland cannot overproduce oil. This is an oral medication with its own ‘baggage’ of side effects but worthy of mention simply because it’s the only ‘once and for all’ option for acne. Every other treatment option only suppresses acne to control it or buy time until we outgrow it. When a patient indicates to me that they are looking for a long term option and do not want to have to deal with regimens this is important to discuss to give them the ability to make a decision that is best for them.
- Topical retinoids. Over the counter we now have adapalene available under the tradename Differin. Prescription options include tretinoin (Retin A) and tazarotene (Tazorac). Retinoids work by preventing the formation of clogged pores and promoting cell turnover. These have been a mainstay of acne treatments for decades. Although for some there can be excess dryness, these are over all well tolerated and work as long as you continue to use them!
- Benzoyl peroxide. Benzoyl peroxide can clear dead skin cells from the surface of the skin. In addition, it is able to kill acne causing bacteria on the skin that lead to the inflammation found with acne. By gently exfoliating and treating bacteria on the skin, benzoyl peroxide can be very useful in people that have inflammatory acne. Benzoyl peroxide can reduce the buildup of dead skin cells in our pores that leads to blackheads developing.These products can be a bit more irritating. I would use with caution in some instances. These are the ones where the next day you may find your skin a little flaky. It’s also important to remember to use white towels, bath mats and pillow cases. Benzoyl peroxide will bleach these products.
- Salicylic acid. If your acne is mostly clogged pores: salicylic acid containing cleansers can be helpful to achieve some exfoliation to help open these pores and unclog them. These work as ‘keratolytics’ that break part dead skin cell to encourage them to exfoliate and not stay attached to the skin to accumulate in our pores and result in blackheads.
Adhesive nasal strips. Products such as Biore nasal strips are very effective at ‘unclogging’ blackhead containing pores manually. A tip to make blackhead removal easier is to use a topical retinoid for several days before extracting. Over the counter you will find Differin. Prescription strength versions include tretinoin and tazarotene. These products loosen up and break apart the keratin and dead skin cells making them easier to extract. It’s good to get into the routine of using these weekly to maintain the effect.