Blackheads | How to safely extract a clogged pore

Blackheads | How to safely extract a clogged pore

January 10, 2021

 
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Discuss what blackheads are: what are they made of, what's inside of them, what do they look/feel like, also how do you know a blackhead from a freckle? 

 

‘Blackheads’ is a skin term 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.

 

Whiteheads, on the contrary, are closed clogged pores not open or exposed to the air. The keratin inside still has a “cheesy” and “whitish yellow” appearance when extracted as it has not been exposed to air as yet.  They tend to appear as an expanded pore with a discolored plug or core inside.  When you run your finger over the top, there is often a slight textural change to the skin and focused around a pore.  

This is distinct from a freckle that tends to be flush with the skin and not necessarily associated with a pore.

 


What causes blackheads? Why do people get them?

 

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.

 

The triggers for blackheads are similar to the triggers for acne.


If you are holding your phone against your face for long periods of time and allowing swear and dirt to build up between your face and your phone then you do have some potential to develop a type of acne called acne mechanica. This similarly occurs with chin straps from helmets and baseball hats over the forehead. This can be reduced by being mindful of frictional forces that trigger breakouts in addition to the regular use of products designed for acne prone skin such as salicylic acid, benzoyl peroxide, and retinoid containing products.

 

Pomade acne can be triggered by the use of hair products, often concentrated around the hair line.  Recognizing patterns for acne distribution can often help focus on a cause or trigger to avoid aggravating more flares.



 

Most acne is primarily hormonal, however.  Recognizing that many factors our outside our control in this regard, focusing on optimal prevention and management of acne is important.

 

If you do have blackheads, how do you address them properly and safely? Do you pop them? 

 

It’s reasonable to remove blackheads at home gently. I usually recommend taking two cotton tips or Q tips, anchor them on either side of the pores and gently push them towards each other to extract out the keratin. This will be less traumatizing than your fingernails! To make blackhead removal easier, 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. 

 

Remember, the ‘black dots’ on the nose are actually not always blackheads. There is a common  genetic trait called trichostasis that results in the appearance of blackheads on the nose and chin. These are actually open pores with sebum and a small hair follicle giving them a dark appearance. These are best managed with adhesive nasal strips such as Biore.

 

 

What are some cleansers, removal aids and acne products you recommend for preventing and getting rid of blackheads?

 

 

  1. “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.

 

  1. 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!

 

  1. 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. 

 

Clean and Clear continuous control acne cleanser

The 10% concentration of benzoyl peroxide in this cleanser makes it the strongest you can get over the counter. In a face wash form, it is less likely to irritate your skin compared to some of the leave on products. 

 

 

Panoxyl acne foaming wash for face, chest and back.

 

Both the clean and clear and panoxyl have a 10 % concentration of benzoyl peroxide. The reason why panoxyl is nice for the body too, however, is because it’s foaming. For larger surface areas like chest and back it tends to spread easier. This is has been a go-to recommendation for years. 


 

 

  1. 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.

 

  1. 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.






 













What are some tips to make blackhead removal easier.


To make blackhead removal easier, 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. 







What are some professional blackhead removal options?


I usually extract these using a lancet or the assistance of a vacuum device such as a microdermabrasion machine. It allows the advantage of treating larger areas to start patients with a ‘cleaner slate’ for deep embedded pores that are difficult to get one step ahead of!

 

Related : Dr Ilyas discusses how to remove blackheads at home with Livestrong- Read more!





 

 

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