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Blackheads are one of the symptoms of acne. They look like dark dots, usually localized on the forehead, nose, chin, and sometimes cheeks, but might appear on the back, chest, etc. This article reviews the recent findings on blackheads, their safe removal, problems that might happen, and other conditions that look just like blackheads.

Does Poor Hygiene Cause Blackheads?

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There is a popular myth that blackheads are dirt within the pores caused by poor hygiene. But it’s not true. Oil and dead skin cells clog the pores (as in any other type of acne). Pigment melanin found in sebum gets oxidized because blackheads are open to the air (that’s why they are called open comedones). Oxidized melanin turns clogged pores into black dots. This is the reason why blackheads are black.

What Causes Blackheads?

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Blackheads are usually caused by hormonal changes in the teenage years, during pregnancy, after stopping birth control, and even menopause. Stress may also contribute to the formation of acne lesions. They affect both men and women.

Are All Black Dots Called Blackheads? Blackhead-like Conditions

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No, not all black dots are blackheads. Several other conditions look very similar to blackheads. They are:

• Sebaceous Filaments;

• Trichostasis Spinulosa;

• Comedo Nevus.

What Are Sebaceous Filaments?

Blackheads might be mistaken for sebaceous filaments (1). These filaments are natural and necessary structures of the skin. They line up the pores and help sebum flow to the skin’s surface through the pores. They are not plugs. But if someone experiences sebum overproduction, those filaments may become whiteheads or blackheads.

Usually, sebaceous filaments are not noticeable, but sometimes they might look like enlarged pores. Sebaceous filaments look like yellowish or skin color dots and resemble hair when squeezed. And that is what peel-off masks take out! Sebaceous filaments, not blackheads! And they come back in 30 days anyway.

How to Get Rid of Sebaceous Filaments?

While they are entirely natural, you cannot get rid of them completely. You may only remove large sebaceous filaments if they bother you. But they will come back.

Do not squeeze them; it will only damage your skin and make it susceptible to infection and inflammation. Squeezing can even make your pores bigger.

How to Reduce Sebaceous Filaments?

While you cannot remove those filaments, you may reduce their appearance. Everything that helps shrink the pores will help reduce the sebaceous filaments (read below).

What Is Trichostasis Spinulosa – the Blackheads That Look Like Hair?

Trichostasis spinulosa is a common condition that looks like black or dark dots and is often confused with blackheads (2). The lesions are usually localized on the nose and extremities but might be found on the chest, back, and scalp.

If you look closer and use a magnifying glass, you can see that multiple short hairs fill up the pore. These hair are so small that the plug is only around 1mm in diameter, containing up to 25 tiny hairs. Trichostasis spinulosa affects adults.

The exact cause of TS is still unknown. Several theories have been proposed, such as congenital dysplasia of the hair follicles, UV rays, heat, Acne bacteria, yeast, dust, and oils.

How to Treat Trichostasis Spinulosa?

It is a benign condition and does not cause pain or other discomforts, so treatment is not necessary. However, if it causes you aesthetic discomfort, you may remove the hair using a tweezer, comedo extractor, or laser depilation. If you want to prevent this condition in the future, use topical retinoids (read below).

What Is Comedo Nevus?

It is an epidermal nevus composed of grouped dilated pores containing keratin. Those dark, enlarged pores look like comedones.

Comedo nevus (4) is usually present at birth but might start later in life, even in adulthood.

A gene mutation causes it. Other health issues might be found.

How to Treat Comedo Nevus?

It is a benign lesion and does not require treatment. But if it causes you cosmetic discomfort, you may use topical retinoids, such as tretinoin, or exfoliating acids, like salicylic acid.

In-office treatment includes dermabrasion, laser therapy, and curettage for smaller lesions. Surgical excision might be applied for larger abnormalities. A novel treatment of microneedling with radiofrequency may also be helpful.

What Skin Type Gets Blackheads?

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Acne and blackheads do not depend on the skin type. Even normal and dry skin types may develop acne and blackheads, only it will happen less frequently.

Can Blackheads Go Away Without Popping?

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If blackheads are close to the surface, they might go away on their own (but it might take time; long time). The skin is capable of clearing out the blockage. But if the blackhead is stubborn and deep embedded (and many blackheads are stubborn), it won’t go away on its own.

How to Get Rid of Blackheads?

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Blackheads may be treated at home or in the office.

It is safe to treat blackheads at home if you use proper products and not over traumatize your skin. Do not:

• Pick your skin, do not squeeze out blackheads. It may lead to inflammation, secondary infection, and scarring (Beauticians and estheticians may remove them using sterile instruments and proper products).

• Do not use abrasive scrubs. They might damage and irritate your skin (and spread the inflammation if you have inflamed acne lesions).

• Do not use facial cleansing brushes. I do not recommend using them on any type of acne. It is tough to keep them clean and not contaminated with bacteria, and they spread the inflammation to other parts of the face or body.

• Do not use LED light devices, blue light wands, etc. (unless you have inflamed acne lesions). They are effective only in inflammatory acne because the blue light kills acne bacteria. Blackheads are considered non-inflammatory, and bacteria are not involved (yet).

OK, while you already know what not to do, let’s discuss what could help you remove blackheads.

• Take care of your skin consistently.

• Use skin exfoliators to prevent dead skin cells, dissolve oil, and unplug your pores: retinoids (such as Differin) or acids (salicylic acid, lactic acid) are the best ingredients to look for.

• Use cosmetic masks with charcoal or clay. They absorb oil and dirt and unclog pores.

• Use niacinamide (vitamin B3) or green tea to reduce sebum production (oil).

• Hydrate, hydrate, hydrate your skin! Dry or dehydrated skin produces more oil to moisturize the skin and may clog your pores.

Does Vitamin C Remove Blackheads?

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Vitamin C is a strong antioxidant and reduces sebum oxidation significantly. No oxidation – no black dots. It can also prevent inflammation and neutralize free radicals. Vitamin C is a perfect choice who wish for more natural treatment of blackheads. And it is also an excellent choice to prevent comedones in the future.

Do Blackhead Vacuums Work?

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The short answer is that they do. Yes, they can remove the clog and dirt, but you need to be careful as they may damage your skin and use them with your skincare routine.

Pore vacuums may damage your skin if you have very thin or sensitive skin. Also, if you have rosacea, spider veins, skin redness, or bruise easily, a vacuum extractor might not be the best device for you to use as it may break capillaries. If you have aging skin, using the highest setting might cause ptosis (drooping of the skin).

Pore vacuums use suction to extract the plug. The suction will be easier and more efficient if you prepare your skin before using a vacuum extractor. Soaked soft comedones will be easier to remove. The ways you can soak up the comedones and prepare your skin are as follows:

1. Gently steam your face. You can do it in a shower, with a warm towel or facial steamer.
2. Use a plumping mask.

When your skin is prepared, use your vacuum extractor.

What Is Ultrasonic Blackhead Remover?

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Ultrasonic spatulas are wonderful for removing blackheads. Unlike vacuum extractors, spatulas are safe to use on almost every skin. Prepare your skin first (steam it or plump it as described above).

Spatulas vibrate up to 30.000 Hz, gently exfoliate the skin, and push the plug to the surface. Ultrasound may penetrate deep into the skin and increase skin renewal. These devices also create a thermal effect, increasing the skin’s temperature and speeding metabolism.

It takes time to see the best results, and several procedures may be needed, but the result will be worth to wait.

How to Remove Blackheads in the Unusual Locations?

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1. Blackheads in the Ear, or Behind Ears

The skin inside the ears has many glands (oil and sweat) and hair follicles, and increased oil secretion may clog the pores in the ear. The ear’s anatomy helps the oil build up inside the ear or behind the ears. The ear may collect the oil from the body and hair. Also, the daily cleansing routine around the ears is often forgotten.

The best way to remove blackheads in the ear area is to wash your ears regularly with your everyday face cleanser (just do not forget to rinse well), exfoliate the skin around the ears once a week, and use salicylic acid anti-acne products. Benzoyl peroxide might be helpful for stubborn blackheads in the ear. If this does not help, consider using a blackhead extraction device or see your doctor.

To prevent blackheads in the ear, wash your hair once they get oily or keep your hair tied back. Wash everything that touches your ears – earbuds, cell phone, pillowcase.

2. Blackheads Around Lips

Blackheads can develop anywhere in the body, except palms and soles, as they do not have hair follicles or oil glands. The area around the lips is no exception. Fast food or greasy meals, alcohol, and smoking may contribute to blackheads around the lips.

Do not squeeze a blackhead around your lips because the skin is fragile there, and you may damage it. The safest solution for the blackheads around lips is to exfoliate the dead skin cells and soften the comedones. The best exfoliator to date is salicylic acid. Look for cleansers, creams, or serums with salicylic acid. Retinoids (e.g., Differin) and benzoyl peroxide work well on blackheads too.

It is crucial to moisturize your skin to avoid excessive oil production and blackhead formation. Use lightweight, non-comedogenic moisturizers containing hyaluronic acid or green tea. Researchers found that hyaluronic acid not only draws moisture to the skin but also decreases oil secretion in the sebaceous glands (5). Green tea is known for its strong antioxidant effect. It works well in reducing oil production, either (6).

3. Blackheads on the Back

Blackheads may form anywhere, and your back is a perfect spot for them to develop. The skin on the back is very thick and may easily clog the pores. Also, body and hair oils (natural and from skincare and haircare) may contribute to blackheads on the back.  

It might be tricky to remove blackheads from your back because they are harder to reach. If the blackheads are deep and stubborn, the best solution to remove them would be to visit your skincare specialist. Read below to find out the best treatment for you.

You can also use body exfoliating cleansers containing salicylic acid.

4. Blackheads Between Thighs and in the Pubic Area

Tight clothing, nylons, leggings, and tight jeans may contribute to the blackheads on the thighs or in the pubic area. Sweating, exercising, and friction can exacerbate the comedonal acne. Also, ingrown hair and folliculitis might be mistaken for blackheads.

Do not pop the blackhead in the pubic area; it might be very dangerous and result in infection.

Change your wet clothing as soon as possible and wash them after your training session.

It is a very delicate area to treat. Avoid any harsh products. Look for gentle washes with a pH between 3,5 and 4,5. It is a slightly acidic pH and is best for acne and your delicate skin. A slightly acidic pH will prevent bacteria and inflammation but will still be gentle on your skin.

Creams used to treat blackheads anywhere else will not work here as they will be wiped off with the clothing. 

If you experience ingrown hair, consider waxing or laser hair removal.

5. Blackheads in the Armpits

The skin in the armpits is fragile and has many sweat glands. Also, friction, sweating, shaving hair (and resulting in razor bumps), tight closing, and comedogenic antiperspirants may clog the pores and contribute to developing blackheads in the armpit.

I do not recommend using antibacterial soap to treat blackheads in the armpit because bacteria do not cause them. They are caused by excessive oil production and dead skin cells that clog the pores.

The best treatment for the blackheads in the armpits is to use an exfoliating body wash that is slightly acidic. Salicylic acid would be a perfect ingredient to look for. It will remove the dead skin cells and dissolve oil. The acidic body wash is helpful even if you have pimples or ingrown hair instead of the blackheads.

Be sure to wash regularly, especially after exercising or sweating. You might also consider changing your deodorant to non-comedogenic, more gentle, and less irritating.

6. Blackheads on or under Breasts

The most common cause of the blackheads in the breasts area is using oily, heavy, comedogenic cosmetic products, such as body balms, pore-clogging sunscreens, tanners, body glitters, etc. The skin under the breasts also sweats a lot and undergoes constant friction, which helps blackheads to emerge.

If you want to get rid of blackheads in this delicate area, avoid causing factors first. Use an acidic body wash that exfoliates the skin, and moisturize, moisturize, moisturize! Choose a lightweight moisturizer, ideally containing hyaluronic acid or green tea that will help to control sebum production.

If you suspect that sunscreen might be causing blackheads, change it but do not skip it. Sunscreens are a must in removing comedones because it prevents the skin from excessive dead skin cells and pigmentation.

Note! If blackheads in the armpit, pubic area, inner thighs, or buttocks progress to larger nodules, it might be hidradenitis suppurativa, an abscess of the sweat glands, and not blackheads. Seek medical care!

What Causes Blackheads in the Elderly?

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Three major factors may cause blackheads in the elderly:

• Postmenopausal hormonal changes in women who undergo major physiological shifts. Also, several conditions may increase androgen levels in menopausal women. Read this article for full coverage;

• Photoaging – sunlight damages skin during the years and thickens the skin’s outer layer, which may clog the pores and cause solar comedones.

• Smoking can cause comedonal acne, called “smoker’s acne.”

How Do Professionals Remove Blackheads?

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If you are wondering what facials extract blackheads, here are a few that work well in removing them:

Chemical peels are good solutions for blackheads. The salicylic peel will exfoliate the dead skin cells from the surface of the skin and dissolve oil. The cell turnover will increase. It will also reduce inflammation and prevent secondary infection. The acids used in chemical peels are of a much higher concentration than those in home skincare. And work deeper and more effectively.

Another possible option is microdermabrasion. It is an abrasive procedure that removes dead skin cells and the thick outer layer of the skin together with the outer part of the blackhead. As not the whole blackhead will be removed during one procedure, several microdermabrasion treatments will be needed. Then blackheads will be gradually removed.

Extraction of comedones is a well-known facial procedure but might be applied to any part of the body. Extraction of blackheads might be performed by fingers, a small needle, loop, or professional vacuum extractors.

Galvanic Treatment softens comedones, and keratin emulsifies sebum, removes blackheads, and deeply cleanses the skin. There are two types of galvanic treatments – desincrustation and iontophoresis. The first one helps to remove comedones, and the second allows the skin to absorb skin products used after facial cleansing (e.g., pore tightening, soothing skin products).

Do Blackhead Extractions Hurt?

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Well, it differs. Chemical peels might give you a burning or tingling sensation but is temporary. As soon as the spirit in which acid is dissolved evaporates, the discomfort vanishes. It may take up to a few minutes.

Microdermabrasion and galvanic treatments do not hurt, and people usually love them. These procedures are an easy way to remove blackheads.

Extraction of comedones might give you a slight discomfort or tingling sensation as the blackheads are extracted, squeezed, or pricked.

Do Blackheads Leave Holes?

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Removal of blackheads may leave temporary holes in your skin. It is normal because the clog is removed suddenly. They usually go away on their own. But sometimes, this process may take longer and leave a scar or loose pores. To speed up the closing of the holes, use one of the following steps:

• Cool your skin. The cold will tighten your pores and accelerate their closure. The simplest way to cool down your skin is by using cold water.  But if you want a more prolonged effect and not to dry out your skin (because of the water), use cooling, non-comedogenic skincare – masks, serums, etc. You can even find a gel cooling mask and give it a try. Another option to cool down your skin and shrink the pores is to use cryotherapy devices.

• Tighten your pores. Retinoids, salicylic acid, and AHA acids are good for that. Retinol tightens the pores, and salicylic acid reduces inflammation, dissolves left oil in the pore, and prevents secondary infection.

• Hydrate your skin. Moisturizing is a key to healthy skin. It also helps to keep your pores closed.

• Remove scars. If the hole does not go away and results in a scar, contact a dermatologist who will perform a punch excision and stitch the wound.

How Long Does It Take to Get Rid of Blackheads?

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It depends on a person and the blackheads, their depths in the skin, amount, and the skin itself. Usually, it takes 1 – 2 months to remove blackheads.

How to Prevent Blackheads?

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• Treat underlying conditions, balance your hormones, and reduce smoking;

• Use non-comedogenic products (skincare and makeup);

• Do not skip the sunscreen (choose non-comedogenic) as they prevent the skin thickening and clogging pores;

• Hydrate, hydrate, hydrate your skin;

• Cleanse your skin daily (do not forget about your body as blackheads tend to develop on the body too); gently exfoliating cleanser would be perfect;

• Wash your hair regularly or keep them tied up;

• Wear loose, breathable clothing and wash them every time they get dirty or sweaty if you experience body blackheads;

• Clean everything that touches your skin: earbuds, phone, pillowcase.

Takeaway

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Blackheads are a common type of acne. It is non-inflammatory acne and caused only by excessive oil production and dead skin cells clogging the pores and not by bacteria.

Several conditions look just like blackheads: sebaceous filaments, trichostasis spinulosa, and comedo nevus.

Blackheads may be removed safely using acidic cleansers or body washes, tightening the pores and hydrating the skin.

Professional procedures, such as chemical peels, microdermabrasion, extraction of comedones, and galvanic treatments, are also available to remove blackheads.

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ARTICLE SOURCES:

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1. Plewig G, Wolff HH. Follicle-Filamente [Sebaceous filaments (author’s transl)]. Arch Dermatol Res. 1976 Mar 10;255(1):9-21. German. doi: 10.1007/BF00581673. PMID: 130839. Read
2. Kositkuljorn C, Suchonwanit P: Trichostasis Spinulosa: A Case Report with an Unusual Presentation. Case Rep Dermatol 2020;12:178-185. doi: 10.1159/000509993. Picture Read
3.  Baddireddy, Kavya & Vasani, Resham. (2021). Trichostasis spinulosa An entity with cosmetic concern. Cosmoderma. 1. 48. 10.25259CSDM_52_2021. Picture Read
4. Comedo Naevus – dermnrtnz.org Read
5. Jung YR, Hwang C, Ha JM, Choi DK, Sohn KC, Lee Y, Seo YJ, Lee YH, Kim CD, Lee JH, Im M. Hyaluronic Acid Decreases Lipid Synthesis in Sebaceous Glands. J Invest Dermatol. 2017 Jun;137(6):1215-1222. doi: 10.1016/j.jid.2017.01.017. Epub 2017 Feb 3. PMID: 28163068. Read
6. Suzana Saric, Manisha Notay, Raja K. Sivamani. Green Tea and Other Tea Polyphenols: Effects on Sebum Production and Acne Vulgaris. Antioxidants (Basel). 2017 Mar; 6(1): 2. Read
7. Yeh, Christopher & Schwartz, Robert. (2022). Favre−Racouchot disease: protective effect of solar elastosis. Archives of Dermatological Research. 314. 1-6. 10.1007/s00403-021-02202-5. Picture Solar Comedones. Read