How to treat blackheads (acne)?

In a Nutshell

  • Blackheads are skin pores that are loaded with dead skin cells, bacterial and debris but are still open to exterior
  • Avoid touching or picking on your blackheads as it may worsen your acne
  • Treatment depends on the severity of lesions and is a combination of topical antibiotics, retinoids, and sometimes oral antibiotics/ hormones for severe cases

What are blackheads?

If a skin pore is clogged up with dead cells, debris, excess oil secretions and bacteria, but remains open to the surface, it is referred to as blackhead (or open comedone). Visually they may appear like black dots, but keep in mind that they are not filled with dirt. Since these pores are open to the exterior, the oil, debris or bacteria gets oxidized to render it a brown / black color. Avoid scrubbing or picking on the blackhead as it may worsen your acne.

According to American Academy of Dermatology, blackheads and resulting acne is the most common dermatologist disorder in the United States that affects about 50 million Americans.

Evidence-Based Treatment Regimen

Daily Skin care Routine

  • Wash your face with a quality face wash that can balance your oil secretion without making your skin too dry.
  • Use water-based cosmetics and skin care products and strictly avoid oil-based products that are more likely to clog your pores
  • Use a facial moisturizer with SPF-30 especially when you are going outdoors to protect your skin from harmful sun rays.
  • Exfoliate at least once a week with a gentle cleanser or exfoliating agent that contains alpha and beta hydroxy acids

  1. Topical Treatments: The management of blackheads revolve around topical treatments that contain ingredients like benzoyl peroxide, salicylic acid, resorcinol, or retinoids like adapalene. These topical treatments are generally available as over the counter gels, cleansers, cleaning pads, and ointments. Topical treatments exert their action by removing excessive dirt and oil secretions, killing bacteria, and shedding dead/ dry skin. These can be applied once a day ideally before bedtime. Make sure to wear a sunscreen when you go outdoors as these topical treatments can make your skin more sensitive to sunrays.
  2. Prescription grade antibiotics: For stubborn blackheads, your dermatologist may advise you prescription grade antibiotics that can help clear your skin by increasing the turnover of skin cells. These include powerful antibiotics or Vitamin A derivatives such as tretinoin or Accutane, Adapalene or Tazarotene. Ideally, these treatments are advised for 3-6 months, depending on the response to therapy.
  3. Comedone Extractor: This is a pen like device that can be used to scoop or extract the blackheads (and/or whiteheads) from your skin to minimize the risk of progression to acne. It is recommended to avoid comedone extraction at home. Dermatologists and trained professionals are trained to perform extraction without increasing the risk of infection and/or scarring.

Other treatment options can be employed in more complex cases of blackheads such as chemical peels, phototherapy, and microdermabrasion.

Nuances/ Safety

Vitamin A derivatives such as Accutane should be consumed with extreme caution as it aggravates the risk of congenital anomalies in the newborn. Women of reproductive age group should avoid Accutane or practice birth control while they are on Accutane therapy.

Strength of Evidence: B

The treatment regimen varies according to nature, severity of condition and individual factors. The listed treatment options are in accordance with best practices suggested by dermatologists, American Dermatology Association, and the National Health Services.

Our Ruling:

Blackheads are open comedones or skin pores that makes you more susceptible to develop acne and other cosmetic issues. Treatment revolves around skin care and topical antibiotics, more severe cases warrant oral or prescription grade medications that may have certain side effects and are only taken if advised by a healthcare professional.

Our Sources:

  1. https://www.nhs.uk/conditions/acne/treatment/
  2. https://www.aad.org/public/diseases/acne
  3. https://www.medicinenet.com/blackheads/article.htm
  4. https://www.medicalnewstoday.com/articles/71615
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How we grade evidence?

Learn more about it here.