Blackheads
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Blackheads are the colloquial term for open comedones (Latin: comedones aperti), one of the most common forms of acne lesions that develop within the openings of hair follicles. They are characterized by the presence of small, dark dots on the skin's surface, which arise from the accumulation of sebum, keratinized epidermal cells and debris in the follicular opening. The dark color is not due to dirt, but to the oxidation of melanin and lipids on the surface of the horny-sebaceous plug. These lesions most often accompany acne vulgaris (acne vulgaris) and appear in areas of skin rich in sebaceous glands. Although they usually do not cause pain or inflammation, they can serve as a starting point for the development of more advanced acne lesions.
Blackheads – location
Open comedones appear primarily in areas where there is high sebaceous gland activity. In these areas sebum production is greater, and the openings of hair follicles are more easily clogged by keratin and lipids.
The most common locations of blackheads are:
- nose – especially the nostrils and the bridge of the nose
- chin and jawline area
- forehead, especially in the T-zone
- cheeks (near the nose)
- back and chest
- auricles and the areas behind the ears
In dermatology it is emphasized that the formation of comedones is related to several biological processes:
- overproduction of sebum by the sebaceous glands,
- abnormal keratinization of the follicular opening (hyperkeratosis),
- colonization by the bacterium Cutibacterium acnes,
- hormonal factors (particularly androgens).
Blackheads often appear during puberty, when sebaceous gland activity increases significantly. However, they can also occur in adults, especially with oily skin, in the course of adult acne, or as a result of using heavy, comedogenic cosmetics.
Blackheads – extraction
Squeezing blackheads is one of the most common practices used by patients, however in dermatology it is not recognized as a therapeutic method. When done incorrectly it can lead to skin damage and complications.
Potential consequences of self-extraction include:
- spread of bacteria within the skin,
- the formation of inflammatory lesions and pustules,
- the development of post-acne scarring,
- post-inflammatory hyperpigmentation (post-inflammatory hyperpigmentation),
- mechanical damage to hair follicles.
Particularly dangerous is manipulating lesions within the so‑called danger triangle of the face (the area of the nose and upper lip), where there are venous connections to the cavernous sinus. Although serious complications are rare, infections in this area require special caution.
In dermatological practice comedones are removed in a controlled manner through manual extraction performed by a specialist, preceded by appropriate skin preparation (e.g., softening or the use of keratolytic agents). This minimizes the risk of tissue damage and scar formation.
Blackheads – how to remove
Treatment of blackheads primarily involves normalizing the keratinization of hair follicle openings and regulating sebum production. Therapy should be tailored individually depending on the severity of the lesions and skin type.
The most commonly used methods include:
Dermatological treatment
Topical preparations used in comedo therapy include, among others:
- topical retinoids (e.g., adapalene, tretinoin) – normalize the keratinization process,
- salicylic acid – has a keratolytic effect and unblocks pores,
- azelaic acid – exhibits anti-inflammatory and sebum-regulating effects,
- benzoyl peroxide – limits the growth of Cutibacterium acnes.
Regular use of these substances leads to a gradual reduction in the number of comedones and improvement in skin texture.
Dermatological and cosmetic procedures
In the case of persistent lesions, procedures performed in a dermatology clinic or aesthetic medicine, such as:
- manual skin cleansing,
- chemical peels (e.g., with salicylic, glycolic, or mandelic acid),
- microdermabrasion,
- laser skin cleansing,
- procedures that regulate sebaceous gland activity.
These procedures work by removing keratinized epidermis, unblocking pores, and reducing excess sebum, which decreases the skin's tendency to form new comedones.
Skincare to prevent comedone formation
Daily skin care plays a key role in prevention:
- use of gentle cleansing products,
- use of non-comedogenic cosmetics,
- regular exfoliation,
- protecting the skin from excessive UV exposure.
Consistent skincare and appropriately chosen dermatological treatment usually make it possible to effectively control blackhead formation and improve the appearance of the skin.
