Blackheads

Blackheads, referred to in dermatology as open comedones (comedones aperti), are one of the most common skin lesions occurring in the course of common acne and seborrhea. They arise as a result of obstruction of the hair follicle opening by sebum (oil), keratin and desquamated epidermal cells. The characteristic dark color is not due to dirt on the skin, but to oxidation of lipids and melanin on the surface of the keratinous-sebum plug after contact with air. These lesions most commonly appear in areas rich in sebaceous glands, such as the face, back or chest. Although blackheads are non-inflammatory, their presence promotes the development of inflammatory lesions and the formation of pustules and papules.

Blackheads – where do they come from

The formation of blackheads is the result of a disruption of the keratinization (cornification) process within the openings of hair follicles and excessive sebum production by the sebaceous glands. Under normal conditions, epidermal cells shed gradually and do not block the follicular opening. In cases of keratinization disorders, keratin and sebum accumulate, leading to the formation of a keratinous-sebum plug.

The most important factors that promote the formation of blackheads include:

excessive activity of the sebaceous glands (seborrhea)
hormonal disorders, particularly increased androgen levels
abnormal shedding of the epidermis
use of comedogenic cosmetics, which clog follicular openings
genetic predisposition
environmental pollution and oxidative factors

The bacterium Cutibacterium acnes also plays an important role in the development of acne lesions; it colonizes hair follicles and can lead to the development of inflammation. In the case of open comedones, these bacteria do not always cause inflammation, however the presence of a keratinous-sebum plug favors their proliferation.

From a dermatological point of view, blackheads represent the first stage in the development of acne lesions. If left untreated, they can transform into inflammatory lesions such as papules, pustules, or nodules.

Blackheads – location

Blackheads appear primarily in areas of skin where there is the highest concentration of sebaceous glands. For this reason, these lesions are characteristic of the so-called seborrheic zone.

The most common locations of blackheads are:

nose – especially the sides and the bridge of the nose
chin
forehead
area between the eyebrows
back and upper part of the chest

On the face, blackheads most often occur in the so-called T-zone, which includes the forehead, nose and chin. These areas are characterized by the highest activity of sebaceous glands and a greater tendency to form comedones.

Less commonly, these lesions also appear:

on the arms,
in the shoulder area,
on the scalp near the hairline,
in the ear area.

The location of comedones has diagnostic significance because it can indicate the dominant cause of their formation. For example, comedones in the forehead and temple area are often associated with the use of hair care products or excessive oiliness of the scalp, whereas lesions in the chin and jaw area may be related to hormonal factors.

Blackheads – how to get rid of them

Removal of blackheads requires above all the normalization of the epidermal keratinization process and regulation of sebaceous gland activity. Effective therapy should be multidirectional and include both appropriate skin care and – in the case of severe lesions – dermatological treatment.

In dermatology, several basic methods are used to reduce comedones.

1. Keratolytic and sebum-regulating preparations

The most commonly used active substances are:

salicylic acid (BHA) – dissolves sebum and cleans the openings of hair follicles
retinoids – normalize keratinization and prevent the formation of new comedones
azelaic acid – has anti-inflammatory and antibacterial effects
AHA acids (e.g., glycolic, mandelic) – help with epidermal exfoliation

2. Dermatological and cosmetic procedures

In cases of numerous comedones, in-office procedures that cleanse the openings of hair follicles and regulate sebaceous gland activity are effective. The most commonly used include:

chemical peels using AHA, BHA, or TCA acids
manual skin cleansing performed in a clinical setting
microdermabrasion, which removes the stratum corneum
laser and light acne therapies, reducing sebaceous gland activity and bacteria

In clinical practice, combining several therapeutic methods gives very good results, as it allows simultaneous reduction of sebum production, improvement of epidermal exfoliation, and limitation of bacterial development.

It is worth emphasizing that mechanical squeezing of blackheads at home is not recommended, because it can lead to skin damage, the development of inflammatory conditions, and post-acne scars.

Regular skin care, the use of appropriately selected dermatological products, and periodic cleansing procedures allow in most cases to effectively reduce the formation of blackheads and improve the overall condition of the skin.