Blackheads on the lips
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Blackheads on the lips are skin lesions resembling small, dark dots that appear on the vermilion border or on the skin directly around the mouth. In dermatology they are most often referred to as open comedones (comedones), which form as a result of the accumulation of sebum, keratin and epidermal cells in the opening of a hair follicle. The dark color does not result from the presence of dirt, but from the oxidation of lipids and melanin present in the keratin-sebum mass. Such lesions may appear singly or in larger clusters, often coexisting with other symptoms of common acne. Due to the specific structure of the skin around the mouth – a thin stratum corneum and high activity of the sebaceous glands – these lesions can be particularly noticeable and difficult to remove on one’s own.
Blackheads on the lips – causes of formation
The formation of blackheads (comedones) around the mouth is associated with the process of comedone formation, which constitutes one of the primary skin lesions in the course of common acne. The mechanism of their development involves several interacting processes occurring within the pilosebaceous unit, that is the skin structure composed of the hair follicle and the sebaceous gland. A key element is an imbalance between sebum production and the process of epidermal cell desquamation.
The most important factors leading to the formation of blackheads include:
- excess sebum production by the sebaceous glands, which leads to the accumulation of sebum at the follicular opening,
- disorders of keratinization, i.e. abnormal cornification of epidermal cells at the follicular opening,
- accumulation of keratin, sebum and epidermal cells, which form the so-called horny-sebaceous plug that blocks the follicular opening,
- colonization by Cutibacterium acnes, which can exacerbate the skin's inflammatory process,
- use of comedogenic cosmetics, such as heavy protective lipsticks, lip balms, foundations or occlusive creams,
- hormonal factors, particularly increased androgen activity, which stimulates sebaceous gland function.
The area around the mouth is particularly predisposed to comedone formation due to the high number of sebaceous glands and the thin skin structure. Additionally, the skin in this zone often comes into contact with skincare and makeup products that can promote blockage of follicular openings. Mechanical factors are also important, such as frequent touching of the face, rubbing of the skin, or wearing protective masks, which can intensify the development of comedonal lesions.
Blackheads on the lips – what do they look like
Blackheads in the perioral area have a characteristic appearance that allows them to be distinguished from other skin lesions, such as milia, sebaceous papules or small epidermal cysts. They are small, round or oval spots of black, brown or dark gray color, arising from dilation of the hair follicle opening and filling with a sebaceous-keratinous mass.
The most common clinical features of blackheads include:
- diameter from 0.5 to 2 mm, less commonly larger,
- dark coloration of the surface resulting from oxidation of the comedo contents,
- absence of inflammation (as opposed to pustules and papules),
- smooth or slightly depressed skin surface,
- occurrence as single lesions or small clusters.
Lesions most often appear:
- in the area of the nasal alae and nasolabial folds,
- on the skin directly above the upper lip,
- less commonly at the vermilion border.
In the differential diagnosis, other structures that may resemble blackheads should be considered. These include:
- prosaki (milia) – small, white epidermal cysts,
- Fordyce papules – ectopic sebaceous glands visible as yellowish dots,
- folliculitis,
- closed comedones (whiteheads).
If numerous lesions are present around the mouth they may be a sign of acne vulgaris, whose pathogenesis includes excessive sebum production, disturbances of follicular keratinization, colonization by Cutibacterium acnes and an inflammatory process.
Blackheads on the lips – what they can be mistaken for
Skin changes appearing around the mouth are not always classic comedones. In dermatological practice many small lesions with a similar appearance can be mistakenly interpreted as blackheads. Therefore, in diagnosis it is important to differentiate them from other benign skin lesions that may occur in this area.
The lesions most often mistaken for blackheads include:
- milia (milia) – small, white or yellowish epidermal cysts filled with keratin; they are usually firm and do not have a visible opening on the skin surface,
- Fordyce spots – ectopic (not related to the hair follicle) sebaceous glands visible as small, pale or yellowish points on the vermilion of the lips or in its immediate vicinity,
- closed comedones – so-called whiteheads that form as a result of the follicle opening being closed by a thin layer of epidermis,
- folliculitis – inflammatory lesions associated with bacterial infection or irritation of the hair follicles, which may take the form of small pustules or papules,
- small epidermal cysts – benign lesions that develop as a result of keratin accumulation within the skin.
Correct identification of the type of lesion matters for choosing the appropriate treatment. In cases of diagnostic uncertainty a dermatologist may use dermoscopy, a noninvasive skin examination that allows assessment of the structure of lesions under magnification. This makes it possible to distinguish comedones from other skin lesions and select the proper therapeutic management.
Blackheads on the lips – how to remove
Removal of comedones in the area around the mouth should be based primarily on normalizing the process of epidermal keratinization and regulating sebum production. Due to the thin and sensitive skin in this area, aggressive squeezing of lesions is not recommended, as it can lead to irritation, inflammatory conditions, and the development of post-inflammatory hyperpigmentation.
In dermatology and cosmetology, several methods are used to reduce comedones.
1. Dermatological care
The basis of therapy is products that regulate the keratinization process:
- topical retinoids (e.g. adapalene, tretinoin) – normalize keratinization of hair follicle openings,
- salicylic acid – has keratolytic and anti-inflammatory effects,
- azelaic acid – reduces sebum production and has antibacterial effects,
- AHA acids (e.g. glycolic acid, lactic acid) – support exfoliation of the epidermis.
Regular use of such products reduces the formation of new comedones and gradually cleanses the skin pores.
2. Cosmetological and dermatological procedures
For persistent lesions, procedures performed in a specialist clinic are effective. The most commonly used are:
- manual skin cleansing preceded by softening of the epidermis,
- chemical peels using AHA, BHA, or PHA acids,
- medical peels regulating the activity of sebaceous glands,
- laser and IPL light treatments, which can improve skin texture and reduce sebaceous gland activity,
- hydrogen or cavitation cleansing, supporting the removal of impurities from the skin.
In the treatment of lesions around the mouth, proper skin hydration and avoiding comedogenic cosmetics, which can promote clogging of hair follicle openings, are also important.
Long-term improvement usually requires a combination of appropriate at-home care and clinic procedures, because comedones tend to recur, especially in people with seborrheic or acne-prone skin.
