Blackheads

When the opening of a pore (hair follicle orifice) becomes occluded with sebum (oil) and dead skin cells, which then solidifies, the surface color often darkens. This is what is commonly called a blackhead. There are several skin conditions in which blackheads are an important component. The medical name of this structure is a comedo (plural: comedones).

The black color of the surface of the comedo is thought to be due to the oxidation of the fat molecules in the sebum. If the surface of the comedo is covered by skin, this oxidation does not occur and the structure might be called by some "a whitehead" or pimple. This terminology could be confused with a pustule, which may often occur at or near a follicular orifice.

Blackheads are most often recognized early in the course of acne vulgaris, the inflammatory skin disease that affects the face, back, and chest of almost all teens as they go through puberty. They are thought to be the first sign of teenage acne and contain inflammatory substances that start the acne process.

Common causes of blackheads include the following:

• Elastotic degeneration of the skin affects sun-exposed areas, mostly on the face. The yellowish bumpy deposits of degenerated collagen are often accompanied by numerous blackheads.
• Chloracne is a condition caused by the absorption of dioxins, which are well-known toxins often encountered as a byproduct in the manufacture of herbicides and defoliants.
• Comedones are seen on the exposed skin of certain workers exposed to insoluble cutting oils in the metal machining industry.
• Certain topical hair products are known to induce blackheads on the adjacent skin, resulting in a condition called "pomade acne."
• Makeup cosmetics occasionally may contain comedogenic substances.
• Certain anti-seizure and antipsychotic medications are thought to induce comedones.
• Certain rare birthmarks called epithelial nevi may contain many blackheads.
• Sometimes a follicular orifice may become so dilated that after it becomes filled with dried sebum and skin it is termed a "giant pore of Winer."

Blackheads rarely produce symptoms in themselves. Blackheads often are a sign of some of the previously listed skin conditions. Most of the time, these little black dots are of no significance aside from their cosmetic appearance, which is dramatically enhanced when using a magnifying mirror.

You do not have to be a specialist to recognize a blackhead. Occasionally, a magnifying glass can be helpful. If they become a bothersome problem, a dermatologist may see you for treatment strategies. A dermatologist specializes in the treatment of acne and other skin diseases and conditions.

A healthcare professional, most often a dermatologist, will likely be able to explain which skin condition is responsible for producing the blackheads.

If blackheads are a significant problem, it may be necessary to apply a prescription topical retinoid like tretinoin (Refissa, Atralin, Tretin-X) or tazarotene (Tazorac, Avage) to successfully get rid of the blackhead.

Occasionally physicians may remove a blackhead. Most often this procedure is performed by a trained esthetician, a skin care specialist, who ought to be able to get rid of the blackhead without damaging the adjacent skin.

Salicylic acid pads and/or 12% ammonium lactate lotion can be found in most pharmacies. They contain a chemical that exfoliates or loosens the blackhead so that it is possible to remove the blackhead when a person cleans his/her face.

Comedo extractors can be purchased in most pharmacies and from Internet retailers. These small metallic devices have a small opening in a spatula-like tip, which when pressed over the blackhead produces enough side pressure on the skin to get rid of the oil plug from the blocked pore. This might not be the best option because the untrained operator (the patient) may be too aggressive and produce more damage than benefit.

Other options for comedo removal include vacuum suction and pore strips. There is little compelling evidence that blackhead removal produces any lasting benefit.

Since most blackheads are due to acne, which is limited to puberty in most people, it is likely that they ultimately will resolve spontaneously.

A person can prevent blackheads by treating the skin condition responsible for their presence. This is most effectively done by a dermatologist.