Ask a Dermatologist: What Are Blackheads?
In the ongoing quest for a flawless, glowy complexion, we can admit we've gone to extremes to erase any trace of acne—but we can all agree that blackheads are the worst. The stubborn little black specks that take up real estate on our nose, chin, and forehead not only compromise the look of our gorgeous skin but are seemingly the worst form of acne because they are notoriously tough to banish for good.
Unless you're getting facials regularly and opt for extractions, chances are you're reading this because you've yet to find the cure-all for pesky blackheads. But before you resort to DIY extractions (which are a big no-no) or engage with harsh scrubs, it's important to understand the blackhead basics—and that's where we come in. We spoke with some of the country's top dermatologists to get to the bottom of what causes this all-too-common skincare woe and, more importantly, how to obliterate them for good.
Keep scrolling to learn everything you need to know about blackheads.
What exactly is a blackhead?
In order to treat blackheads, one must truly understand them. A blackhead—medically known as a comedone—is a pore that's clogged with a mix of dead skin cells and sebum and appears dark (more on that later). Further explaining that pores are actually tiny hair follicles, New York–based celebrity dermatologist Whitney Bowe says, "We have tiny little hair follicles all over our face, chest, and back that open at the surface of our skin, and we see those openings as pores."
Kenneth Howe, MD, at Wexler Dermatology adds that when the pore is close enough to the surface to be exposed to air and clogged, "the tip undergoes oxidation, turning it dark. That's your blackhead." Unlike closed comedones, aka whiteheads, an open pore equals blackhead.
How do blackheads differ from sebaceous filaments?
Commonly mistaken for a blackhead is the imposter known as a sebaceous filament. If you've looked into one of those magnifying mirrors (and let's be honest—who hasn't?), then you've probably confused a sebaceous filament for a blackhead at one point. The two look similar despite being entirely different, as Michele Farber of Schweiger Dermatology group explains. "Sebaceous filaments are natural parts of your pores meant to bring oil [to the surface] to hydrate the skin," she says.
Bowe agrees, adding, "You can't see them without a magnifying mirror. Blackheads, on the other hand, are larger and slightly elevated above the surface of the skin. If you close your eyes and run your hand over the skin, you can feel a blackhead, but you can't feel a sebaceous filament." Translation: Leave the latter alone.
Why do I keep getting blackheads?
We know that blackheads are caused by sebum and dead skin cells clogging up pores, but why won't these dead skin cells just stop? It's a bit complicated. "The skin cells lining follicles (pores) prone to blackheads have been shown to be hyperproliferative, which means they're growing at an abnormally fast rate," says Howe. "Normally, after the skin cells lining a follicle die, they travel to the surface on a stream of oil, but in follicles prone to blackheads, this process is overwhelmed by the fast rate of skin cell growth and turnover." Basically, too many skin cells cause a traffic jam in our pores.
Board-certified dermatologist and Amarte founder Craig Kraffert adds, "Blackheads occur when skin scale and skin oils congeal to form plugs in the ducts leading from oil glands deep in the skin to the skin surface." He says the viscosity of both determine whether or not blackheads will form and, "Those properties are inherited and greatly influenced by hormonal factors."
What are the biggest myths about blackheads?
"First, that washing your face more will get rid of blackheads," says Farber. "Good, gentle, skincare will help any acne prone person—but over-scrubbing has the potential to make you more oily as your skin works to replenish what you’re constantly removing."
Craig Kraffert, MD, says the number one myth is that "blackheads indicate a lack of cleanliness or poor hygiene. In actuality, skin cleanliness does very little to prevent the formation of blackheads in those predisposed to them." Howe adds, "Some think they are dark due to dirt as opposed to the oxidation that occurs."
How can I get rid of them and prevent them in the future?
While every case is different, dermatologists agree that maintaining cleansed skin is a top priority. "Anything congealed at the surface causing surface bumps should be washed away," says Kraffert. "Cleansing after a workout should occur sooner rather than later so oil, scale, and salt do not set in."
He recommends Amate Daily Wonder Cleansing Foam ($40) to get the job done and adds that when it comes to ingredients, "The best to include in such a regimen include retinoids, sulfur, benzoyl peroxide, and, to a lesser extent, AHAs." Howe recommends going for the holy grail of skincare: good ole vitamin A derivatives. "The best known and most effective of these is a tretinoin cream like Retin-A." Retinoids boost cell turnover so that pores are less likely to clog up and result in blackheads, or any sort of acne for that matter. "Some people's skin is too sensitive to use tretinoin, which can be drying. In that case, they might do better with Adapalene or Epiduo, milder 'cousins' of tretinoin," he adds.
Always consult your dermatologist before taking on a targeted skincare regimen, and as Farber points out, over-the-counter options can be just as effective for milder cases. "Products with beta-hydroxy acids such as salicylic acid can help to exfoliate. Gentle peels like Drunk Elephant T.L.C. Framboos Glycolic Night Serum ($90) with ingredients like glycolic acid can also help to smooth out the appearance of the skin." Bowe is also a proponent of acne-fighting salicylic acid and recommends Dermalogica Daily Resurfacer ($70). "It contains just the right amount of salicylic acid, which dives into the pores and dissolves the debris, dead cells, and sebum.—it's powerful but gentle."