A blackhead, or open comedo is a wide opening on the skin with a blackened mass of skin debris covering the opening.
Despite their name, some blackheads can be yellowish in color. A comedo is a widened hair follicle which is filled with skin debris (keratin squamae), bacteria and oil (sebum).
A closed comedo is a whitehead, while an open comedo is a blackhead. The plural of "comedo" is comedomes".
What are blackheads?
The US Library of Medicine describes blackheads as small, dark spots on the skin, caused by a small blockage in the opening of a pore (follicle).7
Blackheads are said to be the first stage of acne. They form before bacteria invade the pores of the patient's skin. A blackhead can develop into a pimple, which is also known as a papule or pustule.
Blackheads and acne in general usually develop after the onset of puberty, when hormone levels surge and reach the skin. Certain hormones overstimulate the sebaceous glands, resulting in the overproduction of sebum.
Sebum is designed to lubricate the hair and skin and usually drains out of the pore opening on the surface. Sometimes the sebum becomes blocked and bacteria begin to accumulate. If the buildup of bacteria and sebum has no opening to the surface of the skin it is called a whitehead. A blackhead forms if the pore opens to the surface allowing air to enter.
Sebum contains melanin, a pigment. It is the same substance that gives skin its color. Melanin turns dark (oxidizes) when exposed to air. That is why blackheads are dark1. The dark color does not mean they are dirty, and scrubbing does not remove them.
Several conditions and circumstances can cause blackheads, or make them worse, such as the use of topical oils and make up.
Blackheads can affect people with any type of skin, but are generally more common in those with oily skin.
What are the causes of blackheads?Blackheads
Blackheads on a man's nose
Blackheads are typically caused by the overproduction of oil, which tends to occur when a person reaches puberty.
Spikes in hormone production can result in the high levels of DHT (dihydrotestosterone), a hormone which triggers overactivity in the oil glands, resulting in clogged pores.
Skin hygiene and blackheads - a myth
Many people believe that if your skin is not cleaned properly more blackheads can appear, especially during periods of fluctuating hormone levels such as puberty or just before menstruation.
Scientists and doctors say this a myth. The National Health Service in the UK explains that most biological reactions that trigger acne do not occur on the surface of the skin, but beneath it.
In some cases, blackheads can emerge if moisturizers, sun screens, make up, or foundations are overused and irritate the skin.
In the majority of cases, blackhead susceptibility is not heredity, with the exception of some severe acnes.
Food does not cause acne
Although parents and grandparents commonly tell their teenage offspring not to eat chocolates and greasy foods because they think they encourage the formation of acne, they do not cause blackheads or make them worse.3
Some studies have pointed towards a link between some dairy products and acne, but the evidence is not compelling.
Stress
Stress does not directly affect blackhead occurrence. However, stress and anxiety can cause people to pick at their blackheads and acne, which may irritate the skin.
What are the treatment options for blackheads?
Hormonal treatments
Contraceptives have often been used for the treatment of blackheads and acne, often with good results.4
Cleaning the skin
Clean your face with a good cleanser, ideally, one for oily skin, such as a salicylic acid cleanser. Do not wash the affected area more than twice a day, otherwise you might irritate the skin and make symptoms worse.8
Medications
Adapalene is a third-generation topical retinoid, used mainly in the treatment of mild to moderate acne. Many patients with blackheads have had good results.
In the USA adapalene is available under brand name Differin, in three preparations - 0.1% cream, 0.1% gel, and 0.3% gel. Since 2010, it has also been available in the USA under the generic name Teva, (0.1% gel). Only the 0.1% cream and 0.1% gel forms are available in Europe.5
Hair
Greasy hair touching the face of your skin can spread infection and in some cases encourage the spread of blackheads and acne. Keeping your hair away from your face may help keep blackheads to a minimum.
Skin virus may fight blackheads and acne
A virus that lives on our skin seems to naturally seek out and destroy the bacteria responsible for blackheads and zits. Researchers from the University of Pittsburgh said that harnessing a virus that naturally preys on the bacteria that cause pimples could offer an extremely useful tool against this skin condition.6
Video - Blackheads
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