Skincare with Friends Ep 80: How to Remove Blackheads

See also our previous episode- 44. Enlarged Pores and how to minimise them

This episode is inspired by my own battle with blackheads. I always have them on my nose and chin. One minute there ain’t nothing, then next, there’s a a pore the size of the moon. So I sort of wanted to torture myself by reading about it and hopefully find out if there are any ways we can deal with blackheads.

What Are Blackheads?

We touched on pores and sebum last time in our body acne episode ep. 79, check out this post for all the info on how to get rid of body acne. We already talked about how there is a sebum gland hiding in the hole which your little velus hairs come out of. For most people a normal amount of sebum comes out of these pores and dead skin cells exfoliate like they are supposed to and come to the skin’s surface in a little nice stream of sebum. 

But in acne prone people this process doesn’t go according to plan and the pore gets clogged with dead cells and sebum which oxidises and turn black. Blackheads are known officially as “open comedones” and blocked pores which are under the skin are called “closed comedones”, they look like skin coloured little bumps. Of course blackheads are mainly seen in the oily parts of the body- the nose, chin, forehead, back.

Side note- the scientific name for pore is infundibulum, which is nice to say.

Are Those Black Dots on my Nose Blackheads?

Normal human noses are peppered with little tiny dots, they might look quite dark but that doesn’t mean they are blackheads or that there is anything wrong that needs fixing. They are known as Sebaceous filaments. If you squeeze your nose (which you shouldn’t), these sebaceous filaments will squeeze out and look like little worms. A blackhead is a pore that has gone rogue, it’s more solid, like a little seed of hard sebum and keratin.

Try not to focus on pores, you can drive yourself mad. Have a good skincare routine (which we will get onto)and your pore contents will take care of themselves.

Why Do You Get Blackheads?

Pore size and tendency to have acne is highly likely to be a genetic thing, One study of 200 patients with post adolescent acne found that 50 percent of patients reported at least one first-degree family relative with acne (Goulden et al, 1997). 

My dad has acne, I take after him. It’s in my genes. Also, Acne is significantly higher among women than men in all age groups, sorry ladies (Collier et al, 2008).

There are certain things you might use on your face that can make the appearance of blackheads way worse- fake tan and pure Vitamin C/Ascorbic Acid. They will accumulate in the pores and turn blacker than night. 

There is also a condition called “Acne Cosmetica” which is medical condition whereby spots and blocked pores are caused by skincare or makeup. I think a lot of women’s adult acne has been historically dismissed by doctors as Acne Cosmetica in a fun sexist victim blaming sort of way. 

How to Treat Blackheads

It’s not seem as a different entity by academics and the studies tend to describe treatment of acne as a whole, there isn’t a lot of research into treating just blackheads. 

This picture is of a condition called Favre-Racouchot Syndrome. It’s a picture of the upper cheeks of an older gentleman with wrinkly skin and very large blackheads. Favre-Racouchot is caused by sun damage and smoking, which destroys the elastin and collagen which keeps the pores nice and tight. In effect, this is another vote for daily spf use/avoiding the sun- it can also prevent enlarged pores.

The study I read had this to say about treating this giant blackhead syndrome- 

“Topical retinoids such as tretinoin, adapalene, and tazarotene are the mainstay of medical treatment. The medication works by repairing collagen and remodeling elastin in the dermis. In addition, the medication may decrease the activity of matrix metalloproteinases within the skin that may further decrease collagen breakdown. Other treatment options include curettage, excision, comedo extraction, dermabrasion, deep chemical peels, and laser ablation.” 

Leung & Barankin, 2016

I’ve also seen very localised high percentage acids used to treat pores that have enlarged to the point that they won’t return to normal- TCA  on a hypodermic inserted into the pore. This is of course only to be attempted by a professional. 

If blackheads are your issue and you’re looking for a treatment, you need to come at it from 2 angles- preventing future blackheads and treating the ones you already have. 

Removing Blackheads

1. Extractions

Those skin vacuum devices are just going to damage blood vessels and nose peel masks might pull out some sebaceous filaments but it won’t unblock a stubborn impacted infundibulum. Just to mention at this point that sebaceous filaments are normal- those little dark dots on your nose, visible pores, they’re fine and normal. A blackhead is a pore that has gone rogue, it looks larger than the other pores and blacker.

Open comedones will require some sort of physical extraction before they improve unfortunately. Large blackheads are not going to go away with just skincare. Home extractions are generally not advised, you are better of seeing an experienced therapist, aesthetic nurse or doctor. If you absolutely have to do a home extraction, it’s really important to do it right-

• Sanitise your skin, hands and any instrument you use.
• Warm the skin to loosen things up
• Use a special tool designed to gently apply the correct pressure- a blunt stainless steel loop to apply gentle pressure to the pore and a little teeny tiny tweezers to pluck out the plug. This kit from Amazon has got some great tools-

• If it doesn’t come out easily leave it alone!
• Resanitise the skin. Hypochlorous acid is good for this

2. Chemical peels or Lasers–

Basically just destroying the skin itself and allowing it to heal anew

How to Stop Blackheads Coming Back

1. Spf– to prevent damage to collagen and elastin that keep the pores tight and small
2. Hydration– to ensure that the skin turns over properly
3. Retinoids- increase collagen
4. Acids- increase collagen and break down dead skin cells. Salicylic acid is the big one, easy to buy and well suited to the task as it is oil soluble and can penetrate the pore. 
5. Niacinamide and zinc can help regulate sebum production, reduce bacteria and inflammation
6. Avoid comedogenic ingredients- big side note on that

There is also the oil cleansing method we discussed in Episode 44, described by beauty blogger Fiddysnails which may help reduce pore size temporarily. I tried it at the time and it made my skin a bit sore. My pores looked clear but it’s not something I would put my skin through regularly.

It involves-

• Applying a BHA (salicylic acid or betaine salicylate) to the affected area for 30 mins
• Apply a clay mask over this as instructed
• Rinse off clay mask
• Apply an oil cleanser, leave on for 20 minutes
• Massage in the oil cleanser for 2 minutes 
• Wet hands and massage to emulsify oil
• Rinse and follow with water based cleanser

Clay masks are very popular, if you Google “How to get rid of pores”, recommendations for clay masks will be top of the search. Some people get on well with clay masks, but by their very nature they will suck the oil out of your skin. They soak up oil so they will give your skin a good clean but it’ll be dry and possibly irritated, inflammation is bad for skin’s health in general.

Product Recommendations for Preventing Blackheads

• The Ordinary Anhydrous 2%Salicylic– bit gentler than TO’s water based SA which came under fire for causing burns.
• The Ordinary Salicylic Masque– a non drying blackhead treatment combining clay and SA for max pore cleansing. This would be my top pick if you’re wanting to try a clay mask
• Cosrx Blackhead Power Liquid– If you found TOs SA too much for your skin try this. I’ve had it and found it really gentle and appeared to be effective. If your skin doesn’t like SA this is a great product. The active in Blackhead Power is Betaine Salicylate which is related to SA but kinder to the skin
• Niod masks– Flavanone Mid, Mastic Must and Sanskrit Saponins- MM is described as a pore minimising mask and it does help, it’s weird stuff but I quite like it. SS is meant to be a cleanser but I loved it as a deep cleaning mask. FM is my favourite mask ever, hydrating and somehow deep cleaning at the same time
• Retinoids– any retinoid will help, find a product which gives you the percentage and work your way up. Tretinoin has been the best thing ever for my pores, check out Dermatica for prescription strength retinoids (we have a discount code for our listeners SKINCAREWITHFRIENDS10)
• Lots of people swear by Paula’s Choice Skin Perfecting 2% SA

Referrences

Collier C, Harper J, Cantrell W, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008;58:56–59

Fiddy Snails Updated Pore Minimising Routine

Goulden V, Clark S, Cunliffe W. Post-adolescent acne: a review of clinical features. Br J Dermatol. 1997;136:66–70

Leung & Barankin, Favre Racouchot Syndrome https://www.consultant360.com/articles/favre-racouchot-syndrome 56-12 (2016)