Blackheads / Comedones

What are Blackheads or Comedones?

Blackheads or comedones is a skin condition wherein pores of the skin get clogged with sebum. Sebum is an oil-like substance secreted by the sebaceous gland that keeps the skin supple. Blackheads are a symptom of acne, a combination of pimples and blackheads.

Blackheads are associated with the pilosebaceous unit, which includes a hair follicle and sebaceous gland. These glands are mainly present on the face, nose, chest, back and shoulders. Hair follicles are made up of keratin and the excess sebum blocks the opening of the follicle, resulting in plugs. These sebum filled plugs are called comedones.

What are the Causes of Blackheads?

Blackheads occur naturally due to certain hormonal changes in the body. There is a common myth that blackheads are caused by dirt. No, it's not true. When the hair follicles filled with sebum get exposed to air, it gets oxidized and appear black in color. These opened comedones are termed as blackheads. There is an another type that is not exposed to air and remains closed and white in color. These closed comedones are termed as whiteheads.

The most common causes of blackheads or comedones are,

• Puberty: Puberty causes hormonal changes in the body which in turn increases the production of sebum by the sebaceous glands.
• Skin Products: Makeup products, skin cream and lotion can block the skin pores resulting in blackheads or acne. They are called comedogenic products example, Vaseline.

• Genetics: Genes also play a role in the formation of blackheads or acne. Certain ethnic groups like Africans, African-Americans are more susceptible to blackheads.
• Age: Anybody can get affected with blackheads or acne. But teenagers are more prone to blackheads or acne due to the bodily changes that occur during this period.
• Faulty Hair Growth: Hair follicles may not emerge properly and block skin pores, leading to accumulation of sebum and inflammation on the skin.
• Androgen: This male sex hormone triggers sebum secretion in excess triggering blackhead formation. This hormone production reduces in boys during adolescence.
• Drugs: Steroids, birth control pills also trigger the formation of blackheads.
• Lifestyle factors: Alcohol and caffeine increase size of the pores and trigger oil glands on the skin. Smoking damages skin leading to dead cells formation.
• Others: Scrubbing and cleaning skin forcibly and frequently will cause irritation on the skin and block pores. Heavy sweating can also lead to blackheads formation.

What are the Symptoms of Blackheads?

Blackheads are open comedones and a milder form of acne. They do not cause any inflammation or pus formation on the skin. Therefore, they are less painful compared to cystic acne.

The prominent symptoms of blackheads include,

• Enlarged pores
• Yellow to black color in appearance
• Tiny dark bumps on face, cheeks and nose
• Irritation
• Stickiness
• Bulging of pores due to sebum
• Increased stress and psychological problems

How Do You Treat Blackheads?

Blackheads can be treated at home with simple natural remedies. Also, certain skin care products rich in salicylic acid can treat blackheads. But activities like poking, pinching, bursting, scrubbing, squeezing a blackhead must not be done as it worsens the condition resulting in inflammation or cystic acne.

Based on the skin type, skin sensitivity, allergic reactions and severity of blackhead the following treatments can be chosen for effective remedy.

Home Remedies: Natural substances can do wonders for your skin. Simple methods to get rid of blackheads include,

• Lemon Juice: Blackheads are open comedones that can easily react with air and turn black. Lemon juice acts as an astringent and lightens up the skin. Damp cotton ball into the squeezed juice of half a lemon. Apply to the affected areas at bedtime and wash your face using lukewarm water in the morning.
• Baking Soda: Exfoliation is a process of removing dead cells from the skin. Baking soda is an effective treatment for blackheads. Mix 2 tbsp of baking soda with water into a paste and rub it gently on the affected skin. After drying, wash it with lukewarm water. Do this for a week to get rid of blackheads completely.

Chemical Exfoliators: As far as it comes to acne or blackheads, the main ingredient one should look for is keratolytic. These products clear blackheads effectively and include salicylic acid, glycolic acid and benzoyl peroxide. Commercial exfoliating gels, creams and lotions rich in these three ingredients are available as a single one or in combination.

Chemical ingredients can cause allergic reactions for some skin types. So, it is best to select these products based on your skin type and salicylic acid is considered to be more effective and less allergic. Be careful when you use products rich in benzoyl peroxide.

Retinoids: Retinoids are Vitamin A derivatives that are known to effectively treat and prevent blackheads. These are available as prescribed formulations and over-the-counter drugs. Retinoids work on the receptors to improve skin formation, where the outer layer of the skin gets thicker and the dead layer of keratin material sheds more efficiently. They must be used regularly for four to six weeks; wherein the side effects lessen and the skin appears more radiant and clear.

Pore Strips: Pore strips are commercially available blackhead removers or peelers. They have a synthetic adhesive that sticks on the blackhead and removes it by peeling. These strips do not prevent the formation of blackheads but only remove it. Natural pore strips can be homemade using cinnamon, milk and honey.

Dermatologists: It is best to consult a dermatologist to check for the severity of blackheads as they are a prominent symptom of acne. Blackheads can lead to inflamed acne or cystic acne which needs professional care and treatment. They are extremely painful and only a dermatologist can prescribe medications or treat it effectively.

Drugs:

• Drugs like tretinoin (Avita, Retin-A), adapalene (Differin) and tazarotene (Tazorac, Avage) prevent plugging of the hair follicles.
• Oral antibiotics like tetracyclines, benzamycin prevent inflammation.
• Spironolactone (Aldactone), an anti-androgen drug controls sebum production.
• Combined oral contraceptives like Ortho Tri-Cyclen, Estrostep and Yaz may help control blackheads in women who tend to have flare-ups before menstruation.
• Isotretinoin tablets are effective medications for severe acne and it will be recommended by doctors only if blackheads worsen.

Health Tips

• Wash your face gently and frequently to remove excess oil on your skin.
• Never sleep with makeup. Ensure you remove it as soon as possible.
• Eat plenty of fresh fruits and vegetables and avoid high glycemic index (GI) foods.
• Never squeeze a pimple, blackhead or acne.
• Consult a dermatologist before taking medications.
• Don't freak out and stress yourself if you have an acne or blackhead.

References:

1. Acne - (https://www.nhs.uk/Conditions/Acne/Pages/Treatment.aspx)
2. Comedo - (https://en.wikipedia.org/wiki/Comedo)
3. About Acne - (http://www.mayoclinic.org/diseases-conditions/acne/basics/treatment/con-20020580)

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