Ugh, blackheads. They’re like party crashers who taunt you while making their presence felt.
We know them as black spots on our face, but what exactly are they?
“Blackheads, the colloquial term for open comedones, are a type of acne caused by an overproduction of oil,” says Dr Teo Wan Lin, dermatologist of TWL Specialist Skin & Laser Centre at Royal Square Novena.
They are usually found on the T-zone of the face (forehead, nose, and chin) but can also appear on the back, chest, arms and shoulders (sorry, they do!). They occur wherever there is a great density of hair follicles (sacs from which hair grows) and their attached sebaceous (oil) glands.
“Everyone has sebaceous (oil) glands and they are affected by hormonal changes. Overproduction of oil happens for women before their period, as well as for teenagers and kids who are stressed out,” says Dr Patricia Yuen, consultant dermatologist of Patricia Yuen Dermatology Medical & Cosmetic Skincare at Paragon.
Blackheads are formed when the buildup of keratin (a hard protein that protects skin from harmful substances and infection) and oil around the follicle is oxidised and turns blackish because the oil itself is oxidised by air, says Dr Teo.
As therapeutic as it may seem to watch Dr Pimple Popper extract blackheads, you should not pick, squeeze or pop them (unless you’re Dr Pimple Popper) because it can lead to inflammation and potential scarring.
Dr Teo adds that the bacteria on your fingers might cause an infection, leading to inflammation and formation of cystic acne.
Cystic acne is a severe form of acne that warrants specialist dermatologist care as it can leave terrible scars and can be secondarily infected leading to cysts and abscesses (collections of pus under the skin) if left untreated.
So how do you get rid of blackheads?
Instead of picking at those black spots, try using topical products that include salicylic acid to clean out pores and benzoyl peroxide to kill the bacteria that causes acne.
“You have to use a proper cleanser that has salicylic acid or lactic acid to help exfoliate the dead skin from the surface of the skin. Use a moisturiser for oil control and topical medication to help to target the problem,” says Dr Yuen.
Dr Teo agrees. “Look for the labels ‘’dermatologist-tested and formulated’ for maximum clinical efficacy. Overall, a good cleanser should leave the skin feeling clean (not squeaky clean though as this usually means over-cleansing) and also still soft and moisturised. It’s a misconception to go for really ‘strong’ harsh cleansers because it generally strips the skin of all moisture with strong lathering agents like SLS (Sodium Laureth Sulfate) leaving the skin red and flaky while the acne problem doesn’t go away.”
Look out for these ingredients when looking for products to treat your blackhead problem.
It sloughs off dead, surface-level skin, but because it is oil-soluble, it also penetrates deeper than other water-soluble face acids (like glycolic, for example) to do a more thorough clean-up of the oil within pores. In short, it not only unclogs blackheads that have already formed, but helps prevent those skin holes from becoming re-clogged all over again.
We often look to retinoids to get smooth the skin, but they are good for banishing blackheads, too. In addition to preventing those future clogs and clumps of keratin, retinoids increase skin cell turnover and recovery times.
Compared to salicylic acid, it is not as skilled at preventing and inhibiting the buildup that eventually forms a blackhead, but it has anti-bacterial powers and ability to calm inflammation around pores that are being treated.
Which blackhead treatment should you go for?
Before you decide which treatment to go for, know that blackheads are completely normal and, unfortunately, not 100% removable. You may want to start with over-the-counter treatments and if you are not satisfied with the level of control, then see your board-certified dermatologist, who can prescribe stronger prescription medications or discuss in-office procedure options.
“I personally treat blackheads using a specialised machine with a vacuum handpiece that gently extracts blackheads without pain or scarring, at the same time, infusing a customised blend of fruit-based acids that exfoliate the skin,” says Dr Teo.
Dr Yuen, on the other hand, says her patients usually do medical facials to exfoliate their skin.
The biggest difference between a medical facial and its counterpart in a spa or beauty salon is that it is performed in a doctor’s office using medical-grade products and tools, tailored to your skin’s needs.
Depending on your ailments or skin conditions, the steps will be very similar to that in a spa or beauty salon, which includes cleansing, exfoliating, extractions, and moisturising, but on a more intense level.
“If you leave them alone, there is a chance of secondary infection in which these blackheads develop into active pimples. Otherwise, they remain as black dots on the skin which may be rather unsightly,” says Dr Teo.
Do pore strips and toner work?
You’ve probably tried a pore strip at least once in your life, but if you’re still using those, time to lay off them. Nose strips or pore strips remove top layers of dead skin cells and blackheads by using a very strong adhesive. “They help to physically remove the bits of keratin and oxidised oil but it tends to accumulate again and the problem recurs,” says Dr Teo.
Does toners help then? Well, contrary to the popular belief that an astringent toner can “close” the pores and reduce blackheads, the fact is, it doesn’t. Dr Liew Hui Min of HM Liew Skin & Laser Clinic at Gleneagles Hospital and Parkway East Medical Centre says, “Toner will not close the pores. Toner helps to clean the debris that got plugged into the pores.”
Dr Teo agrees: “The skin feels dried up instantaneously and the appearance of blackheads is subdued due to the temporary removal of debris. However, in this instance, the skin decides that it is dehydrated and paradoxically, produces even more oil”.
She also cautions against traditional facial blotters to remove oil. “…it can cause the skin to paradoxically feel ‘dehydrated’ and the oil glands to produce even more oil to compensate. For patients with greasy skin in the day, it may help to just wash the grease off with a good cleanser rather than keep blotting. Either that, or use a fragrance or alcohol-free baby wipe to wipe off the grease before touching up makeup,” says Dr Teo.
Because natural hormonal changes in the body lead to excess skin oil, clogged pores and ultimately blackheads, it’s almost impossible to go through life without a few breakouts. Although blackheads are bothersome, they don’t pose health risks, and the good news is, most people can get rid of blackheads with topical products that contain salicylic acid and benzoyl peroxide.