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How do I get rid of blackheads? Should I squeeze them?

How do I get rid of blackheads? Should I squeeze them?

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Jenna C. Lester is a dermatologist and director of the Skin of Color program at the University of California, San Francisco.

Q: I have blackheads on my nose, chin and chest. Should I squeeze them? Does applying moisturizer make them better or worse?

A: Although it’s tempting, squeezing blackheads with your fingers is a bad idea. This can cause trauma to the skin and lead to hyperpigmentation or scarring.

Instead, I suggest you try to get rid of them in one of two ways: You can see a dermatologist or esthetician for extraction, which is the process of removing blackheads with special tools that minimize damage to the surrounding skin. This is a great option if you want to get rid of them quickly. But it can be expensive, costing around $100 to $200 per session.

Or you can try topical treatments, which will take longer but are cost-effective and will do the most for you in the long run, as they can prevent future blackheads from forming. They are also readily available at most drugstores and at a variety of prices, so you can find the best option for your budget and skin.

Salicylic acid chemical peels can also be helpful in treating comedonal acne. Be sure to see a practitioner experienced in exfoliating, especially if you have deeply pigmented skin, as exfoliation can be irritating and cause discoloration.

To understand which treatments are effective, it helps to know how and where blackheads—technically a type of acne—form.

Blackheads form in a part of the skin called a follicle, commonly called a pore, which is a channel that starts under the skin and opens on its surface. A hair protrudes from the pore opening, but it is usually so small that it cannot be seen.

There are millions of pores covering your body. Each pore has a gland that produces oil, which travels to the pore opening and functions as a moisturizer for the skin and hair. Dead skin material is also extruded through the pores, where it can be washed away.

But sometimes oil and dead skin can build up inside the pore and at its opening. This causes a blockage that leads to more oil build-up. When that oil and dead skin material is exposed to air, it turns black and creates the appearance of a blackhead.

Blackheads can develop anywhere, but are most commonly found in areas with the most oil glands, such as the back, chest and face.

They can cause scarring, which usually appears as tiny “ice” scars on the skin and can be associated with a type of acne called comedonal acne. With this type of acne, you may see blackheads along with closed comedones – also known as whiteheads, which are small skin-colored bumps. These are also clogged pores, but instead of being open to the air like a blackhead, they are closed, so the material inside doesn’t turn black.

Some moisturizers can make blackheads worse

Blackheads usually appear during puberty due to increased production of hormones, especially androgens. These hormones stimulate the glands to produce more oil, which in turn leads to clogged pores. Teenagers aren’t the only ones with acne. Hormonal changes that occur throughout life, such as those during pregnancy or menopause, can lead to adult acne.

Many of my patients use oils in their hair, which can end up on the face and cause blackheads. Oils applied directly to the skin or through moisturizers can cause the same result. If you’re prone to developing blackheads, look for moisturizers that are labeled as non-comedogenic (meaning they don’t clog pores) or oil-free.

Topical treatments that really work

Most acne and blackhead treatments require patience. It can take three months to see improvement, and consistency is key.

retinoids: Retinoids can help address the oil production and dead skin buildup that cause blackheads. They are also effective in treating discoloration that can occur due to the formation of blackheads, which is more common in people with darkly pigmented skin.

If you opt for a prescription-only retinoid such as tretinoin, you should discuss the appropriate concentration with your dermatologist. Adapalene 0.1 percent gel is available over the counter.

Retinoids can be applied anywhere on the body where acne exists, but most are intended for use on the face. They can cause irritation, so it’s important to use only a small amount and start using the product a few times a week. Use a moisturizer for dryness and wear sunscreen as it can also make your skin more sensitive to the sun.

benzoyl peroxide and salicylic acid: Both benzoyl peroxide and salicylic acid can help exfoliate the skin and reduce oil production. They are sold as a cream, gel or wash.

I usually recommend washes in concentrations of 4 to 10 percent — because they treat the entire surface — but some patients prefer to use them as spot treatments to speed up the resolution of a particular stain.

Like retinoids, they can dry out the skin, so they should be introduced gradually and paired with a moisturizer when needed.

Benzoyl peroxide can bleach your clothes or towels, so be aware of this after application or choose products with salicylic acid instead.

suntan cream: Sometimes blackheads can develop as a long-term consequence of unprotected sun exposure in a condition called Favre-Racouchot. It is not known why this happens, but sun damage is thought to cause pores to enlarge.

Protect your skin by wearing a wide-brimmed hat if you are outside for extended periods between 10am and 4pm. Wear a sunscreen of at least SPF 30 daily and reapply regularly

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