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Under Your Skin: The Inside Story on Blackheads and Whiteheads

Nearly everyone has them at some point in life, but that doesn’t make having pimples any easier. Whether you have whiteheads, blackheads or an inflamed acne bump, you’d like them to clear up.

The problem starts when greasy secretions from the skin’s sebaceous (oil) glands combine with dead skin cells. This excess oil (called sebum) and the dead cells stop up the tiny openings of hair follicles on your face, shoulders or back. “Then the bacteria that occur naturally in healthy hair follicles start to accumulate, clogging up the pore even more,” explains Jennifer Jordan, physician assistant at Sanova Dermatology in Austin, Texas. The resulting plugs, called comedones, can be open or closed to the outside.


“Blackheads are open comedones” shares Jordan. “The pore is stretched open with the clogging plug,” she continues. Because the plug is exposed to air, the plug material oxidizes and darkens, causing a blackhead. Blackheads are slightly raised or flat with a dark center.


If the affected pore opening stays small, the follicle becomes filled with bacteria and sebum (oil). This is a closed comedo – the plug material does not contact air and it remains white. A whitehead is pale in color and slightly elevated.


Both blackheads and whiteheads are mild forms of acne. “Although the main cause of acne is unknown, heredity and hormones both influence how a person is affected,” Jordan states. While some lesions stay small, others can develop into swollen tender lumps, when an overload of bacteria accumulates in a pore, secreting enzymes that break down sebum and cause inflammation.


Although it may be tempting to squeeze or pop a blackhead or whitehead, the best approach is to keep hands off! “Not only will squeezing irritate the skin, it may also spread bacteria to other pores or cause scarring,” Jordan warns. Some other preventative ideas are to use oil-free and non-comedogenic makeup and sunscreen, change pillowcases weekly and wash twice a day with a gentle non-drying cleanser. Do not underestimate the benefit of washing one’s face twice a day. It is also recommended that you wash your face as soon as possible after any physical activity: workouts or sporting event to help prevent the worsening of comedonal acne.


Early treatment is the best way to prevent infection. Over the counter face washes containing salicylic acid or benzoyl peroxide help open the pores, flushing out bacteria, dead cells and oil. A dermatologist or physician assistant may also prescribe topical medications, antibiotics and retinoids, or in more severe cases, oral antibiotics.

There are also in office procedures that can help to clear acne prone skin: acne facials, hydrafacial and chemical peels that may help to provide a jump start in the improvement in comedonal acne…. AND –  Sometimes a little jumpstart in the improvement will encourage compliance with a newly started regimen.

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Are you experiencing blackheads or whiteheads, or are you interested in treating your stubborn acne? Contact us today and set up an appointment!