You know a blackhead when you see one. The center of the blackhead is the dark grey, brown or tan material which is stuck inside a pore. They can range from being as tiny as a point to being much much larger. You might have found it irresistable to try to give it a good squeeze to get the material out from between your fingers and nails. But be careful! You don’t want to do more harm than good.
Here are some FAQs I often get about blackheads.
What makes a blackhead black?
While not truly black, the center of the blackhead is often dark in color. This darkening occurs when the debris which is normally whitish or ivory is exposed to the air and oxidizes. This oxidation process darkens the debris.
What is that material inside a blackhead anyway? What is a blackhead made of?
The material inside a blackhead is a mix of a variety of substances normally made and shed through your pore. They may include sebum as well as dead skin cells.
How do I get rid of blackheads?
You may have heard of people extracting blackheads or you may have tried it yourself as well. In general, it’s best to leave this to a trained professional to minimize the risk of scarring, inflammation, infection, and further skin damage.
There are medications which can also shrink pores and the blackheads. Retinoids are a type of medication that could be used for this. There are over the counter retinoids such as retinol and adapalene/Differin as well as prescription retinoids. These can be irritating so start slowly at first and slowly increase until you can tolerate it. If you’re pregnant or trying to get pregnant, your physician may advise you to hold off on using retinoids.
Yes, it’s real. Being on a progestin only contraceptive like the Mirena IUD can trigger hormonal acne. Yes, the type of acne that can hound you even though you’re in your 20s, 30s or 40s etc and even though you thought you had said goodbye to acne forever. Yes, the type of acne that shows up as pesky red uncomfortable bumps of your chin and jawline. Yes, the type of acne that can leave a little blemish – maybe a pink or dark spot – even when it goes away. Yes, the type of acne where maybe you have one bump that just keeps coming back — like a bad teen movie sequel – Parts I, II, III and more.
So what should you do?
You could have your physician remove your IUD and that could help your hormonal acne. However, that’s not a practical option for everyone. After all, there’s a reason you chose to have it placed in the first place. There are practical benefits to having an IUD after all.
You could also see your dermatologist. Most of the time, we are able to “treat through” the hormonal effects of the Mirena IUD. We can tailor your acne treatments to your acne. This may involve a medication called spironolactone which helps address hormonal acne. We may use other meds in combination with spironolactone or even choose a different med all together.
So in short, don’t despair! If your Mirena comes along with a tag-along called acne, it may be time to see your dermatologist (or get your Mirena removed)!
Differin (adapalene) gel is now available over the counter. This is great news since it means you no longer need a prescription for it. Also, the prices over the counter (e.g. at your local Walgreens or CVS) have been quite reasonable. Or you can purchase online also.
So what is Differin (adapalene) used for?
Differin is marketed for acne. It can be used in combination with other products or on its own depending on the type of acne you have and the severity of your acne. It is also particularly good for comedonal acne (eg whiteheads or blackheads) which other types of medications might not address.
Differin is also a topical retinoid and as such it may be helpful for reducing appearance of wrinkles, and helping with skin texture and pigmentation issues. (You may have heard of using retinols for anti-aging.) There are a lot of topical retinoids out there though so definitely consult with your dermatologist if you’re wondering whether Differin is right for you.
Are there side effects to using Differin?
Any medication has potential side effects. Most commonly, people will report dryness, redness, or flaking. This is actually to be expected to a degree. We recommend spacing out use to every other night or mixing with some moisturizer if you need to. Your skin tends to get used to the medication after a month or so. You may also need to take it easy on other products you are using (eg benzoyl peroxide or salicylic acid which can also be drying and irritating)
Also, if you are pregnant or trying to get pregnant, you should discuss with your obstetrician before using this medication (it is still a medication after all!) Many/ ?most will recommend that you stop your topical retinoid.
Spironolactone is an oral medication that is used to treat hormonal acne. Although it is often thought of as a blood pressure medication, it is also effective for hormonal acne. Hormonal acne manifests in women as acne that has a predilection for the jawline and chin. Additionally, the acne often flares before periods. Patients with polycystic ovarian syndrome (PCOS) often have hormonal acne as well. Do you have hormonal acne? If so, talk to your medical provider. There are side effects and contraindications to this medication so it’s important to discuss whether this medication is appropriate for you. Additionally, don’t be surprised if the effect of the medication does not kick in immediately. It may take a few months or further dosage adjustments to see an effect!
By Jodi LoGerfo, MSN, APRN, BC, FNP-C
“Yay! More zits,” said no one ever, upon waking up in the morning and looking in the mirror. Acne can cause a lot of anxiety and even depression depending on how bad it is. The good news is there is help and you are not alone.
Actually, acne vulgaris is the most common skin disorder in the United States and nearly 85 percent of all people have had acne at some time during their lives, according to statistics from the American Academy of Dermatology. Acne most often begins during teen years (as we can all attest), but can follow into adulthood. It occurs most often on the face, chest, and back which are areas that have a large number of oil glands.
Acne lesions are caused by a combination of overactive oil glands that produce oil, along with the build-up of dirt and bacteria and irregular shedding of dead skin cells. Contrary to popular belief, acne is not caused by chocolate or dirt or eating greasy foods. Although there is a link between the amount of oil produced in the skin and acne, the amount of oil is not created by food. Instead it is caused by changing hormone levels like those during puberty or cyclical hormonal changes in a female’s menstrual cycle.
How a simple pimple forms
When an oil gland opening (called a pore or hair follicle) becomes clogged with skin’s natural oils, dirt, dead skin cells and bacteria, a comedo forms. We often call those blackheads (open comedo) or whiteheads (closed comedo). Additionally, the surrounding skin can respond by becoming red and inflamed, appearing as small red pimples (pustules or papules) or it can get infected and cause deeper, large and more painful nodules and cysts. These larger, deeper cysts and nodules can cause scarring, so you always want to get treatment from a dermatologist to avoid permanent pits and discoloration.
How you can make pimples worse
While you can’t “cause” your own acne, there’s lots you can do to make it worse:
- Oily, moisturizing products, cosmetics and many sunblocks can further clog up pores causing excess oil to get trapped. Look for formulas that say, “non-comedogenic” on the label, which means, “non-pore-blocking” or use cosmetics that are oil-free.
- Heat, humidity and excessive sweating amplify skin inflammation. Be sure to wash off excess sweat, dirt and oil after excessive activity, especially after exercising or in the summer months.
- Picking or squeezing acne lesions with fingernails or other objects causes acne to look worse and may result in further infection and deeper, permanent scarring. Lesion removal (called acne surgery) should only be done by a medical professional.
How your dermatologist tries to stop your acne in its tracks
There are various approaches dermatologists use for effectively treating acne. Often, we use a combination of methods at the same time to attack acne in different ways. These include:
- Acne Surgery (including corticosteroid injections) performed in a dermatologist’s office to extract blackheads and to open and drain whiteheads. This helps prevent pustule and cyst development, which are the main causes of acne scarring. Inflammatory lesions (pustules, pimples and cysts) are often injected with low potency cortisone to decrease inflammation and help an acne lesion disappear quickly. These intra-lesional injections also help decrease the remaining discoloration that can occur when acne is resolving.
- Isotretinoin, an oral prescription medication can permanently help severe or troubling cystic acne (you may remember it by the brand name Accutane®) or poorly responsive acne that improves less than 50% after 6 months of combined traditional treatment. About 85% of patients treated with isotretinoin see permanently clear skin after just one treatment course.
- Chemical peel (e.g., TCA) is a non-toxic chemical (trichloroacetic acid) that is applied to the skin. It has been used for over 20 years and works by drying up the top layers of skin cells, causing them to peel off. The old skin is removed and a new undamaged layer is revealed.
- Oral antibiotics can help manage the severity and frequency of acne outbreaks. There are a number of oral antibiotics used depending on the type of acne you have.
- Topical lotions, creams or gels containing benzoyl peroxide, antibiotics (e.g., clindamycin and erythromycin) or salicylic acid are known to kill bacteria, unplug pores, exfoliate and decrease inflammation.
- Topical retinoid medications help other acne medications absorb better, have an anti-inflammatory effect and also speed up cell turnover so pores can’t clog. These include Retin-A® (tretinoin), Differin® (adapalene) and Tazorac® (tazarotene).
- Laser or light treatments (e.g., Blue Light, Infrared Light) are designed to target and eliminate acne-causing bacteria and decrease inflammation.
- Androgen blockers (e.g., spironolactone) have been used in acne for years. They decrease the amount of oil that is produced by oil glands and are also effective in those female patients who also have excess hair growth.
- Oral contraceptives have been shown to improve acne by normalizing hormonal spikes and reducing testosterone and progesterone, the hormones responsible for hormonally-induced acne. This may be especially helpful in women with acne along with menstrual irregularities or hirsutism (facial hair growth).
How you can help your acne regimen work better
- Read and follow any label, package or doctor’s instructions exactly for any acne product or medication you are using. If medications are to be applied at different times of the day or in a particular order, follow the regimen exactly because that’s how it is designed to work.
- Treat the acne-affected area (e.g., face) entirely, not just individual pimples (don’t spot treat), so the medication can prophylactically prevent future breakouts.
- Never pick, pop or squeeze your pimples because that often causes more damage to the pore resulting in permanent scars, pits and discoloration. A dermatologist can offer you acne surgery done properly by a medical professional in the office.
- Keep your hands (and the bacteria on your hands) away from your face. Constantly touching your face can cause more infection to inflamed, irritated or open skin.
- Reduce the amount of oily face makeup. Try to use a makeup that is oil-free and always wash it off at night before going to sleep.
- Gently cleanse the acne-affected area; scrubbing inflamed skin (whether from acne itself or as a side effect to acne treatment) can be more irritating.
- Use a cleanser your dermatologist recommends for your specific skin type twice per day and use warm (not hot) water.
- Avoid using over-the-counter alcohol-based astringents, which strip your skin of it’s natural oils, and stick to only products and medications your dermatologist recommends.
- Avoid excessive sun exposure as many acne medications (including Retin A®,oral antibiotics and isotretinoin) make your skin more sun-sensitive. Always use a non-comedogenic, broad spectrum sunscreen recommended by your dermatologist daily to prevent your acne lesions from becoming darker and pigmented.
- The most recent research on acne and inflammation found that people with acne (and more severe acne at that) had lower levels of antioxidants in their bloodstreams and that both oral and topical antioxidants can potentially be used in treating acne. That means a more nutritious diet of fruits and vegetables is more important to acne patients than we thought, and can only help.
Finally, acne treatment regimens usually require 6-8 weeks of treatment before results are noticeable. Don’t give up and stop treatment if you do not see faster results and don’t stop treatment if you notice some preliminary clearing. After 8 weeks, if you see no improvement, your dermatologist will adjust your treatment or suggest different therapies to try.
Keep it up!
Jodi LoGerfo, MSN, APRN, BC, FNP-C is a Family Nurse Practitioner
Board-Certified in Family Medicine and Dermatology at the Orentreich Medical Group in New York City. She runs a patient Question & Answer blog at Orentreich.com/blog.