- Blackheads & Whiteheads
This recommended article has written by Heather Brannon,
MD, for about.com
is the most common skin disease treated by physicians.
It is a chronic condition that affects over 85% of
adolescents and young adults. One study showed that
two thirds of teenagers with acne wanted to talk to
their physician about their acne, but only one third
all acne is the same. Simplistically, acne can be
divided into red bumps and blackheads/whiteheads.
This division is important because each type is treated
differently. Blackheads and whiteheads, known as comedones,
can be more numerous on the face and shoulders than
red bumps filled with pus. Good consistent skin hygiene
can help improve this condition. Therefore, knowing
more about what causes comedones and how to treat
them is a step towards clearer skin.
Does Acne Occur?
All acne is a disorder of the pilosebaceous unit,
which is made up of a hair follicle, sebaceous gland,
and a hair.
units are found everywhere on the body except the
palms, soles, top of the feet, and the lower lip.
The number of pilosebaceous units is greatest on the
face, upper neck, and chest. Sebaceous glands produce
a substance called sebum, which is responsible for
keeping the skin and hair moisturized. During adolescence
sebum production increases under the influence of
hormones. After about age 20, sebum production begins
oily substance produced by the sebaceous gland combines
with cells being sloughed off within the hair follicle
and "fills up" the hair follicle. When the
follicle is "full", the sebum spreads over
the skin surface giving the skin an oily appearance.
When this process works correctly, the skin is moisturized
and remains healthy.
arise when the sebum is trapped in the hair follicle.
For reasons that are still unclear, some hair follicles
become obstructed. The sebum is produced but gets
trapped on the way out. A certain bacteria called
Propionibacterium acnes multiplies in this trapped
sebum and causes a tiny infection. This leads to inflammatory
acne, or red bumps and pustules. In some follicles
the bacteria does not cause an infection, but rather
changes the lining of the hair follicle and forms
plugs called comedones.
Blackheads, also known as open comedones, are follicles
that have a wider than normal opening. They are filled
with plugs of sebum and sloughed off cells and have
undergone a chemical reaction resulting in the oxidation
of melanin. This gives the material in the follicle
the typical black color.
Whiteheads, also known as closed comedones, are follicles
that are filled with the same material, but have only
a microscopic opening to the skin surface. Since the
air cannot reach the follicle, the material is not
oxidized, and remains white.
The key to skin care for acne is consistency. An overnight
cure has not been found. But using good skin care
methods aids in the daily, steady improvement of follicle
health. Since acne is not caused by eating certain
foods, restricting the diet is not helpful. Since
it is also not caused by "dirty" skin, excessively
scrubbing does not help and can even make the skin
more irritated. The best skin care for comedones consists
of once-a-day cleansing with a mild soap or facial
scrub to aid in the removal of excess sebum and dead
skin cells. Oil-based makeup should not be used since
these can contribute to the buildup of oil in the
follicles. Water-based makeup labeled as non-comedogenic
can be used safely.
Treatment of whiteheads and blackheads takes time.
Most treatments take several weeks to months before
a noticeable change is seen.
peroxide has an antibacterial effect and may also
decrease the chemical reaction that changes the lining
of the hair follicle. This may help reduce the plugging
that causes comedones. Benzoyl peroxide may be used
for a mild case of comedones or to help prevent formation
Tretinoin (Retin-A, Avita, Renova) is the mainstay
of treatment for whiteheads and blackheads. Tretinoin
is a derivative of vitamin A and works by increasing
cell turnover and reducing the "stickiness"
of the sloughed cells. It causes expulsion of the
plugged material and converts closed comedones into
open comedones. The material in these newly converted
open comedones can be easily extruded. Tretinoin can
be irritating, so specific instructions on how to
use it can be found here.
have not been shown to help whiteheads or blackheads.
Isotretinoin (Accutane) is used for severe cystic
acne and has many side effects. It is very effective
for comedones when used properly, but is not usually
prescribed for mild acne of either type.
Extraction may be used by a health care provider on
open comedones. This process is performed using a
device called a comedone extractor. This is a small,
metal, circular instrument that is centered on the
comedone and pushes down the surrounding skin, causing
the plug to extrude.
Whiteheads and blackheads are types of acne that affect
many people. There are good treatment options available,
so there is no need to "suffer" with this
condition in silence. A primary care provider can
initiate treatment for acne and follow mild to moderate
cases. Severe cases or those resistant to treatment
should be seen by a dermatologist.