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What Causes Blackheads?
Blackheads, also known as open comedones, form when dead skin cells, sebum, and bacteria become trapped in a hair follicle. This is due to a clogged pore that doesn’t let the skin cell and oil debris escape. As a result, a blackhead forms. They can appear on the nose, chin, forehead, chest, and other areas of the body. To prevent blackheads from forming, it’s important to regularly wash your face with a gentle cleanser to remove dirt and oils. Exfoliating two to three times per week can also help to keep pores unclogged and avoid the buildup of dead skin cells. However, if blackheads do form, there are ways to treat them. One method is popping or squeezing the blackheads. If you decide to pop your blackheads, it’s important to take caution and follow Dr. Sandra Lee’s instructions for the safest way to get rid of pimples by popping blackheads. First, you should use clean hands and fingers (or a sterile cotton swab) to gently press around the sides of the blackhead. If done correctly, this will cause the blockage inside the pore to come out without damaging your skin. Life with acne can be annoying, but we can help you clear your skin with our acne products. A consultation with one of our skin care experts is the best way to determine which of these treatments will help brighten your skin and get rid of acne for a long time. After your first in-studio acne treatment, one of our experienced estheticians can review a variety of products with you to help you customize products designed to fight acne and improve your skin. Our team of Holladay dermatology and aesthetic experts can uncover the root cause of your acne flare-ups and provide you with the right treatment that will work better and faster than products available on pharmacy shelves. Dr. Fua can incorporate all of these treatment options into your acne treatment plan, depending on what works for your skin.

If topical treatment alone does not improve acne, or if acne is severe or extensive, oral medications are the best option. If you’ve tried several topical medications without success, or if your condition is severe, oral acne medications are usually the next step in the treatment process. Treatment usually includes oral antibiotics and applying a prescription gel or topical cream to the skin.

1. Excess Sebum Production

The sebaceous glands, located in the skin, are responsible for producing sebum, an oily substance that helps keep the skin moisturized. Excess sebum production is one of the leading causes of blackheads. The overproduction of sebum can lead to clogged pores, providing an environment for blackheads to form.

How Excess Sebum Contributes to Blackheads:

• Hormonal Fluctuations: During times of hormonal changes, such as puberty, menstruation, pregnancy, or using birth control, sebaceous glands become more active. The increase in hormones like androgens (testosterone) triggers the sebaceous glands to produce more sebum.
• Diet and Sebum Production: Certain foods can influence sebum production. Diets high in refined carbohydrates (e.g., sugars, white bread) and dairy products have been linked to higher levels of sebum production, which can contribute to clogged pores.

Reference:

• Journal of the American Academy of Dermatology (2017) reports that excess sebum production is a key factor in acne and blackhead formation. Hormonal fluctuations during puberty or menstruation are often associated with increased oil production.
• A study published in Dermato-Endocrinology (2015) emphasizes the impact of dietary factors, particularly high-glycemic index foods, on sebum production and acne.

2. Clogged Hair Follicles

A blackhead forms when hair follicles (pores) become clogged with a combination of sebum and dead skin cells. Normally, dead skin cells are shed and replaced by new skin cells. However, when this shedding process becomes disrupted, dead cells accumulate in the pores and contribute to the formation of a plug inside the follicle.

Key Factors Leading to Clogged Follicles:

• Impaired Skin Cell Turnover: The natural process of skin cell turnover slows down in some people, leading to the buildup of dead skin cells inside the follicle. These dead cells mix with sebum and form a plug.
• Excessive Use of Exfoliants: Over-exfoliation of the skin can irritate it and lead to an imbalance in cell turnover, resulting in more clogged pores and blackheads.

Reference:

• Dermatologic Therapy (2018) explains how impaired desquamation (the shedding of dead skin cells) leads to a buildup of cells within the hair follicle, which can result in blackhead formation.
• British Journal of Dermatology (2019) highlights the relationship between keratinization (skin cell formation) and blackhead development due to clogged follicles.

3. Bacterial Growth

While blackheads are considered non-inflammatory acne lesions (unlike pustules or cysts), the presence of bacteria inside a clogged pore can exacerbate the condition. The bacteria commonly involved in acne, particularly Propionibacterium acnes (P. acnes), can thrive in the oily, blocked environment of a follicle, potentially leading to further inflammation.

How Bacteria Contribute to Blackhead Formation:

• Bacteria feed on the sebum and other organic matter inside the follicle. This may lead to increased inflammation, which can contribute to the development of other types of acne, like papules or pustules.
• While bacteria do not directly cause the formation of blackheads, they can worsen the condition by creating an environment that promotes inflammation.

Reference:

• A review in British Journal of Dermatology (2019) discusses how P. acnes bacteria can thrive in blocked follicles, exacerbating acne development, including blackheads.
• The Journal of Clinical Microbiology (2018) explains how bacteria in clogged pores can contribute to secondary inflammation in acne, although bacteria are not the initial cause of blackheads.

4. Poor Skincare Practices

Certain skincare habits can either increase the risk of clogged pores or worsen existing blackheads.

Examples of Poor Skincare Habits:

• Over-washing or Harsh Scrubbing: While it’s important to keep skin clean, excessively washing or scrubbing can strip the skin of its natural oils. In response, sebaceous glands may increase sebum production to compensate for the loss of moisture, leading to more clogged pores.
• Comedogenic Products: Skincare or makeup products containing comedogenic ingredients (those that clog pores) can contribute to blackhead formation. Common comedogenic ingredients include lanolin, mineral oil, and petrolatum.

Reference:

• American Academy of Dermatology (2020) advises against using overly harsh exfoliants or comedogenic products, as these can lead to clogged pores and worsen blackhead formation.
• A study in Journal of the European Academy of Dermatology and Venereology (2017) notes that using non-comedogenic products and gentle skincare routines can significantly reduce the risk of blackheads.

5. Environmental Factors

Environmental factors like pollution, humidity, and exposure to certain weather conditions can contribute to the formation of blackheads.

How Environmental Factors Play a Role:

• Air Pollution: Exposure to pollutants, such as dirt and chemicals in the air, can clog pores and increase the likelihood of acne, including blackheads.
• Humidity: In humid conditions, sweat combines with sebum and dead skin cells, potentially leading to clogged pores.

Reference:

• Research in Dermato-Endocrinology (2018) demonstrates that environmental pollution, such as exposure to particulate matter, can exacerbate acne and blackhead formation by clogging pores.
• A study in Environmental Health Perspectives (2020) discusses the relationship between air pollution and skin conditions, including blackheads.

6. Genetics

Genetic factors significantly influence how the sebaceous glands function, how the skin sheds dead cells, and how pores behave. People with a family history of acne are more likely to develop blackheads.

Genetic Factors Linked to Blackhead Formation:

• Sebaceous Gland Activity: Individuals with a genetic predisposition may have more active sebaceous glands that produce more sebum, increasing the likelihood of clogged pores and blackheads.
• Skin Characteristics: Genetic variations affecting skin characteristics, such as thicker skin or slower cell turnover, can contribute to blackhead formation.

Reference:

• Journal of Investigative Dermatology (2016) emphasizes the role of genetics in determining how the skin produces sebum and sheds dead skin cells, contributing to acne and blackhead formation.
• A genetic study in Journal of Dermatological Science (2017) discusses how family history and genetic traits can influence the development of acne and comedones like blackheads.

7. Stress

Stress triggers the release of cortisol, a hormone that increases sebaceous gland activity, resulting in more oil production. This excess sebum can clog pores and contribute to blackhead formation.

How Stress Contributes to Blackhead Formation:

• Increased Sebum Production: The rise in cortisol levels during stress leads to an overproduction of sebum, which can contribute to clogged pores and blackheads.
• Worsening Acne: Chronic stress may also exacerbate existing acne, including blackheads, by making sebaceous glands more reactive to environmental or hormonal triggers.

Reference:

• Acta Dermato-Venereologica (2018) notes that stress-induced hormonal changes, particularly increased cortisol levels, can lead to more sebaceous gland activity and the subsequent formation of blackheads.
• A study in Psychosomatic Medicine (2016) reports a direct link between stress and increased acne severity, including the development of comedones.

8. Medications

Certain medications can lead to increased sebum production or clogged pores, both of which can contribute to the formation of blackheads.

Medications that Contribute to Blackheads:

• Steroids: Oral or topical steroids can increase the size of sebaceous glands and result in more sebum production, leading to blocked pores and blackheads.
• Oral Contraceptives: Some forms of birth control can influence hormonal levels and sebaceous gland activity, leading to the development of blackheads.

Reference:

• Clinical and Experimental Dermatology (2017) discusses how steroid use can trigger increased oil production, resulting in acne, including blackheads.
• A review in American Journal of Clinical Dermatology (2015) discusses how certain oral contraceptives can exacerbate acne by increasing sebum production.

Conclusion

Blackheads are primarily caused by excess sebum production, clogged hair follicles, and environmental and lifestyle factors. While bacterial growth and inflammation are more associated with other types of acne, they can exacerbate blackhead formation. Genetic predispositions, poor skincare practices, stress, and certain medications can also contribute to the development of blackheads.

References:

• Journal of the American Academy of Dermatology (2017)
• British Journal of Dermatology (2019)
• American Academy of Dermatology (2020)
• Journal of Investigative Dermatology (2016)
• Clinical and Experimental Dermatology (2017)
• Dermato-Endocrinology (2015)