Back Blackhead Extraction – Addressing the Inflamed

This video may contain dermatologic surgical and/or procedural content. The content seen in this video is provided only for medical education purposes and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Comedo extraction is a widely used method of treatment for acne vulgaris. A dermatologist or cosmetologist may extract blackheads (open comedones) using gentle pressure around the pore opening, and whiteheads (closed comedones) by incision with a large needle or a blade.

If performed skillfully, this treatment may be beneficial to the patient. Possible negative effects of the procedure include incomplete extraction, refilling, scarring and tissue damage. There are few articles describing the use of comedo extraction in peer-reviewed dermatology journals. In one 1964 study of extraction of non-inflamed whiteheads on patients’ foreheads (the only study of the procedure cited in a 2007 literature review), the procedure reduced the number of future inflamed lesions and the recurrence rate of comedones, but worsened patients’ inflamed cystic lesions.

Cause

Oil production in the sebaceous glands increases during puberty, causing comedones and acne to be common in adolescents.Acne is also found premenstrually and in women with polycystic ovarian syndrome. Smoking may worsen acne.

Oxidation rather than poor hygiene or dirt causes blackheads to be black.Washing or scrubbing the skin too much could make it worse, by irritating the skin. Touching and picking at comedones might cause irritation and spread infection. It is not clear what effect shaving has on the development of comedones or acne.

Some, but not all, skin products might increase comedones by blocking pores, and greasy hair products (like pomades) can worsen acne. Skin products that claim to not clog pores may be labeled noncomedogenic or non-acnegenic.Make-up and skin products that are oil-free and water-based may be less likely to cause acne. It is not known whether dietary factors or sun exposure make comedones better, worse or have no effect.

A hair that does not emerge normally can also block the pore and cause a bulge or lead to infection (causing inflammation and pus).

Genes may play a role in the chances of developing acne.Comedones may be more common in some ethnic groups. People of recent African descent may experience more inflammation in comedones, more comedonal acne, and earlier onset of inflammation.

Management

Using non-oily cleansers and mild soap may not cause as much irritation to the skin as regular soap.Blackheads can be removed across an area with commercially available pore-cleansing strips (which can still damage the skin by leaving the pores wide open and ripping access skin) or the more aggressive cyanoacrylate method used by dermatologists.

Squeezing blackheads and whiteheads can remove them, but it can also damage the skin. Doing so increases the risk of causing or transmitting infection and scarring, as well as potentially pushing any infection deeper into the skin. Comedo extractors are used with careful hygiene in beauty salons and by dermatologists, usually after using steam or warm water.

Complementary medicine options for acne in general have not been shown to be effective in trials. These include aloe vera, pyridoxine (vitamin B6), fruit-derived acids, kampo (Japanese herbal medicine), ayurvedic herbal treatments and acupuncture.

Some acne treatments target infection specifically, but there are treatments that are aimed at the formation of comedones as well. Others remove the dead layers of the skin and may help clear blocked pores.

Dermatologists can often extract open comedones with minimal skin trauma, but closed comedones are more difficult. Laser treatment for acne might reduce comedones, but dermabrasion and laser therapy have also been known to cause scarring.

Macrocomedones (1 mm or larger) can be removed by a dermatologist using surgical instruments or cauterized with a device that uses light. The acne drug isotretinoin can cause severe flare-ups of macrocomedones, so dermatologists recommend removal before starting the drug and during treatment.

Some research suggests that the common acne medications, retinoids and azelaic acid, are beneficial and do not cause increased pigmentation of the skin. If using a retinoid, sunscreen is recommended.

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