Blackheads: why they form and how to really get rid of them

Blackheads are not dirt trapped in the skin. This is the most widespread misconception, and it is also why most attempts to eliminate them end up making things worse: if you think you need to remove dirt, the logical response is to scrub, squeeze, and strip away oil. Three actions that cause inflammation.

A blackhead is an open comedone: a dilated pilosebaceous follicle filled with a plug of sebum and keratin. The top of the plug remains exposed to the air and darkens through oxidation—not because it is dirty. It is the same principle that makes a cut apple turn brown.

Distinguishing the mechanism from the perception completely changes the approach: there is no need to remove something from the outside; the process that produces it needs to be slowed down from inside the follicle.

Article written by Elisa Avalle, founder of LeLang Skin Care and dermocosmetics specialist. Cover image generated with the assistance of artificial intelligence.

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Why blackheads are black

There are two reasons for the dark color, and neither is dust.

There are two reasons for the dark color, and the first is melanin: the cells of the infundibulum—the upper part of the follicle—contain pigment, which builds up in the keratin plug as it becomes more compact. The second, and more important, is the oxidation of squalene, a lipid found in abundance in human sebum. When exposed to oxygen and ultraviolet radiation, squalene turns into squalene peroxide, which is darker and—less widely known—also more comedogenic than the original squalene.

This second point has a practical, counterintuitive consequence: the sun makes blackheads worse, even if it seems to "dry out" the skin on the surface. UV radiation accelerates the peroxidation of sebum lipids, and the product of that reaction in turn contributes to blockage. This is one reason many oily skin types return from vacation in September with more comedones than they had in June.

How a comedone forms: the four factors

Comedogenesis has no single cause. It results from four processes that feed into one another within the same follicle.

1. Infundibular hyperkeratinization

Keratinocytes lining the follicular canal multiply more than normal and struggle to separate from one another. Instead of shedding and coming out, they remain attached and form a compact plug. This is the factor that triggers everything else, and it is also the one cosmetic active ingredients can actually address.

2. Excess sebum production

Sebaceous glands are under hormonal control, particularly by androgens. The more sebum is produced, the more material accumulates behind the plug. This is not a matter of hygiene: skin can be washed perfectly and still produce a lot of sebum. We discussed this in the oily skin routine.

3. Changes in sebum composition

It is not only how much sebum is produced that matters, but also its composition. In acne-prone skin, sebum is typically lower in linoleic acid, and this deficiency makes the follicle lining more fragile and more prone to abnormal keratinization.

4. The follicular microbiome

Cutibacterium acnes normally lives in everyone's follicles. The problem is not its presence but its behavior: in an oxygen-poor, sebum-rich environment, some strains form a biofilm, a matrix that makes the plug more cohesive and harder to clear, and produce enzymes that release pro-inflammatory free fatty acids. This is the bridge connecting the blackhead — which is not itself inflamed — to an actual pimple, which we covered in the acne guide.

Blackheads or sebaceous filaments? The distinction that changes everything

This is the point almost no one clarifies, and it concerns many people who think they have blackheads on their nose when they actually have something else.

Sebaceous filaments are physiological structures: thin cylinders of sebum and cells that line the inside of each follicle and channel its contents toward the surface. They are normal. Anyone with active sebaceous glands has them, and they are more visible on the nose, where follicles are larger and more numerous.

Why it matters: sebaceous filaments cannot be eliminated because they are not a defect. They can be made less noticeable, but any treatment designed to make them disappear permanently is bound to fail — and, if aggressive, leave the skin irritated with the filaments back in place within two weeks.

Where they appear and why specifically on the nose

The distribution of blackheads closely follows the density of sebaceous glands. The nose, nasolabial folds, chin, and forehead have the highest concentration in the body: up to over 400 glands per square centimeter, compared with just a few dozen on the arms and legs.

Other common areas:

• T-zone: forehead, nose and chin, the classic area, including for combination skin.
• Ears and concha: very oily and almost always overlooked during cleansing.
• Back and shoulders: the follicles here are large, and occlusion from clothing and sweat aggravates the problem.
• Chest and décolleté: a typical area in skin with pronounced seborrhea.

What doesn’t work (and what actively makes things worse)

It’s worth being explicit, because these are the most common and most harmful practices.

1. Adhesive pore strips. They remove the top, visible part of the plug, leaving the rest in place. The result lasts three or four days. In return, they tear off the stratum corneum and can further dilate the follicular opening, making the next comedone more visible than the last.
2. Squeezing with your fingernails. Lateral pressure can rupture the follicle wall inward: its contents spill into the dermis, turning a non-inflamed comedone into an inflamed papule, with a real risk of a post-inflammatory mark.
3. Vacuum pore extractors. Suction isn’t enough to remove a compact plug, but it is enough to break superficial capillaries. On the nose, an area already rich in blood vessels, the risk is real.
4. Baking soda, lemon, toothpaste. They alter the skin’s natural pH and damage the barrier. A compromised barrier reacts with more inflammation, and inflammation worsens keratinization. Specifically on baking soda, here’s why it isn’t a facial exfoliant.
5. Stripping away all the oil. Highly alkaline or alcohol-based cleansers remove surface sebum and trigger a compensatory response: the skin dries out on the surface while continuing to produce sebum underneath. This is the cycle that leads to asphyxiated skin.

One exception is manual extraction performed by a professional, with the skin prepared and sterile tools: it’s a legitimate and sometimes useful procedure. What doesn’t work is trying to replicate it in front of your bathroom mirror at eleven at night.

What actually works

An effective strategy targets the two modifiable factors: slowing down keratinization and regulating sebum, without ever causing inflammation. Everything else is secondary.

A cleanser that cleans without being harsh

The first step isn't the most aggressive one; it's the most consistent. You need a cleanser that removes excess sebum and residue without throwing the pH off balance or stripping the skin. For skin with many comedones, evening double cleansing is the most sensible solution: an oil-based step that dissolves sebum—like dissolves like—and a water-based step that rinses it away.

Salicylic acid: the only exfoliant that penetrates the follicle

This is the technically decisive point. L'salicylic acid is a lipophilic beta hydroxy acid: it dissolves in sebum, so it penetrates into the follicular canal, where the plug is. Alpha hydroxy acids are hydrophilic and work well on the surface, but don't reach inside the follicle. That's why BHA has a structural advantage for comedones.

In over-the-counter cosmetics, its concentration is legally restricted: Annex III of Regulation (EC) 1223/2009 sets the limit at 2% in leave-on facial products. This is no bureaucratic detail: it means that the much higher percentages you read about are for professional or medical use, not for a serum you buy at a pharmacy.

Combined with Zinc PCA, which helps control sebum production, and niacinamide, which improves barrier function while the other two do their work, this addresses the entire mechanism.

Gentle, consistent exfoliation, not intense and sporadic

For comedones, frequency matters more than strength. A highly tolerable exfoliant used twice a week for three months achieves far more than an aggressive peel once a month, which causes inflammation and undoes all your progress. L'mandelic acid has a large molecule that penetrates slowly, making it one of the best-tolerated AHAs, even on reactive skin.

Green clay: once a week, not every day

L'green clay genuinely absorbs surface sebum and is useful as a targeted weekly treatment for the T-zone. Using it every day or all over the face causes dehydration, and dehydrated skin produces more sebum, not less.

When comedones are accompanied by inflammation

If red papules appear alongside blackheads, you need to add an anti-inflammatory step. L'azeloglycine works on keratinization, bacterial activity, and skin tone at the same time — useful because it’s the inflammatory phase that leaves marks.

All products designed for this skin type are available in the oily skin collection.

The routine, in practice

A realistic routine to follow for at least three months before evaluating it.

1. Morning: gentle cleanser, sebum-balancing serum, lightweight moisturizer, sunscreen. Sunscreen isn’t optional: sun protection limits squalene peroxidation.
2. Evening: double cleanse, salicylic acid serum, moisturizer.
3. Twice a week, in the evening: use a gentle exfoliant instead of the acid serum to avoid layering them.
4. Once a week: apply a clay mask to the T-zone only, leave on for 10 minutes, then rinse.
5. Never: pore strips, squeezing, or grainy scrubs on inflamed comedones.

How long it takes to see results

Complete epidermal turnover takes about 28 days in younger people and slows with age. An already-formed comedone needs to pass through that cycle to clear, and comedones forming now will become visible in four to six weeks.

The first noticeable differences appear between the fourth and sixth weeks; stable results come after 8 to 12 weeks of consistent use. Anyone who changes their routine every three weeks because it “isn’t working” is interrupting the process just as it’s about to pay off. It’s also useful to know in advance: in the first two weeks, an exfoliant may bring existing deep comedones to the surface, making it seem like things are getting worse.

When to see a dermatologist

The cosmetic has a specific scope and equally specific limitations: it improves the skin’s appearance and reduces how often comedones recur, but it does not treat a dermatological condition. It’s time to seek medical advice when:

• deep, painful nodules or cysts develop alongside the comedones;
• atrophic or raised scars appear;
• three months of a proper, consistent routine have produced no change;
• comedones appeared suddenly in adulthood, especially alongside irregular periods or hirsutism, a pattern that warrants an endocrinological evaluation;
• the lesions are concentrated on the forehead and temples in a pattern of small, uniform bumps, which may point to Malassezia folliculitis, a condition that requires medical treatment rather than exfoliants.

In conclusion

Blackheads are treated by understanding what they are: not dirt to be removed, but a keratinization process to be slowed down. Consistent use of salicylic acid, gentle and regular exfoliation, cleansing that doesn't irritate the skin, and daily sun protection cover everything a cosmetic can do — and do it well, provided you give the process the twelve weeks it needs.

You can also find LeLang products at partner pharmacies throughout Italy.

Sources for this article

01 Regulation (EC) No 1223/2009 of the European Parliament and of the Council on cosmetic products, Annex III (entry on salicylic acid: 2% in leave-on facial products, 3% in rinse-off hair products, 0.5% in other applications; prohibited in products for children under 3 years except shampoos).
02 Commission Regulation (EU) No 655/2013, common criteria for the justification of claims relating to cosmetic products.

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