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

Blackheads are not dirt trapped in the skin. It is the most widespread belief, and it is also why most attempts to eliminate them end up making the situation worse: if you think you need to remove dirt, the logical consequence is to scrub, squeeze, and degrease. Three actions that cause inflammation.

A blackhead is an open comedone: a dilated pilosebaceous follicle filled with a plug of sebum and keratin. The upper part 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 perception completely changes the approach: there is no need to remove something from the outside; the process that produces it inside the follicle needs to be slowed down.

[INDICE:h2]

Why is a blackhead black?

The dark color has two causes, and neither of them is dust.

The first is melanin: the cells of the infundibulum — the upper part of the follicle — contain pigment, which becomes concentrated in the keratin plug as it compacts. The second, and more important, is the oxidation of squalene, a lipid that is highly abundant in human sebum. Upon contact with oxygen and ultraviolet radiation, squalene turns into squalene peroxide, which is darker and — less well known — also more comedogenic than the original squalene.

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

How a comedone forms: the four factors

Comedogenesis does not have a single cause. It is the result of four processes that fuel one another within the same follicle.

1. Hyperkeratinization of the infundibulum

The keratinocytes lining the follicular canal multiply more than normal and have difficulty detaching from one another. Instead of shedding and exiting, they remain stuck together and form a compact plug. This is the factor that triggers everything else, and it is also the one that cosmetic active ingredients can genuinely act on.

2. Excess sebum production

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

3. Altered sebum composition

It's not only how much sebum is produced that matters, but also what it is like. In comedone-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 microbiota

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

Blackheads or sebaceous filaments? The distinction that changes everything

This is the point that almost no one clarifies, and it concerns many people who believe they have blackheads on their nose when in fact they have something else entirely.

Sebaceous filaments are physiological structures: thin cylinders of sebum and cells that line the inside of every 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, to leave irritated skin with the filaments still in place within two weeks.

Where they appear and why specifically on the nose

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

The other common locations:

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

What does not work (and what actively makes things worse)

It is worth being explicit, because these are the most common and most damaging practices.

1. Adhesive strips. They remove the upper, visible part of the plug while leaving the rest in place. The result lasts three or four days. In return, they tear away the stratum corneum and can further dilate the follicular opening, making the next comedone more noticeable than the previous one.
2. Squeezing with your fingernails. Lateral pressure can rupture the follicle wall inward: its contents spill into the dermis, turning a non-inflammatory comedone into an inflamed papule, with a real risk of post-inflammatory hyperpigmentation.
3. Vacuum extractors. On a compact plug, suction is not enough to extract it, 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 physiological pH and damage the skin barrier. A compromised barrier responds with more inflammation, and inflammation worsens keratinization.
5. Deep degreasing. Highly alkaline or alcohol-based cleansers remove surface sebum and trigger a compensatory response: the skin becomes dry on the surface while continuing to produce sebum underneath. This is the cycle that leads to congested skin.

An exception should be made for manual extraction performed by a professional, with the skin prepared and sterile instruments: it is a legitimate and sometimes useful procedure. What does not work is replicating it in front of the bathroom mirror at eleven at night.

What really works

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

Cleansing that cleans without irritating

The first step is not the most aggressive one, but the most consistent. You need a cleanser that removes excess sebum and residue without pushing the pH out of range or stripping the skin. For skin with many comedones, evening double cleansing is the most sensible solution: an oil-based phase that dissolves sebum—like dissolves like—and a water-based phase that rinses it away.

Salicylic acid: the only exfoliant that enters the follicle

This is the technically decisive point. Salicylic acid is a lipophilic beta hydroxy acid: it dissolves in sebum, so it penetrates the follicular canal, where the plug is located. Alpha hydroxy acids are hydrophilic and work well on the surface, but they do not reach the follicle. That is 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 not a bureaucratic detail: it means that the much higher percentages you read about belong to the professional or medical field, not to 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 work, it 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 the work already done. Mandelic acid has a large molecule, penetrates slowly, and is therefore one of the best-tolerated AHAs, even on reactive skin.

Green clay: once a week, not every day

Green clay has a genuine ability to absorb surface sebum and is useful as a targeted weekly treatment for the T-zone. Used daily or all over the face, it causes dehydration, and dehydrated skin produces more sebum, not less.

When comedones are accompanied by inflammation

If red papules appear alongside blackheads, an anti-inflammatory step should be added. Azeloglycine works simultaneously on keratinization, the bacterial component, and complexion uniformity — useful because it is precisely the inflammatory phase that leaves marks.

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

The routine, in practice

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

1. Morning: gentle cleanser, sebum-balancing serum, lightweight moisturizer, sunscreen. Sunscreen is not optional: photoprotection limits squalene peroxidation.
2. Evening: double cleansing, salicylic acid serum, moisturizer.
3. Twice a week, in the evening: gentle exfoliant instead of the acid serum, to avoid layering them.
4. Once a week: clay mask on the T-zone only, for 10 minutes, then rinse.
5. Never: 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 becomes longer with age. An already formed comedone must be cleared through that cycle, while comedones forming today will become visible in four to six weeks.

The first tangible differences appear between the fourth and sixth weeks; stable results arrive between 8 and 12 weeks of consistent use. Anyone who changes their routine every three weeks because it “isn’t working” is stopping the process exactly when it would begin to deliver results. It is also useful to know this in advance: during the first two weeks, an exfoliant may bring comedones already present deep within the skin to the surface, creating the impression of worsening.

When to see a dermatologist

Cosmetics have a specific scope of action and equally specific limitations: they improve the appearance of the skin and how often comedones re-form, but they do not treat a dermatological condition. It is time for a medical evaluation when:

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

Frequently asked questions about blackheads

Are blackheads dirt?

No. They are compacted sebum and keratin inside the follicle. The dark color comes from the oxidation of squalene when it comes into contact with air and from melanin present in the cells lining the follicular canal, not from dust or dirt. This is why washing your face more often or more vigorously does not eliminate them: you are acting on the surface while the problem is two millimeters beneath it.

How can blackheads on the nose be eliminated permanently?

Definitively, no, and it is important to be honest about that: as long as the sebaceous glands on the nose remain active, they will continue to produce sebum and comedones may re-form. What a correct routine achieves is stably reducing their number and visibility, maintaining the result with continued use. Regular use of salicylic acid, gentle exfoliation twice a week, and daily photoprotection are needed.

Can blackheads be squeezed?

Doing it yourself is not recommended. Pressure from fingernails can rupture the follicular wall inward, turning a non-inflamed comedone into an inflamed papule, with a risk of residual pigmentation or a small scar. Manual extraction performed by a professional, with softened skin and sterile instruments, is instead a legitimate procedure and useful in some cases.

What is the difference between blackheads and sebaceous filaments?

Blackheads are blockages: raised, dark, and irregularly distributed. Sebaceous filaments are physiological structures present in every follicle: light gray or beige, level with the skin, evenly and closely distributed, typically on the nose. The former can be treated; the latter can only be made less visible — they are not there because the skin is malfunctioning, but because the skin is functioning.

Do blackhead strips work?

They provide an immediate but superficial and short-lived result because they remove only the protruding portion of the plug, leaving the deeper part in place. The comedone reforms within a few days. In the meantime, the adhesive strips away the stratum corneum and may dilate the follicular opening, making the next comedone more visible. They should be avoided entirely on sensitive or couperose-prone skin.

Does steam open pores and help remove blackheads?

Pores have no muscles and do not open or close, as we explained in this in-depth article. Heat and humidity soften the keratin plug and make any extraction less traumatic: this is a real effect, but different from the way it is usually described. Excessively hot or prolonged steam, on the other hand, can worsen redness in reactive skin.

Does diet affect blackheads?

The strongest evidence concerns high-glycemic-index foods and, with less consistent data, skimmed milk. Both can increase IGF-1 levels, which stimulates sebum production. The effect is real but modest compared with the influence of genetic and hormonal factors: diet is a supporting factor, not the main lever, and no dietary change can replace a proper topical routine.

In conclusion

Blackheads should be 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 does not irritate, and daily sun protection cover everything a cosmetic product can do — and they do it well, provided you give the process the twelve weeks it requires.

You can also find LeLang products in 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 of age, except shampoos).
02 Commission Regulation (EU) No 655/2013, common criteria for the justification of claims concerning cosmetic products.

On the website: salicylic acid · asphyxiated skin · routine for oily skin · how to exfoliate the skin.