Blackheads are a mild, very common form of acne. They mostly affect teens and young adults, but a growing number of adults get them too.
The strongest current evidence supports topical retinoids and benzoyl peroxide, so the practical next step is to choose a proven treatment and stop squeezing. A blackhead is a clogged hair follicle, or pore, that stays open at the skin's surface. This guide covers what causes the dark colour, who gets acne, what the 2024 dermatology guideline recommends and how long treatment takes to work.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- What Makes a Blackhead Black?
- Who Gets Blackheads and Acne?
- What the 2024 Guideline Recommends
- When Stronger or Newer Treatment Makes Sense
- What to Do Next
- Frequently Asked Questions
What Makes a Blackhead Black?
A blackhead forms when oil and skin cells plug a hair follicle. The plug reaches the surface and stays open. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the dark colour comes from air reacting with the oil (sebum) inside the pore. It is not dirt.
This matters for how you treat it. Harder scrubbing will not wash away a colour change that is inside the pore. Treatments that keep pores from clogging do more than cleansing alone. A whitehead forms the same way, but its pore stays closed. That keeps air from reaching the oil, so it stays pale.
Who Gets Blackheads and Acne?
acne is mainly a condition of youth. The American Academy of Dermatology's skin condition statistics show that about 85% of people aged 12 to 24 get at least minor acne. It does not always end with the teenage years. The AAD reports that adult acne keeps rising and affects up to 15% of women.
A 35-year-old with new breakouts has a common problem, not an unusual one. Acne also affects mental health. NIAMS links it to depression, anxiety and lower quality of life. That is why dermatologists treat it as a medical condition and not just a cosmetic one.
What the 2024 Guideline Recommends
The AAD published its acne treatment guideline online on January 30, 2024, in the Journal of the American Academy of Dermatology. As summarised in the guideline's PubMed record, it strongly recommends: The guideline also recommends combining treatments that work in different ways. Using an antibiotic together with benzoyl peroxide or a retinoid lowers the risk of antibiotic resistance.
retinoids are the main prescription option for clogged-pore acne such as blackheads. The guideline found no evidence that any of the four FDA-approved topical retinoids works better than the others. Those four are tretinoin, adapalene, tazarotene and trifarotene. In practice, cost, availability and how well your skin tolerates one can guide the choice.
- Benzoyl peroxide
- Topical retinoids
- Topical antibiotics
- Oral doxycycline
When Stronger or Newer Treatment Makes Sense
The AAD strongly recommends oral isotretinoin for some cases. These include acne that is severe, leaves scars, causes significant distress, or has not improved with standard oral or topical treatment. If blackheads come with painful, scarring breakouts, ask a dermatologist about it.
Clascoterone is a newer topical cream that blocks androgens, the hormones that drive oil production, and males can use it too. The evidence for it was rated high. Even so, the guideline recommends it only conditionally, because its high price may keep many patients from getting it.
What to Do Next
The AAD advises against squeezing blackheads or popping pimples. According to the AAD's guidance on pimple popping, picking can slow clearing, make acne worse and raise the risk of scarring. A dermatologist can safely remove stubborn blackheads.
A practical plan: Be patient. Most people see some improvement 4 to 6 weeks after starting treatment. Clearly clearer skin can take 2 to 3 months or longer, so give a product that long before deciding it has failed.
- Start one proven treatment, such as a topical retinoid or benzoyl peroxide.
- Keep your hands off spots, including blackheads that look easy to remove.
- Use the treatment consistently before judging it.
- See a dermatologist if acne leaves scars, hurts, or affects your mood.
Frequently Asked Questions
Are blackheads caused by dirty skin?
No. The dark colour comes from air reacting with the oil inside an open pore, not from dirt.
Is one prescription retinoid better for blackheads than the others?
The 2024 AAD guideline found no evidence that tretinoin, adapalene, tazarotene or trifarotene works better than the others.
Why use more than one acne treatment at once?
The AAD recommends combining treatments that work in different ways, partly to lower the risk of antibiotic resistance.