What contributes to blackheads?
Sleeping with makeup on is contributor, not cleaning your face appropriately, or using skin care products that make matters worse. The use of skin-care or makeup products containing ingredients similar to the composition of sebum compounding the condition. Sebum (the oil produced in the pore) is a mixture of triglycerides, fatty acids, wax esters, squalene, cholesterol, and cholesterol esters. All these substances are typically found in thousands of cosmetic products and they can absorb into the pore, adding to the build up of sebum. Interestingly and contrary to popular belief, the ingredients mineral oil and petrolatum cannot absorb into the pore because their molecular size is too large. Both ingredients feel greasy, especially on oily skin, but neither has the consistency or research showing it contributes to blackheads or clogged pores.

Why do I have blackheads while others don’t?
Good question, but there is no easy answer. In fact, this question puzzles physicians and researchers alike. Whether or not a person gets blackheads (and lots of people do) seems to be primarily a genetic predisposition accompanied by the right conditions hormones or the type of skin care and makeup products you are using. Blackheads occur randomly taking place in any one of the thousands of pores we have on our face. Another frustrating consideration is the unknown reaction to the hundreds of different cosmetic ingredients we may come in contact with from the various products we use.

How do I get rid of blackheads?
Other than avoiding products that are too emollient (meaning thick or greasy creams) and not using moisturizers unless you truly need them, there are really only three over-the-counter essentials for getting rid of blackheads:

Avoid bar soaps and use a gentle, water-soluble cleanser instead. The ingredients that keep soap in its bar form can clog pores, and irritation can cause skin cells to flake off before they're ready and accumulate in the pore. The good news is that there are lots of gentle cleansers to consider. It's actually getting more and more difficult to find a cleanser that isn't gentle. Someone with dry skin would want to use a slightly more moisturizing cleanser—but be careful: cleansers that are too emollient can contain ingredients that add to the sebum in your skin causing further problems.

Gentle exfoliants that can both remove the excess skin cells on the surface of the face (so they don't build up in the pore) and exfoliate inside the pore (to improve the shape of the pore, allowing a more even flow of oil through it). Keep in mind that the pore itself is lined with skin cells that can build up, creating a narrowed shape that doesn't allow for natural oil flow out of the pore. But don't get carried away with this step. Overdoing it (removing too many skin cells) can cause problems and hurt skin. Exfoliation is essential for both dry and oily skin to eliminate blackheads. Someone with dry skin will want an exfoliant that has a more moisturizing base; those with normal skin can base this decision on personal preference (gel, lotion, or cream texture).

There are still only limited options for this one, and Paula’s Choice offers more options than any other cosmetic company. BHA stands for beta hydroxy acid; also known as salicylic acid, this ingredient can penetrate the pore and exfoliant inside its lining, dissolving debris and helping to restore normal oil flow. Plus BHA also has anti-inflammatory properties, so it reduces the redness of blemishes, and antibacterial properties to reduce breakouts (that handles two skin care problems quite beautifully).

If you cannot use salicylic acid, you might want to try an alpha hydroxy acid, but AHAs are not able to penetrate the pore lining as well, and affect mostly the surface of skin. That can be helpful, but not as efficacious as salicylic acid.

By the way, topical disinfectants such as benzoyl peroxide or topical antibiotics available by prescription do not help in the treatment of blackheads because there is no bacterial involvement related to their formation. You may also want to consider routinely getting a BHA (salicylic acid) peel. This is best performed by a dermatologist and can be a successful adjunct to an at-home routine for battling blackheads, especially if they prove stubborn. It is generally best to wait 4-6 weeks between peels.

Absorbing excess oil. This step is for those with oily skin and is not necessary for those with dry skin, because with dry skin the problem isn't about excess surface oil, it's only the oil trapped inside the pore. For those with oily skin, clay masks (that don't contain irritating ingredients of mint, peppermint, camphor or the like) are an option and oil-absorbing papers can also help.

What about prescription options for getting rid of blackheads?
Retinoids (such as tretinoin) play an important role in successfully battling blackheads. Retinoids are forms of vitamin A that can actually help skin cells function normally and improve the shape of the pore so oil flow is normalized and clogs are far less apt to take place (this is well documented in medical studies). The most typical and well-researched retinoids are tretinoin (found in prescription medications such as Retin-A, Renova, and Avita,), adapelene (found in the prescription drug Differin) and tazarotene (found in the prescription drug Tazorac). These can be used on their own or with a BHA product. Research has definitely established that tretinoin and adapelene have positive effects on how pores function, and these products should be a strong consideration for battling blackheads or breakouts in general. Vitamin A or retinol products are also an option but these have not been researched for this skin condition.
Hormone blockers, birth control pills, and isotretinoin: For those with severe oily-skin conditions, prescription medications such as hormone blockers or certain low-dose birth-control pills can reduce hormone levels of androgens which are the cause of excess oil production. And, when all else fails, isotretinoin should definitely be considered. Though many doctors are reluctant to prescribe isotretinoin for "merely" oily skin and blackheads, for those with that kind of persistent skin problem, it does not feel like a "mere" problem in the least and isotretinoin can be a cure. Either way these are all options (albeit serious ones) you can discuss in detail with your physician.

Can I remove blackheads myself?
This isn't a pretty topic, but it is a fact of life and human nature that just leaving a blemish or blackhead alone is almost impossible. Fortunately, gently removing a blackhead or blemish with light-handed squeezing can actually help the skin. Removing the stuff inside a blackhead or especially a pimple relieves the pressure and reduces further damage. Yes, squeezing can be detrimental to the skin, but how you squeeze determines whether you inflict harm. If you oversqueeze, pinch, scrape the skin with your nails, or press too hard, you are absolutely doing more damage than good. Gentle is the key word and, when done right, squeezing with minimal pressure is the best, if not only, way to clean out a blackhead or blemish.

How not to over-squeeze? Although I never recommend steaming the face (heat can cause spider veins to surface and create irritation), a tepid to slightly warm compress over the face can help soften the blackhead or blemish, making removal easier. First, wash your face with a water-soluble cleanser. Pat the skin dry, then place a slightly warm, wet cloth over your face for about 10 to 15 minutes. Once that's done, pat the skin dry again, then using a tissue over each finger to keep you from slipping and tearing the skin, apply even, soft pressure to the sides of the blemish area, gently pressing down and then up around the lesion. Do this once or twice only. If nothing happens, that means the blemish cannot be removed, and continuing will bruise the skin, risk making the infection or blackhead worse, and cause scarring. Again, only use gentle pressure, protect your skin by using tissue around your fingers, and do not over-squeeze.

Paula's Choice Skin Care Solution for Blackheads
The Paula's Choice Skin Care Solutions for blackheads below include effective yet gentle cleansers, state-of-the-art toners (which, depending on your skin type may be the only moisturizer you need), topical exfoliants, oil-absorbing products, and lightweight serums and/or moisturizers if you do have dry areas.

Based on the above recommendations, you may wish to consider these products for your skin type:

Step-by-Step Skin Care for Blackheads
Normal/Combination Skin
Oily/Combination Skin
Dry/Combination Skin

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