In general, the process for dealing with blackheads and large pores is fairly similar to the way you deal with blemish-prone skin, although if pimples aren’t present you don’t need the topical antibiotics and antibacterial agents. Bacteria are not involved in the formation of blackheads.
I understand the frustration of battling blackheads. Insidious and glaring, blackheads make skin look mottled and unclean. The truth about blackheads (which are usually accompanied by oily skin) and whiteheads (usually accompanied by dry skin) is hard to accept. What is the truth? The truth is they are just hard to get rid of. It is hard to win the battle against clogged pores! However, because there are only a handful of options for dealing with this annoying skin malady, it’s relatively simple to explain.
Pores that are functioning normally produce a normal amount of sebum (oil) and easily distribute the oil to the surface of skin. Hormones, almost exclusively, regulate the amount of sebum production. When a normal amount of oil is produced it moves effortlessly through the pore and out onto the surface of skin, where it melts into an imperceptible film that forms a protective barrier over the face.
Hormones can cause too much oil to be produced, or skin cells can block the exit path of the oil, or, when you have pores that are malformed, the oil in the pore can get clogged and then blackheads or whiteheads form. Further exacerbating these conditions is the buildup in the pore of skin-care or makeup products—mixed in with skin cells, these can get trapped in the sticky sebum sitting in the pore. When sebum and skin cells sit in a pore that is not covered over by skin, they are exposed to air, which causes the sebum and skin cells to oxidize and turn black. If the sebum and skin cells are sitting in a pore that is covered by skin, they are not exposed to air and remain clear, forming a slight white bump under the skin.
What’s behind all this is primarily a genetic predisposition accompanied by the right conditions (mentioned above) randomly occurring in any one of the thousands of pores we have on our face. Not to mention unknown reactions to the over 50,000 cosmetic ingredients we may come in contact with from products we use.
Other than avoiding products that are too emollient (meaning thick or greasy creams), not using moisturizers when you don’t need them, and not using drying or irritating products, the basic skin-care needs for dealing with whiteheads and blackheads are:
Gentle, water-soluble cleansers (and avoiding bar soap). The ingredients that keep bar 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. It’s actually getting harder and harder to find a cleanser that isn’t gentle. But be careful of cleansers that are too emollient and leave a greasy film on the skin, which can cause further problems.
Use salicylic acid in a gel or liquid with no extraneous irritating ingredients to exfoliate skin. Gently exfoliating skin 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 inside structure of the pore itself is lined with skin cells that can build up, creating a narrowed shape that doesn’t allow natural oil flow. But don’t get carried away with this step. Removing too many skin cells (overdoing it) can cause problems and hurt skin. Exfoliation is essential for both dry and oily skin when you are trying to eliminate blackheads or whiteheads. The only difference is that someone with dry skin will want an exfoliant that has a more moisturizing base. The best option for exfoliating skin both within the pore and on the surface of the skin is a salicylic acid (beta hydroxy acid—BHA) lotion, gel, or liquid. Salicylic acid can penetrate the pore to help improve the shape of the pore lining, allowing an unobstructed path of oil flow.
Absorbing excess oil. This step is more for those with oily skin. It’s really not an option for those with whiteheads (milia) and dry skin, because with milia the problem has less to do with excess oil, and more to do with oil trapped in the pore. Clay masks are an option as long as they don’t contain other ingredients that are irritating. Cosmetics companies also offer a handful of silicone-based oil-absorbing products meant to be worn under makeup; these get mixed reviews from women but are worth a trial run. A few of my personal favorites are OC Eight Professional Mattifying Gel, Clinique Pore Minimizer Instant Pefector, and Smashbox Anti-Shine or Compact Anti-Shine.
Improving cell production can help the pore function more normally. Effective products to consider for all skin types are the tretinoins (Retin-A, Tazorac, Avita, Renova), as well as Differin. These can be used by themselves or with a BHA product. Research has definitely established that Retin-A, Renova, and Differin have positive effects on the way pores function, and these products should be considered for very stubborn cases or when blackheads are accompanied by breakouts.
For those with oily-skin troubles, certain low-dose birth-control pills may be an option to reduce the hormone levels that create the excess oil that is at the root of the problem. And, when all else fails, Accutane can be considered. Be aware that many doctors are reluctant to prescribe Accutane for “merely” oily skin and blackheads.
Blackheads can be made to seem less noticeable with pore strips, but only when the instructions on the box are followed exactly and they are not overused. Pore strips do not affect pore function.
Facialists and aestheticians can extract blackheads without damaging skin, which is a helpful service when they know what they are doing.
For all skin types, AHA or BHA peels, microdermabrasion, and laser resurfacing can improve the appearance of blackheads and whiteheads; however, they don’t necessarily improve pore functioning (which depends on the depth of the treatment); rather, they temporarily get rid of the surface problem, making your skin look better.