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 four essentials for dealing with whiteheads and blackheads:
- Gentle, water-soluble cleansers (and avoiding bar soap). 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 or whiteheads. Again, someone with dry skin will want an exfoliant that has a more moisturizing base.
The best option for a good exfoliant is a 1% or 2% BHA gel, liquid, or lotion. There are still only limited options for this one, including Olay Total Effects Anti-Aging Anti-Blemish Daily Moisturizer, Paula's Choice 1% or 2% Beta Hydroxy Acid products, and Serious Skin Care Clarifying Treatment with 2% Salicylic Acid. If you cannot use a beta hydroxy acid, you might want to try an alpha hydroxy acid, but AHAs are not able to penetrate the pore lining and affect mostly the surface of skin. That can be helpful, but salicylic acid can absorb into the pore lining and improve conditions.
By the way, topical disinfectants such as benzoyl peroxide or topical antibiotics available by prescription do not help in the treatment of blackheads and milia because there is no bacterial involvement related to these conditions.
- Deeper exfoliation treatments for stubborn blackheads and milia are options you may want to consider. Microdermabrasion, either from an at-home treatment (Neutrogena's At Home Microdermabrasion System) or the procedure performed at a doctor's office or spa are options. Also AHA or BHA peels and laser resurfacing may possibly have a positive impact on the appearance of blackheads and milia. However, the research on this is at best limited. Anecdotally, it appears to be an option. Keep in mind that none of these treatments alter hormone function or the structure of the pore, or improve pore functioning—rather, they temporarily get rid of the surface problem, making the skin look better in the short term.
- Absorbing excess oil. This step is for those with oily skin and is not necessary for those with whiteheads and 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.
- Retinoids 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. 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.
- Hormone blockers, birth control pills, and Accutane: 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, Accutane should definitely be considered. Though many doctors are reluctant to prescribe Accutane 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 Accutane can be a cure. Either way these are all options (albeit serious ones) you can talk over with your physician.
- Removing blackheads: 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.
Battle Plan for Fighting Blackheads