Cause and Remedies for Better Skin

Blackheads are such a common and challenging issue. Understanding the causes and adjusting your skin care regimen for the long term is the best remedy for clearing your skin.

Blackheads (“open comedones”) form when a pore becomes clogged with dead skin cells. Normally, dead skin cells shed, but when the body makes excess oil (sebum), cells can stick together inside the pore and become trapped. This sebum-skin cell combo turns black when it oxidizes on exposure to air. It has nothing to do with dirt, and scrubbing your face uncontrollably will just make your skin inflamed and aggravated.


1. Excess oil, often caused by an increase in hormones, especially testosterone or cortisol

2. Adherent dead skin cells

Anything that addresses these two causes will help reduce the number and severity of blackheads. Gentle exfoliation is the simplest thing to do to remove the dead skin cells and oil trapped in your pores.

Salicylic acid wash and toner

Salicylic acid is attracted to oil and is excellent at lifting off the excess skin cells from the pores. If you are really oily and your skin can handle it, use both a cleanser and toner twice a day. Keep the cleanser in contact with the skin for two minutes before rinsing. For those with sensitive or combination skin, I recommend a cleanser at night and a toner in the morning only. Use the exfoliating cotton rounds with your toner for an enhanced effect. My favorite: Derivations Purifying Cleansing Fluid and Toner.

Manual exfoliation

The Clarisonic brush uses sonic technology to gently vibrate and loosen the plugged pores. Most other imitation brushes will be too abrasive and aggravate the skin. Despite the initial investment, the brush should last many years and only needs a replacement brush head every three to six months. Use two minutes twice a day with your cleanser.

Topical Vitamin A

Prescription-strength vitamin A derivatives (tretinoin, Retin-A, Atralin, Differin or Tazorac) are the most potent. These products enhance cell turnover so the dead skin cells don’t have the chance to adhere and get stuck in the pores to develop into blackheads. This will make the pores also appear smaller. Products containing retinol over the counter are less potent but still work. These vitamin A derivatives also help smooth the complexion, reduce brown spots and build collagen. The challenge with these products is that if too much is used or it is used too frequently, the skin may actually look worse— with excessive peeling, redness and burning. I recommend a gradual approach, choosing over-the-counter retinol nightly for a month and graduating slowly to a prescription-strength product under professional guidance. Using an oil-free moisturizer over it, once dry, is acceptable. It can take three to six months to see really good results, but when you get there, your skin is on autopilot! My personal belief, since these products have so many benefits, is to start in your 20s and continue forever, except avoid use in pregnancy.

1. Choose oil-free, non-comedogenic products— look for hair products, makeup, lotions and sunscreens labeled as such. Completely remove makeup at the end of the day.

2. Avoid blocking your pores with items that touch your face— cell phones, helmets, hats, hair bands or even leaning your hand against your face. The occlusion of these items against your skin can manually force the cells into the pores.

3. Control stress to avoid release of cortisol from your adrenal glands, which will increase the production of oil and worsen blackheads.

4. Dairy products (including excess whey protein) and high-glycemic foods will raise insulin levels and increase oil production.

At-home treatment takes six to eight weeks to initially see improvement. If you don’t want to wait this long, I recommend an in-office procedure, such as a chemical peel, microdermabrasion, or extraction to expedite the resolution of your blackheads. Then use the skin care regimen as maintenance for prevention of further blackheads from forming.

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