Blackheads
What are blackheads?
Acne comes in two main forms:
Comedonal acne – blackheads and whiteheads
Inflammatory acne – red pimples, pustules, and cysts
Blackheads form when oil and dead skin clog hair follicles. The trapped oil oxidizes on exposure to air, turning black or dark brown.
When treating blackheads, price doesn’t equal results—many affordable products contain the same active ingredients as expensive ones.
How do I treat blackheads?
The most effective treatment for blackheads is a topical retinoid, especially adapalene, which is stronger than retinol or retinal.
Adapalene gel (Differin, Effaclar, Glenmark, AcneFree, ProActiv) – Once prescription-only, it’s now available over-the-counter. Adapalene works particularly well for blackheads and whiteheads and helps minimize the appearance of pores. Apply a thin layer at bedtime (see below).
Additional tips for blackheads:
Manage stress: Acne often worsens during stressful times—deadlines, relationship issues, illness, or loss. If you know stress is coming, start treating blackhead-prone areas early to help prevent flares. This site has simple, practical ideas for lowering stress.
Eat for clearer skin: Diet can affect acne. Fast food and junk food often make breakouts worse, especially when combined with stress. Switching as many meals as possible to whole-food, plant-based options can help improve acne and reduce flares.
How do I extract blackheads?
Some blackheads are stubborn and will not clear with adapalene. For these, blackheads can be removed or extracted with a comedone extractor tool (Revlon or similar). It need to be a continuous piece of stainless steel to be the most effective.
Place the opening of the extractor tool over the blackhead.
Either push or pull the extractor tool across the skin with gentle downward pressure to pop the blackhead out of the pore.
Notes:
Be gentle with the extractor tool - too much pressure can bruise or even scar the skin
How to use adapalene at bedtime
Start with clean, dry skin.
Dab a pea-sized amount of adapalene gel on the forehead, sides of the face, and chin (outer areas of face).
Rub it in gently.
Use whatever is left on your fingers to lightly spread around the nose, cheeks, and lips (these spots are more sensitive).
💡 Note: This will make your skin dry and flaky at first. That’s normal—it happens to everyone. Your skin will adjust after a few weeks.
🚫 Warning: Don’t use adapalene if you’re pregnant or trying to become pregnant. It may harm a developing baby.
After Adapalene: Moisturize
Right after applying adapalene, use lots of moisturizing cream or ointment. My favorites are CeraVe Cream, Vanicream Cream, or Vaseline (#SlugLife)
Put on a thick layer and go to bed a little shiny—your skin will soak it in overnight.
🕒 Stick with adapalene for at least 30 days—it takes about a month to start seeing results.
My face is peeling from adapalene—What should I do?
Peeling is very common when starting adapalene. Most people think their skin is “too sensitive,” but often the problem is how it's being used—not that it’s the wrong product.
Adapalene dries out your skin before it helps it. The first month is tough—but stick with it! It takes about 30 days for your skin to grow from the bottom up, and that’s when you’ll start seeing real results. It will work! Trust the process!
Tips to reduce peeling and redness from adapalene:
Use the right amount: Only a pea-sized amount is needed for your whole face.
Start on the outside of your face: Apply to the forehead, cheeks, jawline, and chin first. Use what’s left on the nose and near the lips—these areas are more sensitive.
Moisturize a lot: You can’t over-moisturize. Use CeraVe, Vanicream, or Vaseline—especially at night.
Stick with it: Use it every night for one month to see benefits. If nightly use is too much, try every other night—just stay consistent.
Try the “sandwich method”—Put on a thin layer of moisturizer, then adapalene, then a thick layer of moisturizer on top. This helps reduce peeling while still giving you the benefits.
What if my blackheads aren’t getting better?
Most people improve with the steps above, but sometimes prescription creams or pills are needed, especially if there is scarring or stubborn spots. Sometimes isotretinoin (Accutane) may be the best option. If over-the-counter treatments aren’t working, see a board-certified dermatologist. If you are in or near Utah, you can see me virtually through Honeydew or visit one of my excellent colleagues at the University of Utah.
DISCLAIMER
The statements expressed and content of this website are not intended to be a substitute for professional medical advice. Readers should seek their own professional counsel for any medical condition or before starting or altering any treatment, exercise, or dietary plan. Please see our full disclaimer here.