Blackheads 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.