The Blackhead Blight

Something that comes up often in patient discussion groups is the awful manifestation of what appears to be blackheads, but are technically double-ended pseudocomedones. One person might describe theirs as long-ish tunnels with the oxidized dark part stretching under the skin for a bit, and there are clusters of them doubled up. Another person might say that theirs are a bunch of dots and the contents are just ready and bursting to come out. One little squish and there is the odd-looking snake made up of dark and light content that is now roaming free.

Our inclination is to pick and squeeze. Really, it seems like an easy solution for these awful little things that have taken up residence in our skin and are sitting so close to the surface and in formation. But wait! Stop! Is that really the best thing to do? Because our fellow patients have lamented that as soon as they have kicked out these ugly culprits, they have experienced much larger, painful HS lesions, and have always regretted their actions (even though they can’t seem to help themselves and they do it time and again). Who doesn’t want a bunch of ugly blackheads gone? They make us feel dirty and unattractive.

Are my blackheads related to hidradenitis suppurativa?

This is actually a known issue with hidradenitis suppurativa patients, and if this is something you are experiencing, you aren’t alone. I had problems with these blackheads for a while myself before I was diagnosed – and then found out that because of their location and number, it should have been obvious that I was suffering from HS.

Blackheads are an accumulation of skin cells, dirt, and oil, and they get their name because part of that accumulation turns dark from the oxygen and light basically cooking everything to a deeper shade of brown/black. With HS, we have an overabundance with everything including oils and inflammation, and our lesions of all kinds pack a wallop with a variety of bacteria. It’s not that we’re not clean. This disease just overwhelms our bodies. Do you watch those pimple popping videos? Those do not apply to this breed of blackheads! Don’t go to an esthetician to have them squeezed or needled out. Don’t ask your partner or kids or parent to “clean” those out.

How can I get rid of the blackheads?

Well, first, talk to your dermatologist. This is the stuff they live for. Likely they will talk to you about the importance of not using pressure to push out the contents, because again, you will likely experience a much more painful flare. The hidden bacteria will get their revenge! They may have options for topicals or oral medications to use to gently encourage the plugs to soften and eventually release their hold as well as annihilate the bacteria.

If you prefer to tackle the issue on your own, products that contain benzoyl peroxide can be used in a wash two to three times a week on the affected areas. Please be aware that if the benzoyl peroxide is used too frequently, the bacteria will all be killed in the affected area on the surface of the skin, and so the fungi in the same area that occur naturally will be able to take over because there won’t be any bacteria to balance everything out, so a fungal infection may occur. Another option is to try mixing baking soda and water into a paste and very gently massaging it over the affected area to loosen the plugs, using this method two to three times a week. Remember to always check with your healthcare provider before trying anything new.

The bottom line is to be nice to your skin, as anxious as you may be to get rid of these stubborn, ugly spots. HS operates by different rules.