A Guide to Managing Hidradenitis Suppurativa Blackheads

A frequent topic in hidradenitis suppurativa discussion groups is the distressing appearance of spots that look like blackheads. In reality, these skin plugs are double-ended pseudocomedones, a common HS symptom.

Some people might describe them as long-ish tunnels with the oxidized dark part stretching under the skin for a bit, appearing in doubled-up clusters. Others might say they are a bunch of dots with contents that are ready and burst. One little squish and an odd-looking snake made up of dark and light content roams free.

Resist the temptation to squeeze

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 so close to the surface. But wait! Stop! Is that really the best thing to do?

Many patients lament that as soon as they kick out these ugly culprits, larger, painful HS lesions, appear in their place. They regret 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.

What causes hidradenitis suppurativa blackheads?

This is well-known symptom of hidradenitis suppurativa, 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. I later learned, that because of their location and number, it should have been obvious that I was suffering from HS.

Blackheads are accumulations of skin cells, dirt, and oil. 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 of everything, including oils and inflammation. Flares bring lesions of all kinds that 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? That method does 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.

Speaking with your dermatologist

Instead, talk to your dermatologist. This is the stuff they live for. It's likely your doctor 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 revenge! Your dermatologist might suggest topical or oral medications that gently soften the plugs and eventually release them. The medication often annihilates the bacteria as well.

Trying at-home remedies

If you prefer to tackle these skin plugs on your own, products that contain benzoyl peroxide can help. Simply wash the affected area with benzoyl peroxide two to three times a week, but don't over do it. If used too often, benzoyl peroxide can kill off all bacteria on the skin's surface, including good bacteria. That allows naturally occurring fungi to take over, possibly resulting in a fungal infection.

Another home treatment option baking soda. Create a paste with baking soda and water. Then gently massage it over the affected area to loosen the skin plugs. Try 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.