blackheads



OVERVIEW

Definition

Blackheads are open pimples that occur on the nose and are characterized by enlarged nose skin pores with black spots in the center that are able to extrude apical black, thin strips of lipid plugs, and are classified as acne that occurs on the skin of the nose.

Open acne is when the top layer of a pore-clogging lipid plug is exposed to the air and oxidized and blackened.

Acne vulgaris is the initial skin lesion manifestation of acne [1-5].

Morbidity

Nose blackheads are a common dermatologic condition that occurs in young men and women between the ages of 15 and 30 years [1], and the incidence is currently unknown.

Etiology

Pathogenic causes

Enlarged sebaceous glands and increased sebum secretion due to various causes, sebaceous plugs and other accumulations at the mouth of the hair follicle, and exposure to air are oxidized and form blackheads.

Endocrine factors

Sebaceous glands of hair follicles are regulated by sex hormones. Increased level of androgens or imbalance between male and female hormones after puberty may lead to enlargement of sebaceous glands and increased sebum secretion.

Abnormal keratinization of follicular sebaceous gland ducts

Hyperkeratosis of the sebaceous gland ducts can cause the duct opening to become small, narrow or blocked, affecting the normal discharge of epithelial cells and sebum from the hair follicle wall, and when sebum and keratin plugs accumulate in the mouth of the hair follicle, acne is formed.

When sebum and keratin plugs accumulate at the mouth of the follicle, acne is formed. Open pimples that open outward are blackened by the oxidation of sebum and keratin plugs when they are exposed to the air, forming blackheads.

Genetic factors

There is a genetic predisposition to the occurrence of acne, with family clustering seen. Blackheads on the nose, the first sign of acne, may also have some family aggregation.

Other factors

High-sugar and high-fat diets can alter the lipid composition of the skin surface or increase sebum production, which can lead to the formation of blackheads [1-5].

For example, the use of powdered cosmetics, lack of attention to facial cleansing, oily skin, etc., prone to follicular sebaceous gland duct obstruction.

Symptoms

Nose blackheads are mainly characterized by enlarged skin pores on the nose with black spots in the middle, which are able to extrude a blackened, thin strip-shaped lipid plug at the tip.

Main Symptoms

Prevalent Areas

Nose blackheads are most commonly found on the tip and wings of the nose.

Characteristics of lesions

Enlarged pores: blackheads are often associated with enlarged pores.

Sebaceous plugs: black sebum and keratin plugs are formed in the enlarged pores, with black dots in the center, and blackened, thin stripes at the top can be discharged by squeezing the mouth of the hair follicle [1-5].

Progression of the disease may present with larger inflammatory papules, pustules, nodules, cysts and abscesses.

Consultation

Department of Medicine

Dermatology

Dermatology should be consulted when there are enlarged pores on the nose, blackheads, and the ability to squeeze out the blackened lipid plugs at the tip.

Endocrinology

Women with blackheads on the nose, irregular menstruation, hirsutism, obesity, etc. should consult an endocrinologist.

Preparation

Consultation: Registration, Preparation of documents, Frequently Asked Questions

Tips

Keep the lesion area clean and do not apply topical medicines or cosmetics.

Preparation Checklist

Pay particular attention to the time of onset of symptoms, special manifestations, etc.

When did blackheads appear on the skin of the nose?

Are there localized changes, such as the appearance of red papules, pustules, etc.?

Is it possible to squeeze out streaks, black color?

Do immediate family members, such as parents, have similar symptoms?

Do you like to eat greasy, fried, or high-sugar foods?

Do you often wear makeup?

Do you often stay up late at night?

Test results in the last six months, which can be carried to the doctor

Laboratory tests: sex hormone test, etc.

Special examination: dermoscopy, etc.

Medication in the last 3 months, if available, bring along the box or package for medical consultation

Retinoids: adapalene gel, tazarotene gel, isotretinoin, vinblastine, etc.

Topical antimicrobials: benzoyl peroxide, fusidic acid, erythromycin, clindamycin, mupirocin, nafloxacin, and other topical preparations [1-5].

Diagnosis

Diagnosis is based on

Medical history

There may be poor dietary habits such as high sugar diet and preference for oily diet.

May have bad lifestyle habits such as staying up late.

May wear make-up frequently.

May have a history of polycystic ovary syndrome.

Immediate family members (e.g. parents) may have a history of acne.

Clinical manifestations

The main symptoms are enlarged skin pores on the nose with outward-facing openings, visible blackheads, and the ability to extrude thin, white, odoriferous lipid plugs with blackened tips.

Laboratory Tests

If polycystic ovary syndrome is suspected, a sex hormone test can be performed, which often shows elevated testosterone and androstenedione, and combined with ultrasound, the diagnosis can be made.

Dermoscopy

Dermoscopy is mainly used to magnify localized skin lesions and obtain high-definition localized images, which can better help doctors determine the type of acne and the severity of the patient’s condition.

Through dermoscopy, the color of the skin surface scales, vascular pattern, and the arrangement pattern of blood vessels can be observed to identify the condition.

Differential Diagnosis

Rosacea

Similarities: Both may occur on the face with pimples.

Differences: Rosacea, commonly known as “rosacea”, occurs in middle-aged people; the distribution of lesions is mainly on the nose, cheeks, forehead, and chin, often accompanied by localized capillary dilatation, and in the late stage, nasal congestion is formed. Nose blackheads occur in teenagers and are not accompanied by capillary dilatation.

Treatment

Aim of treatment: to relieve symptoms, restore skin lesions, and avoid progression and recurrence of the disease.

Treatment principle: to remove blackheads, local medication, can be supplemented by chemotherapy and physical therapy [1-7].

General treatment

Choose water or suitable cleansing products to remove excess oil, dandruff and bacterial mixtures on the skin surface, but not over-cleaning, pay attention to oil control and moisturizing, and use mild moisturizing milk externally.

Avoid squeezing and scratching the skin lesions with hands.

Appropriately limit the intake of high-sugar foods and milk, keep the bowel movement, avoid staying up all night to avoid aggravating the skin lesions [1].

Medication

The medication should be taken under the guidance of a physician, and should not be self-administered.

Topical medications

Commonly used adapalene gel, tazarotene gel, retinoic acid and so on.

It helps dissolve and discharge blackheads and acne, prevents the formation of new acne, and also improves and prevents hyperpigmentation.

They should be used in low concentrations and in small areas away from light [4].

Drugs such as benzoyl peroxide, erythromycin, lincomycin, chloramphenicol, fusidic acid, mupirocin, nafloxacin, or clindamycin are commonly used.

Benzoyl peroxide can be used alone or in combination with topical retinoids or antibiotics.

Topical antibiotics tend to induce drug resistance in Propionibacterium acnes and should not be used alone or for long periods of time.

Oral medications

Commonly used drugs are isotretinoin, which can inhibit sebaceous gland lipid secretion and regulate abnormal keratinization of follicular sebaceous gland ducts.

It is mainly used for severe, coalescing or eruptive acne; frequent recurrence of acne that has failed other treatments; acne with severe seborrhea; mild to moderate acne but patients with a need for rapid results, but oral isotretinoin treatment is not recommended for simple blackheads on the nose.

Other Treatments

Acne vulgaris removal

Blackhead acne picking is an effective treatment for nose blackheads and can be done using an acne needle under aseptic manipulation, or an acne extruder can be used to remove the acne [5].

Avoid the use of acne extruders for pimples with inflammation, and pay attention to the strength of the extrusion, as improper force can lead to rupture of the sebaceous gland sacs, resulting in the development of inflammatory papules.

Avoid self-removal.

Keep the area clean after acne picking and do not scratch with hands [5,7].

Chemical peeling therapy

Commonly used chemical exfoliators include fruit acid, salicylic acid, etc., which can weaken the adhesion of the skin stratum corneum in order to correct the abnormalities of follicular epithelial keratinization, so as to make the follicular funnel part of the drainage smooth, sebum smoothly discharged, and to prevent sebum from accumulating and clogging the pores.

After chemical peeling treatment, attention should be paid to sun protection and moisturizing, avoid scratching, and do not peel off the scabs or flakes by yourself.

Prognosis

Cure

Nose blackheads are usually relieved or cured with prompt care and active treatment, and the prognosis is generally good.

If the disease is not actively treated the symptoms may gradually worsen and develop into moderate to severe acne, which is difficult to treat.

Harmfulness

Nose blackheads may recur, affecting aesthetics. Patients need to follow the doctor’s instructions for treatment and avoid picking them on their own with acne needles that are not thoroughly sterilized, etc., as this may cause infection or lead to the development of acne scarring.

Nose blackheads have a certain impact on aesthetics, and may affect the patient’s socialization, work and life; they may also cause some psychological pressure on the patient, and even cause the patient to develop psychological disorders such as anxiety and depression [1-7].

Daily

Daily management

Dietary management

Daily should pay attention to the diet light, eat more fresh vegetables and fruits, try to avoid eating high sugar, greasy, spicy stimulating food, such as chili, coffee, fat meat, cream, chocolate, sausage, snacks, sugar cubes and so on.

Eat more crude fiber food to keep the bowel movement smooth.

Life management

Daily should pay attention to facial cleanliness, but not excessive cleaning, wash your face with lukewarm water, do not be too cold or too hot, stimulate the skin.

Do not squeeze or scratch the blackheads on your nose by yourself to avoid infection.

Pay attention to sunscreen, mainly physical sunscreen, go out and wear a sun hat, play umbrella and so on.

Try to choose oil-control cosmetics; prohibit the use of oily cosmetics. Use sunscreen, isolation cream and foundation with caution to avoid clogging pores.

Keep a regular routine, ensure adequate sleep, and avoid staying up late [9-10].

Psychological support

Maintaining a good mental state and a pleasant mood can help improve the skin condition and reduce recurrent episodes.

Family members should care about the patient, increase communication, channel the patient’s bad mood in a timely manner, and consult a psychological clinic if necessary [5,8].

Prevention

Nose blackheads are caused by enlarged sebaceous glands and increased sebum secretion, which can help prevent this disease by the following measures.

Paying attention to daily skin cleansing and hydration to maintain the balance of skin oil and water.

Maintain good living habits, regular work and rest, do not stay up late, keep bowel movement, prevent constipation.

Pay attention to daily reasonable diet, try to prohibit or eat less high-fat, high-sugar and stimulating food [5,8].

Actively treat endocrine diseases such as polycystic ovary syndrome.