Acne and Blemish-fighting – Exfoliants, Antibiotics and Birth-control pills
Each of the following products and product categories reflects state-of-the-art treatments for blemishes, acne, and blackheads.
All of the products described below address each of the factors that cause pimples. These are the best options for reducing oil production, disinfecting the skin, improving exfoliation, and for controlling hormonal activity, and are a potential cure for blemishes. Finding the combination that works for you is the first goal, and then you must focus on hitting all the steps and carrying them out consistently.
Gentle cleansing is the first place to start. I’ve already elaborated on the need for gentle cleansing, but let me say it one more time for added emphasis. Using a water-soluble cleanser gently cleans your skin without stimulating the oil glands, increasing redness, or creating dryness. This step is standard for any skin-care routine because it makes an instant difference in the appearance and feel of the skin, and it is essential for reducing breakouts. Once you stop using drying, irritating, pore-clogging soaps or bar cleansers, and you realize how nice your skin feels when it is no longer dry and irritated, you will never go back to the old way again.
Just be certain the water-soluble cleanser you select doesn’t contain irritating ingredients and won’t dry out the skin. Using cleansers that contain exfoliating agents, topical disinfectants, or oil-absorbing ingredients is not the best option because the active ingredients would be washed away before they had a chance to have an effect on skin. Save these ingredients for another step.
Killing acne-causing bacteria comes next. There aren’t many options for disinfecting the skin. Alcohol (when used in the right concentrations) and sulfur can be good disinfectants, but they are too drying and irritating, causing more problems than they help, and that can generate more breakouts. Plant-derived disinfectants such as tea tree oil (melaleuca) are an option but there are no products currently being sold that contain a high enough concentration to reliably kill bacteria. Benzoyl peroxide is still the best over-the-counter disinfectant to consider, and is available over-the-counter in 2.5%, 5%, and 10% concentrations.
If benzoyl peroxide isn’t effective, a topical antibiotic or a topical antibiotic combined with benzoyl peroxide prescribed by a doctor are excellent options. If you are seeing a physician, one of typical treatments they might choose is to prescribe an oral antibiotic to
kill stubborn, blemish-causing bacteria from the inside. However, an oral antibiotic should be a last resort because of systemic problems and problems with resistant bacteria. Oral antibiotics can indeed kill blemish-causing bacteria, but they also kill good bacteria in the body, causing yeast infections and stomach problems. In addition, P. acnesin your body can develop resistant strains in a short period of time, making the antibiotic you’re taking ineffective, and then you have to move on to the next one, which reduces your choices of antibiotics should you need them for a serious illness.
Exfoliate! Because blemishes occur inside the pore and involve oil production, an effective 1% to 2% salicylic acid (beta hydroxy acid—BHA) product is a crucial over-the-counter starting point for exfoliating the skin. Salicylic acid is lipid soluble, which means it can exfoliate through oil, so it can get inside the pore and exfoliate the pore’s cell lining and improve its shape, plus it is extremely gentle. I recommend using BHA in a gel, liquid, or extremely light lotion formula because these formulas are unlikely to contain waxy thickening agents or emollients that can clog pores. Alpha hydroxy acids (AHAs) can be helpful for surface exfoliation, but they can’t affect the pore lining, and it’s essential to do that to deal with one of the root causes of a blemish.
Scrubs are an option for extra exfoliation, but because they typically come in thick formulations and those ingredients can clog pores, a washcloth with your gentle cleanser can provide the same benefit without any problematic added ingredients.
Improving cell production with retinoids is also very helpful. Tretinoins or other vitamin A prescription derivates, as found in Differin, are prescription options for generating healthy cell growth that can change the shape of the pore, allowing for normal oil flow. This improvement can eliminate the environment that allows the blemish to develop.
Absorbing or controlling excess oil is another consideration. Clay masks are an option for absorbing oil as long as they contain no irritating ingredients. Using milk of magnesia as a facial mask is a simple and effective way to absorb oil. Birth-control pills and hormone blockers can also equalize hormones, reducing or eliminating the source of excess oil production.
When all else fails, meaning your breakouts persist after you’ve tried these over-the-counter and prescription options, then you can still try photodynamic therapy or Accutane. Accutane is the only medication that can essentially cure acne and is essentially the last option in any experiment to deal with acne because of its serious side effects especially if a woman becomes pregnant while using it.
Exfoliants: Bha versus Aha
Referred to as beta hydroxy acid (BHA), salicylic acid can be a judicious starting point in the treatment of breakouts for all skin types. This is a multifunctional ingredient that addresses many of the systemic causes of blemishes (Source: Seminars in Dermatology, December 1990, pages 305–308), and it is exceedingly effective when combined with benzoyl peroxide (Source: Skin Pharmacology and Physiology, May 2006, pages 283–289). For decades dermatologists have been prescribing salicylic acid because it is such an effective keratolytic (exfoliant).
Yet, in addition to salicylic acid’s incredibly helpful exfoliating properties, it can do even more. Salicylic acid is a derivative of aspirin (both are salicylates—aspirin’s technical name is acetyl salicylic acid) and so it also functions as an anti-inflammatory (Sources: Seminars in Cutaneous Medicine and Surgery, September 2008, pages 170–176; and Archives of Dermatology, November 2000, pages 1390–1395). Combining exfoliation with reduced irritation has many advantages for skin, especially for someone struggling with breakouts. Diminishing or eliminating the redness and swelling blemishes cause can help skin heal, prevent scarring, and decrease the chance of further breakouts.
Preventing pores from becoming clogged is a requisite key to preventing blemishes. One way to achieve this is to improve the shape of the pore lining. The lining of a pore is made of skin cells (epithelial tissue) that can become thick and misshapen, preventing the natural flow of oil out of the pore. To act on the pore lining it is necessary to exfoliate inside the pore, dislodging excess skin cells.
Exfoliants such as alpha hydroxy acids (AHAs) or mechanical scrubs have limitations for blemish-prone skin due to their inability to penetrate inside the pore. AHAs are water-soluble and can’t get through the oil. Mechanical scrubs have particle sizes that are too large for them to have any effect below the surface of skin, though they can make the surface smoother. Salicylic acid is the perfect answer. It is an effective exfoliant, it is lipid soluble (so it effortlessly penetrates into the pore), and it is an anti-inflammatory so it can actually reduce irritation, swelling, and redness.
Another notable aspect of salicylic acid for breakouts is that it has antimicrobial properties (Sources: Preservatives for Cosmetics, by David Steinberg, Allured Publishing, 1996; Health Canada Monograph Category IV, Antiseptic Cleansers). That means it can be effective in killing the bacteria that cause acne. Together, all these properties mean salicylic acid is one of the more multifunctional ingredients in combating the causes of acne.
As wonderful as this sounds, salicylic acid is a tricky product to buy. The concentration must be at least 0.5%, but 1% to 2% is far more effective. Additionally, the formula’s pH is a critical factor. For salicylic acid to work as an exfoliant on skin, it must be in a formulation with a pH of 3 to 4; if it isn’t, it loses its ability to exfoliate skin (Source: Cosmetic Dermatology, October 2001, pages 65–72). Plus the product must not contain any irritating ingredients. Well-formulated salicylic acid products do exist, and once you’ve found the right one, it can be a successful part of your battle plan to fight blemishes.
(Other sources: Journal of the European Academy of Dermatology and Venereology, May 2008, pages 629–631; Dermatology, January 2003, pages 68–73; and European Journal of Dermatology, July–August 2002, pages 64–50.)
Over-the-counter Antibacterial options
Benzoyl peroxide, which was briefly discussed above, is considered the most effective over-the-counter choice for a topical antibacterial agent in the treatment of blemishes. (Sources: Dermatologic Clinics, January 2009, pages 33–42; and Skin Pharmacology and Applied Skin Physiology, September–October 2000, pages 292–296.) The amount of research demonstrating the effectiveness of benzoyl peroxide is exhaustive and conclusive.
Benzoyl peroxide’s main attributes are its ability to penetrate into the pore that holds the hair follicle to reach the bacteria and prevent them from creating inflammation, in essence destroying their ability to cause breakouts. Benzoyl peroxide has a low risk of irritation, and it also doesn’t have potential to create the problem of bacterial resistance that some prescription topical antibacterials (antibiotics) do. (Sources: British Journal of Dermatology, August 2008, pages 480–481; and Dermatology Therapy, March–April 2008, pages 86–95.)
Benzoyl peroxide solutions range from 2.5% to 10%. For the sake of your skin, start with the less potent concentrations. A 2.5% benzoyl peroxide product is much less irritating than a 5% or 10% concentration, and it can be just as effective. It completely depends on how stubborn the strain of bacteria in your pores happens to be.
Despite benzoyl peroxide’s superior disinfecting and penetrating properties, some bacteria just won’t give up easily, and in those situations a different weapon may be necessary. That’s when you should consider prescription topical disinfectants (topical antibiotics).
If your skin doesn’t respond to benzoyl peroxide in the various over-the-counter higher strengths or in combination with a well-formulated BHA (salicylic acid), the next step is a prescription topical antibacterial, meaning some type of antibiotic, in a liquid, lotion, or gel form. Topical antibiotics have limitations. They can have difficulty penetrating the hair follicle, and long-term use can lead to antibiotic-resistant strains of bacteria. Erythromycin, tetracycline, and clindamycin are the most popular topical antibiotics.
You can use these antibiotics alone, but a good deal of research points to the greater benefit of combining these with benzoyl peroxide to create a potent and effective treatment. Studies indicate that when topical clindamycin or erythromycin are combined with benzoyl peroxide, both have demonstrated clinical efficacy in the treatment of acne. When used in tandem, they promise greater efficacy than either individual agent alone, through their antibacterial and anti-inflammatory complementary effects.
Together they have an earlier onset of action, are significantly more effective against inflamed and total lesions, and are better tolerated, which should improve usage. (Sources: Dermatology Clinics, January 2009, pages 25–31; British Journal of Dermatology, January 2008, pages 122–129; Journal of Cutaneous Medical Surgery, January 2001, pages 37–42; and American Journal of Clinical Dermatology, 2001, volume 2, issue 4, pages 263–266.)
Warning:Do not apply benzoyl peroxide and a retinoid (such as Retin-A, Renova, Tazorac, Avita, generic tretinoin) at the same time. Benzoyl peroxide inactivates retinoids (Source: British Journal of Dermatology, September 1998, page 8). The exception to this is Differin (adapalene), which is compatible with benzoyl peroxide.
Dapsone: the latest Antibacterial option
Dapsone is a topical disinfectant gel available by prescription in 5% strength. The brand name for the anti-acne drug is Aczone, and it is made by Allergan (of Botox fame). Dapsone is a drug that comes from the sulfone family of drugs. Its relation to sulfur explains its antibacterial action.
Double-blind, large-scale studies examining dapsone’s effectiveness on adolescent acne have shown that it is well-tolerated and brought about “clinically meaningful” improvements in acne lesion count after 12 weeks, with improvements continuing with ongoing usage. Side effects were similar to that of the “vehicle gel,” which was not identified in the studies.
Although Aczone is an option for inflammatory acne and research on its efficacy is positive, what’s lacking are critical comparative studies with other known, established anti-acne drugs (both prescription and over-the-counter). I wouldn’t consider Aczone unless you have tried benzoyl peroxide, retinoids, and salicylic acid, all of which have a large body of research proving their efficacy and safety. If those actives haven’t produced satisfactory results, talk to your physician about Aczone/dapsone.
Sources: Cutis, February 2008, pages 171–178 and November 2007, pages 400–410; Journal of Drugs in Dermatology, October 2007, pages 981–987; and Journal of the American Academy of Dermatology, March 2007, pages e1-e10).
Tea tree oil versus Benzoyl peroxide
Tea tree oil has some interesting research demonstrating it to be an effective antimicrobial agent. The Journal of Applied Microbiology(January 2000, pages 170–175) stated that “The essential oil of Melaleuca alternifolia(tea tree) exhibits broad-spectrum antimicrobial activity. Its mode of action against the Gram-negative bacterium Escherichia coliAG100, the Gram-positive bacterium Staphylococcus aureusNCTC 8325, and the yeast Candida albicanshas been investigated using a range of methods….
The ability of tea tree oil to disrupt the permeability barrier of cell membrane structures and the accompanying loss of chemiosmotic control is the most likely source of its lethal action at minimum inhibitory levels.” In addition, “In a randomized, placebo-controlled pilot study of tea tree oil in the treatment of herpes cold sores, tea tree oil was found to have [a] similar degree of activity as 5% acyclovir” (Source: Journal of Antimicrobial Chemotherapy, May 2001, page 450).
For acne there is also some published information showing it to be effective as a topical disinfectant for killing the bacteria that can cause pimples (Source: Letters in Applied Microbiology, October 1995, pages 242–245). But there is also a medical review of tea tree oil challenging the viability of these studies (Source: Journal of Antimicrobial Chemotherapy, February 2003, pages 241–246).
However, the crux of the matter for any potential efficacy in a commercial product is, how much tea tree oil is needed to have an effect? The Medical Journal of Australia(October 1990, pages 455–458) compared the efficacy of tea tree oil to the efficacy of benzoyl peroxide for the treatment of acne. A study of 119 patients using 5% tea tree oil in a gel base versus 5% benzoyl peroxide lotion was discussed. There were 61 patients in the benzoyl peroxide group and 58 in the tea tree oil group.
The conclusion was that “both treatments were effective in reducing the number of inflamed lesions throughout the trial, with a significantly better result for benzoyl peroxide when compared to the tea tree oil. Skin oiliness was lessened significantly in the benzoyl peroxide group versus the tea tree oil group.” However, while the reduction of breakouts was greater for the benzoyl peroxide group, the side effects of dryness, stinging, and burning were also greater—“79% of the benzoyl peroxide group versus 49% of the tea tree oil group.”
Given these results, a 2.5% strength benzoyl peroxide solution would be better to start with to see if it is effective, rather than starting with the more potent and somewhat more irritating 5% or 10% concentrations. However, if you were interested in using a 5% strength tea tree oil solution to see if that would be effective, at this time I know of no products stating how much tea tree oil they contain. It appears that almost all tea tree oil products on the market contain little more than a 1% concentration, if that, which is probably not enough to be of much help for breakouts.
Tretinoin for Blemishes
Retinoid is the general category name for any and all forms of vitamin A. Tretinoin is a form of vitamin A and, therefore, comes under the general heading of retinoids. The best-known products that contain tretinoins are Retin-A, Renova, Retin-A Micro, Tazorac, Avita, and generic tretinoin. These are all basic treatments for blemishes because they change the way skin cells are formed in the layers of skin as well as in the pore. If skin cells have an abnormal shape, they tend to stick together and shed poorly, often getting backed up in the pore.
Tretinoin can transform cell production by improving shedding and by unclogging pores, thereby producing a significant reduction in inflammatory lesions. Topical tretinoins and antibacterial agents have complementary actions and they work well together, but their application must be separated, at least if the antibacterial agent you’re using is benzoyl peroxide. Benzoyl peroxide can render tretinoin ineffective when the two are applied together. The solution is to use benzoyl peroxide in the morning and your tretinoin product at night. Tretinoins are not able to kill P. acnes, the bacteria that cause the breakouts, but an antibacterial agent can. Meanwhile, tretinoins can improve and restore the shape of the pore, opening a clear pathway for the antibacterial agent so it can be more active. (Sources: American Journal of Clinical Dermatology, June 2008, pages 369–381; Clinical Therapy, June 2007, pages 1086–1097; and Journal of the European Academy of Dermatology and Venereology, December 2001, page 43.)
One of the major drawbacks to the use of tretinoin is the irritation it can cause. For some people this can be so severe as to prevent its use. But there are alternatives. There is a great deal of research showing that adapalene (brand name Differin), another retinoid but different from tretinoin, can be just as effective as tretinoin but without the irritation (see the following section on Differin).
Meanwhile, remember that using any tretinoin product can make the skin more vulnerable to sun damage and sunburn. It is essential to wear an SPF 15 sunscreen that contains the UVA-protecting ingredients avobenzone (butyl methoxydibenzylmethane), Mexoryl SX (ecamsule), Tinosorb, titanium dioxide, or zinc oxide as the active ingredient. Zinc oxide and titanium dioxide are occlusive and can possibly clog pores, and synthetic sunscreen ingredients can be sensitizing for some skin types, so it may take experimentation to find the right sunscreen that works best for your skin type.
Where does Differin fit into this picture? Differin (also called adapalene) is a retinoid, a form of vitamin A that has been shown in clinical studies to be less irritating than tretinoin. According to a study published in the March 1996 Journal of the American Academy of Dermatology, Differin was also significantly more effective in reducing blemishes and was better tolerated than tretinoin gel. Other more recent studies have come to the same conclusion, which is that, by several measures, adapalene cream and gel were less irritating upon multiple dosing than various tretinoin creams and gels. (Sources: International Journal of Dermatology, October 2000, pages 784–788; and Journal of Cutaneous Medical Surgery, October 1999, pages 298–301.)
It seems that Differin has a radarlike ability to positively affect the skin-cell lining of the pores, substantially improving exfoliation and helping to prevent blockage. Moreover, for those with oily skin, the original Differin comes in a lightweight gel formula that is barely felt on the skin. It contains little more than water and cellulose, a sheer thickening agent. Differin is also available in a cream base for those with dry skin and blemishes.
Should you consider Differin? If you have tried Retin-A or other tretinoins and had difficulty dealing with the irritation, or if you just want to see if Differin can work better for you (which it may), then it is certainly an option. Unlike tretinoin products, Differin is not inactivated by benzoyl peroxide, which means you can apply both at the same time.
Azelaic acid 15% gel was approved for the treatment of rosacea in the U.S. in 2008, but has also been approved for the treatment of acne in many European countries, where it has demonstrated success. Two randomized, multicenter, controlled clinical trials compared the effects of azelaic acid 15% gel with those of topical benzoyl peroxide 5% or topical clindamycin 1%, all using a twice-daily dosing regimen. The primary endpoint in the intent-to-treat analysis was a reduction in inflammatory papules and pustules. Azelaic acid resulted in a 70% to 71% median reduction of facial papules and pustules compared with a 77% reduction with benzoyl peroxide 5% gel and a 63% reduction with clindamycin.
Azelaic acid 15% gel was well-tolerated. In addition, a one-year European observational study conducted by dermatologists in private practice evaluated the safety and efficacy of azelaic acid 15% gel used as monotherapy or in combination with other agents in more than 1200 patients with acne. Most physicians (81.9%) described an improvement in patients’ symptoms after an average of 34.6 days, and 93.9% of physicians reported patient improvement after an average of 73.1 days.
Both physicians and patients assessed azelaic acid 15% gel to be effective, with 74% of patients being “very satisfied” at the end of therapy. Azelaic acid 15% gel was considered “well-tolerated” or “very well-tolerated” by 95.7% of patients. (Sources: Journal of Drugs in Dermatology, January 2008, pages 13–16; and Journal of the American Academy of Dermatology, August 2000, Supplemental, pages 47–50.)
If topical exfoliants, retinoids, and antibacterial agents don’t provide satisfactory results, an oral antibiotic prescribed by a doctor may be an option to kill stubborn, blemish-causing bacteria. Several studies have shown that oral antibiotics, used in conjunction with topi-cal tretinoins or topical exfoliants, can control or reduce many acne conditions. (Sources: Cutis, August 2008, pages S5–S12; and International Journal of Dermatology, January 2000, pages 45–50.)
As effective as oral antibiotics can be, they should be a near-last resort, not a first line of attack. Oral antibiotics can produce some unacceptable long-term health problems. Some dermatologists tend to give the negative side effects of oral antibiotics short shrift and prescribe them as if they were nothing more than candy for their acne patients. Oral antibiotics are anything but candy. They kill the good bacteria in the body along with the bad, and that can result in chronic vaginal yeast infections as well as stomach problems.
A more worrisome side effect is that the acne-causing bacteria can become immune to the oral antibiotic. According to an article in the American Journal of Clinical Dermatology (2001, volume 2, issue 3, pages 135–141), “The main cause for concern following the use of systemic antibiotics is the emergence of antibiotic-resistant strains of P. acnes.” Similarly, a paper presented at the General Meeting of the American Society for Microbiology in May 2001 (www.asmusa.org/memonly/abstracts/AbstractView.asp?AbstractID=47544) stated that “antibiotic treatment in patients with severe acne causes development of anti-biotic resistance….
The prevalence of antibiotic resistance to tetracycline, erythromycin, clindamycin and trimethoprim-sulphamethoxazole…” was found after two to six months. “When patients with acne are treated with antibiotics, the risk of development of antibiotic resistance should be realized. The use of antibiotics to treat acne should be restricted and other regimens should be tested.”
This means that if you have been taking an oral antibiotic to treat your acne for longer than six months it can stop being effective. It also explains the situation that leaves many women puzzled, since initially the antibiotic they were taking gave incredible results, but then became ineffective. (Source: Seminars in Cutaneous Medicine and Surgery, September 2008, pages 183–187.)
An even more serious argument against taking oral antibiotics was discussed in the American Journal of Clinical Dermatology(July–August 2000, pages 201–209), which stated: “At a time when there is global concern that antibiotic resistance rates in common bacterial pathogens may threaten our future ability to control bacterial infections, practices which promote the spread of antibiotic-resistant bacteria must be fully justified.”
The decision to use oral antibiotics should not be taken lightly. The course of action you take should be discussed at length with and monitored by both you and your dermatologist.
Niacinamide and Nicotinic acid for Acne
Niacinamide and nicotinic acid are derivatives of vitamin B3. There is a handful of studies showing they can be helpful for improving the appearance of acne, most likely for their anti-inflammatory capacity. Many cosmetics companies are beginning to include these two ingredients in the products they’re aiming at blemish-prone skin as well as in “anti-wrinkle” products. Especially when they’re part of a great skin-care routine that also includes either an over-the-counter benzoyl peroxide antibacterial and salicylic acid exfoliant, or a prescription topical antibiotic with benzoyl peroxide, they contribute to a powerful combination of products to combat the events taking place in skin that is fomenting acne. (Sources: Journal of Cosmetic Laser Therapy, June 2006, pages 96–101; and Journal of Cosmetic Dermatology, April 2004, pages 88–93.)
Birth-control pills for Acne?
Oral contraceptives (OCs) can reduce acne lesions, in part by decreasing androgens (male hormones) as well as by increasing estrogen levels in the body, both of which are important factors in what causes blemishes. OCs should not be the first-line therapy or monotherapy for acne, but they can serve as a good alternative for those with mild to moderate acne.
If you are a woman (sorry, guys) looking for a way to reduce breakouts, you might want to discuss your skin problems with your gynecologist instead of your dermatologist. The FDA has approved low-dosage birth-control pills (Ortho Tri-Cyclen and generic norgestimate/ethinyl estradiol) for use in the treatment of acne. In Canada, Diane-35, a combination of cyproterone acetate and ethinyl estradiol is approved for the treatment of acne (Source: Skin Therapy Letter, 1999, volume 4, number 4). Depending on your lifestyle and medical history, you could solve two problems with one prescription.
How does the birth-control pill work on acne? Increased oil production can be caused by the body’s androgen (male hormone) production, which can be highest just before menstruation starts. It appears that low-dosage birth-control pills can decrease the presence of excess androgens, thereby decreasing breakouts. They work particularly well when used in conjunction with other therapies such as topical antibacterial agents or tretinoins (Source: Skin Therapy Letter, February 2001, pages 1–3). For a lot of women this is no surprise. Many have noticed an improvement in their skin after they started taking birth-control pills.
According to a double-blind, placebo-controlled study published in Fertility and Sterility(September 2001, pages 461–468), other “low-dose birth-control pills can be an effective and safe treatment for moderate acne.” The double-blind, placebo-controlled, randomized clinical trial found that the birth-control pill containing levonorgestrel (Alesse®) reduced acne.
Low-dose oral contraceptives also result in a low occurrence of estrogen-related side effects like nausea, headaches, and breast tenderness, in addition to low, if any, weight gain (Source: Medscapepress release, September 7, 2001).
Is taking birth-control pills to control acne right for you? There are risks associated with taking birth-control pills, and these should be taken into account before you make a final decision. These risks include increased chances of heart attack, strokes, blood clots, and breast cancer (and these are compounded if you smoke), not to mention possible side effects such as vaginal bleeding, fluid retention, melasma (dark-brown skin patches), and depression. All of those potential side effects may not be a worthwhile trade-off for clear skin. However, if you’re already considering or using the pill for birth control, this remedy may be worth looking into.
This isn’t a pretty topic, but it is a fact of life and human nature that just leaving a blemish or blackhead alone is almost impossible. Fortunately, gently removing a blackhead or blemish with light-handed squeezing can actually help the skin. Removing the stuff inside a blackhead or especially a pimple relieves the pressure and reduces further damage. Yes, squeezing can be detrimental to the skin, but it’s the way you squeeze that determines whether you inflict harm. If you oversqueeze, pinch the skin, scrape the skin with your nails, or press too hard, you are absolutely doing more damage than good. Gentle is the operative word and, when done right, squeezing with minimal pressure is the best (if not the only) way to clean out a blackhead or blemish.
Although I never recommend steaming the face (heat can overstimulate oil production, cause spider veins to surface, and create irritation), a tepid to slightly warm compress over the face can help soften the blackhead or blemish, making it easier to remove. First, wash your face with a water-soluble cleanser, pat the skin dry, then place a slightly warm, wet cloth over your face for approximately 10 to 15 minutes. Once that’s done, pat the skin dry again.
Using a tissue over each finger to keep you from slipping and tearing the skin, apply even, soft pressure to the sides of the blemish area, gently pressing down and then up around the lesion. Do this once or twice only. If nothing happens, that means the blemish cannot be removed, and continuing will bruise the skin, risk making the infection or lesion worse, and cause scarring. Again, only use gentle pressure, protect your skin by using tissue around your fingers, and do not oversqueeze.
Be sure to use a salicylic acid or benzoyl peroxide solution after you’re done to soothe the skin and reduce inflammation. Do not remove blackheads or blemishes more than once or twice a week or you can cause too much irritation.
Pore strips in all their varying incarnations are meant to remove blackheads. You place a piece of cloth with a sticky substance on it over your face, as you might do with a Band-Aid, wait a bit for it to dry, and then rip it off. Along with some amount of skin, blackheads are supposed to stick to the strip and come right out of your nose. There is nothing miraculous about these products, nor do they work all that well. The main ingredient on these strips is a hairspray-type substance. If the instructions are followed closely you can see some benefit in removing the very surface of a blackhead. In fact, you may at first be very impressed (or grossed out) with what comes off your nose.
Unfortunately, that leaves the majority of the problem deep in the pore. What has me most concerned about pore strips is they are accompanied by a strong warning not to use them over any area other than the intended area (nose, chin, or forehead) and not to use them over inflamed, swollen, sunburned, or excessively dry skin. It also states that if the strip is too painful to remove, you should wet it and then carefully remove it. What a warning!
Also, despite the warning on the package, I suspect most women will try these strips wherever they see breakouts. If I didn’t know better, I know I would. The way these strips adhere, they can absolutely injure or tear skin. They are especially unsafe if you’ve been using Retin-A, Renova, Differin, AHAs, or BHA; having facial peels; taking Accutane; or if you have naturally thin skin or any skin disorder such as rosacea, psoriasis, or seborrhea.