What are the treatment options for comedones (blackheads)?

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Last updated: May 13, 2025View editorial policy

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From the Guidelines

To treat blackheads, a combination of daily cleansing with benzoyl peroxide face washes and regular exfoliation 2-3 times weekly using products containing alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs) is recommended, as supported by the most recent guidelines 1. The treatment of blackheads, a form of acne, involves addressing the underlying causes of comedone formation and preventing further clogging of pores.

  • Daily cleansing with benzoyl peroxide face washes can help reduce bacterial load and prevent pore clogging.
  • Regular exfoliation using products containing alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs) can help remove dead skin cells and other debris that can clog pores.
  • Applying a retinoid cream like adapalene (Differin) or tretinoin at night can promote cell turnover and prevent pore blockage, as recommended by recent guidelines 1.
  • For immediate extraction, using a comedone extractor tool after softening the skin with warm water or steam can be effective, but it is essential to be gentle to avoid scarring.
  • Clay masks containing ingredients like kaolin or bentonite can be used weekly to absorb excess oil and reduce the appearance of blackheads. It is crucial to maintain this routine consistently, as blackheads form when oil and dead skin cells clog pores and oxidize upon exposure to air.
  • Avoid picking at blackheads with fingers, as this can introduce bacteria and cause inflammation. If over-the-counter treatments do not work after 6-8 weeks, consider seeing a dermatologist who may recommend prescription-strength treatments or professional extractions, as suggested by recent guidelines 1. The use of topical retinoids, benzoyl peroxide, and other agents can be effective in treating blackheads, and their combination can enhance treatment outcomes, as supported by recent studies 1. Overall, a comprehensive treatment approach that includes daily cleansing, regular exfoliation, and the use of topical retinoids and other agents can help effectively manage blackheads and prevent their recurrence.

From the FDA Drug Label

FOR DERMATOLOGICAL USE ONLY. NOT FOR OPHTHALMIC, ORAL OR INTRAVAGINAL USE. Use for the treatment of acne

  • Salicylic acid and benzoyl peroxide are used for dermatological conditions, with benzoyl peroxide specifically indicated for acne treatment.
  • Blackheads are a type of acne, so benzoyl peroxide may be used for treatment.
  • There is no direct information on the use of salicylic acid for blackhead treatment in the provided labels, but it can be used for dermatological conditions.
  • Based on the information, benzoyl peroxide can be considered for the treatment of blackheads 2.

From the Research

Treatment of Blackheads

Blackheads are a type of comedonal acne, and their treatment typically involves the use of topical agents that help to unclog pores and reduce inflammation. Some of the key treatments for blackheads include:

  • Topical retinoids, such as tretinoin, which help to prevent clogged pores and reduce inflammation 3
  • Benzoyl peroxide, which helps to kill bacteria that can contribute to acne and reduce inflammation 4
  • Salicylic acid, which helps to exfoliate the skin and unclog pores 5, 6, 7
  • Azelaic acid, which has antibacterial and anti-inflammatory properties 3

Efficacy of Treatments

Studies have shown that these treatments can be effective in reducing the number of blackheads and other types of acne lesions. For example:

  • A study found that treatment with tretinoin 0.025% gel reduced acne lesion counts by 63% compared to baseline 3
  • A study found that treatment with salicylic acid pads reduced the number of primary lesions and the number and severity of all lesions associated with acne 5
  • A study found that treatment with a combination of benzoyl peroxide and salicylic acid reduced the total number of acne lesions by 56.9% to 61.6% 6

Safety and Tolerability

While these treatments can be effective, they can also have some side effects, such as:

  • Skin irritation, dryness, and redness 4
  • Mild to moderate adverse events, such as local dryness, irritation, dermatitis, erythema, application site pain, and pruritus 4
  • Risk of treatment discontinuation due to adverse effects, which may be higher with benzoyl peroxide compared to placebo or no treatment 4

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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