December 2001

Myths about acne die hard. Comments from AcneNet Website visitors indicate that acne myths are not only alive but thriving by being passed along on the Internet. A persistent myth about acne is that acne clears up faster when blackheads are squeezed. Not only is this myth false, squeezing blackheads may result in harm to the skin.

As tempting as it may be to squeeze open or closed comedones (blackheads and whiteheads)—don’t do it. Squeezing comedones is much more likely to make acne worse than to improve it.

All scientific evidence indicates that blackheads should not be squeezed. Neither should they be removed at home using a "blackhead extractor" for sale on the Internet or in magazine advertisements. The fully developed blackhead does usually not become inflamed unless it is manipulated by squeezing. The trauma of squeezing can (1) injure the sebaceous follicle and the tissue around it, and (2) force contents of the blackhead deeper into tissue as well as extruding it to the surface of the skin. The result can be initiation of an inflammatory reaction (1) to tissue injury and (2) to bacteria and their chemical products contained in the blackhead’s contents. Left alone, fully developed blackheads usually do not become inflamed.

Squeezing or picking whiteheads (closed comedones) or microcomedones is potentially even more harmful. The microcomedo (a "sandpaper comedo"—almost too small to be seen but may be felt as roughness on the skin), and the whitehead (closed comedo) are more likely than blackheads to become sites of inflamed lesions. Depending on the site and extent of inflammation, the microcomedo and closed comedo may eventually evolve into a pustule or a papule. Any attempt to manipulate these acne lesions by squeezing or picking can aggravate the inflammatory process.

In any case, squeezing a microcomedo or closed comedo will not extrude its contents. The microcomedo is an undeveloped comedo, so there is really nothing to squeeze. The closed comedo (whitehead) differs from the fully developed open comedo (blackhead) in that (1) the follicular opening is so small as to be invisible, so little or no comedo contents can be extruded through it by pressure of squeezing, and (2) the contents of the whitehead are not as compact as the contents of blackhead, so unlike the paste-like contents of a blackhead it cannot be extruded by pressure.

The difference between an "open" and "closed" comedo is apparent in their description. The solid contents of an open comedo (blackhead) is continuously being extruded from the sebaceous follicle to the surface of the skin. In contrast, the contents of a closed comedo (whitehead) is completely retained within the sebaceous follicle. The contents of a closed comedo includes inflammatory chemicals and bacterial by-products that can produce an inflamed acne lesion. Acne investigators have called closed comedones "time bombs" waiting to explode into inflamed lesions [Strauss JS, Kligman AM. The pathologic dynamics of acne vulgaris. Arch Dermatol 1968; 82:779-782.].

Picking or squeezing can cause tissue injury and reactive inflammation that complicates the complex inflammatory environment inside a closed comedo.

When closed comedones follow a pattern of development into pustules and papules they should be treated by a dermatologist. A regular program of treatment based upon your medical needs is the best way to keep acne under control.

Reference

Cunliffe W. The Acnes. 1989. (Reprints of chapters from previous AcneNet review panel.