Comedones – colloquially called blackheads – (Latin comedere “eat'”, “eat along”, “consume”; ICD-10-GM L70.0: Acne vulgaris) are primary, non-inflammatory efflorescences (pathological changes of the skin). They are dilated hair ducts (hair follicles) filled with keratin and sebum. Comedones can occur alone or in association with acne (e.g., acne vulgaris).
Symptoms – complaints
Frequent occurrence of the various efflorescences.
- Primary, non-inflammatory efflorescences (so-called blackheads) – microcomedones, closed comedones (whitish small skin entities), open comedones (skin entities with a dark sebaceous plug).
- Secondary, inflammatory efflorescences – papules (nodular thickening of the skin), pustules (pustules), nodules, abscesses.
- Tertiary, no longer inflammatory efflorescences – scars, cysts (lump filled with fluid in the body tissues), fistula comedones (connecting ducts between individual comedones).
Predilection site (body regions where the changes occur most frequently).
- Face
More rarely, the following areas of the body are affected
- Neck
- Neckline
- Back
- Upper arms
There are two types of blackheads:
- Whitehead – bright, closed blackhead.
- Blackhead – open blackhead
Blackheads are initially still closed and are called whitehead, because they have a white head. If the blackheads open, their surface turns black due to the reaction of the skin pigment melanin with air, light and bacteria, they are then called blackhead.
Pathogenesis (disease development) – etiology (causes)
In the skin there are the so-called hair channels – hair follicles – from which the fine facial hairs grow out. Inside these ducts are sebaceous glands. The glands produce sebum, which is released to the skin surface through the hair canal to protect the skin from drying out. When the hair follicle becomes clogged, for example by tiny skin particles, blackheads form. The sebaceous gland is closed and the sebum can no longer be released, causing the follicle to swell. Normally, so-called horny lamellae are also located inside the gland, which ensure that the sebum is drained off. However, due to the large amount of sebum, the horny lamellae are compressed in such a way that they harden and can no longer perform their task – a blackhead has formed.
Diagnostics
Blackheads are detected by eye diagnosis.
Therapy
General measures
- Only reach into the face with clean hands.
- No manipulation (“scratching”) on papules (from Latin : papula “vesicle” or nodule) and pustules (from Latin : pustula; pustule).
- No wearing headbands
- Skin care tips:
- Acne patients should gently remove sebum and grease from the skin of the face with a mild cleanser (or better with only pure water) no more than once a day, without much rubbing. Caution. Larger amounts of washing substances lead to redness!
- As a washing substance are suitable soap-free pH-neutral wash syndets (compound term from synthetic detergents; this refers to synthetic washing-active substances), which should be used sparingly.
Therapy recommendation
- In a professional treatment, the skin is first softened by means of compresses or steam baths. This loosens the top horny layer and the blackhead can then be removed with special tools.
A subsequent treatment with disinfectants kills any remaining bacteria and thus prevents a new formation. Attention. Blackheads should not be removed yourself. The “pushing around” ensures that the bacteria spread further and can lead to painful inflammation.
