Blackheads: HS' Best Friends
We all have them, they’re HS’ best friends...blackheads. These are not your typical blackheads, they're actually called DEPs (double-ended pseudocomedones). DEPs are keratin-filled interconnected multi pores and are considered a typical sign of HS that may be overlooked.
DEPs are not normal surface blackheads and are best left alone. If you feel that you need to do something to try and rid yourself of them, the best option is to try and promote bringing them to the surface and hopefully they will come out on their own or working with your Dermatologist on methods for removal (keep reading for options). Given that HS is a follicular occlusion, using devices, picking, scratching or trying to squeeze or dig them out can actually make the situation worse. In some cases it can cause a flare to develop, which can contribute to tunneling or make your HS worse.
A few options to try:
During or after a warm/hot bath or shower, while the skin is still soft, lightly exfoliate and make this part of your shower regimen.
Apply a thick paste of 2-3 teaspoons of baking soda and 1 teaspoon of water on the blackheads, gently massage for 3-4 minutes. Rinse off once dry after a few minutes. Repeat several times per week.
Dab raw filtered honey on the area that is affected by blackheads. The dabbing motion and the stickiness of the honey can remove the blackheads. Repeat several times per week.
Milk and Gelatin Mask (use caution in areas without hair)
Mix 1 tablespoon of Knox Unflavored Gelatin and 1.5 teaspoons of milk together and put in the microwave for 10-15 seconds. Quickly apply the mixture to the affected area. It hardens fast! Once the mask has dried, which takes about 15 minutes, peel off. Repeat several times per week.
You can also discuss your concerns regarding DEPs with your dermatologist for help in figuring out how to safely remove them.
Science of DEPs:
Under dermoscopy, DEP appear as coupled deepening hollows presenting a keratin mass at each end, sometimes connected by a bluish tract detectable through a translucent, cicatricial tissue. Most DEP's are a result from the healing of previous inflammatory lesions, as confirmed by their constant presence within a cicatricial tissue. DEP may result from keratinization of the residual stump of adjacent follicles. With several studies, using dermoscopy, presence of scars with different depth levels, suggesting a long-lasting, wax and wane tissue repair, as confirmed by all patients. Suggesting mechanical stress (friction), may hypothetically play a role in triggering such relapsing inflammatory processes with DEP and HS.
Histopathology of DEP showed cavities lined by normal multilayered epithelium and filled with corneal lamellae, cellular debris, and amorphous material, in which the hair follicles, which were destroyed by the inflammatory process, were no longer detectable. As a result, no hairs are typically observed on clinical and dermoscopy evaluation. Both clinically and at dermoscopy they present as superficial, follicular papules with a central, roundish opening filled with a keratotic plug, epidermis and depressed scars from previous lesions may be present.
Read more about a Follicular Occlusion here.
Content in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking treatment because of something you have read on this website.
Written by Denise Panter-Fixsen
Edited by Brindley Kons