HS's Best Friend: Blackheads & Whiteheads

Updated: Jun 30

We all have them, they’re like HS’s best friends...blackheads and whiteheads. These are not your typical blackheads, they're actually called DEP (double-ended pseudocomedones) and are keratin-filled interconnected multipores. DEPs are considered a typical sign of HS, which can be overlooked with this condition.

We all wonder what to do with these DEPs and the best option is to leave them alone. Don't pick at them, scratch them, or try to squeeze/dig them out. If you pick or try to remove them, in some cases a flare can develop, which can contribute to tunneling, or make your HS worse. The best option is to try and promote bringing them to the surface and hopefully they will come out on their own; just keep in mind these are not typical surface black heads.

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.

Baking Soda

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.

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 dermo-scopy 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.


This is an awareness article for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.

Written by Denise Panter-Fixsen

Edited by Brindley Kons

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