✅ In teenagers with acne, blackheads (open comedones) are very common—especially on the nose, forehead, and chin—due to hormonal surges that increase oil (sebum) production and cause dead skin cells to stick together inside pores. While it’s tempting to squeeze them, DIY extraction at home is strongly discouraged because it often leads to redness, scarring, dark spots (post-inflammatory hyperpigmentation), or even infection. Instead, the safest approach combines gentle professional extraction (when needed) with daily medical skincare.
For a teenager, blackhead extraction should only be done by a dermatologist or licensed medical aesthetician in a clean, clinical setting—not at home. The process starts with cleansing the skin, then applying a warm compress or steam for 3–5 minutes to soften the skin and open pores. Using sterilized tools (like a comedo extractor loop), the professional applies gentle, even pressure around—not on—the blackhead to coax out the dark keratin plug. If the plug doesn’t come out easily, they stop and don’t force it. Afterward, a soothing, anti-inflammatory product (like azelaic acid or a light moisturizer) is applied, and sunscreen is used if it’s daytime—since sun exposure worsens dark spots after extraction. Importantly, extraction alone is not a long-term solution; it must be paired with daily treatments to prevent new blackheads. First-line topical treatments include adapalene 0.1% gel (a retinoid) used 2–3 nights per week (buffered with moisturizer to reduce irritation), and salicylic acid 0.5–2% cleansers or leave-on products to gently exfoliate inside pores. For mild-to-moderate acne, combining adapalene at night with benzoyl peroxide 2.5–5% in the morning (to fight bacteria and inflammation) is highly effective and well-studied. A 12-week clinical trial showed that adapalene/benzoyl peroxide fixed-dose combination reduced comedones by over 60% with good tolerability in teens (Tanghetti et al., J Drugs Dermatol. 2015). In addition to topicals, daily habits matter: washing the face twice a day with a gentle, non-soap cleanser, avoiding heavy makeup or oily hair products near the face, changing pillowcases 2–3 times a week, and never picking or scrubbing the skin. If over-the-counter products aren’t helping after 8–12 weeks, a dermatologist may recommend prescription options like stronger retinoids, oral antibiotics (short-term, e.g., doxycycline 40 mg modified-release), or—in severe, persistent cases—low-dose isotretinoin (formerly Accutane), which has high success rates and is safe in teens under careful monitoring (Zaenglein et al., J Am Acad Dermatol. 2016). The goal isn’t just to remove existing blackheads—but to create a sustainable routine that keeps pores clear and skin healthy long-term.
Key References:
- Zaenglein AL, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945–973. doi:10.1016/j.jaad.2015.12.037
- Tanghetti EA, et al. Efficacy and safety of fixed-dose adapalene 0.3%/BPO 2.5% gel in adolescents with moderate-to-severe acne. J Drugs Dermatol. 2015;14(10):1092–1098.
- Draelos ZD. Cosmetic Dermatology: Principles and Practice, 3rd ed. Thieme, 2022.
- American Academy of Dermatology (AAD). Acne Resource Center for Teens & Parents. aad.org/public/diseases/acne
