What should you know about old blackheads?

A blackhead forms when oil and shed skin cells block a pore that remains open to air. The dark surface is caused by oxidation of the material in the pore, not by dirt. Persistent blackheads often occur on the nose, forehead, cheeks, or chin, where oil production can be greater. They can be part of [Acne](/conditions/acne/) or [Comedonal Acne](/conditions/comedonal-acne/), but a dark mark that does not behave like a plug may have another cause.

Wash gently and avoid abrasive scrubs, pore strips used aggressively, and repeated squeezing; these can irritate the follicle and leave marks. A clinician may recommend [Topical Retinoids](/treatments/medical-dermatology/topical-retinoids/) to help prevent blocked pores, with instructions suited to your skin and pregnancy status. Professional removal such as an [Acne Extraction Facial](/treatments/aesthetic-procedures/acne-extraction-facial/) can be considered when plugs are stubborn. More extensive acne may need medical review; [Isotretinoin Treatment](/treatments/medical-dermatology/isotretinoin-therapy/) is not a self-treatment and requires careful prescribing and monitoring.

Arrange a dermatology assessment if blackheads keep returning despite a careful routine, are accompanied by tender lumps or scarring, or are actually firm dark spots that cannot be gently washed away. Seek prompt review for a changing or bleeding mark, since not every dark spot is a comedone.

Ask whether the spots are comedones, which retinoid routine fits your skin, how to manage irritation, whether extraction is appropriate, and how long to try the plan before reassessment.