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Blackhead or sebaceous filament? Clearing up the confusion.

Unsure of the differences between blackheads, those pesky blemishes that seem to appear out of nowhere, and sebaceous filaments, the part of your skin you may not know exists? No clue what the dark spots on your nose are, but you're ready to squeeze, scrub, and scrape them off your face? Stop before you pop. Before choosing a treatment plan, it's important to understand what you're dealing with.


What are blackheads?

Blackheads are a type of acne called an open comedone. Open comedones form when hair follicles become clogged with oil, dead skin cells, and bacteria. That bacteria, Cutibacterium acnes (C. acnes), causes the area to become inflamed. Because this type of acne is open, the dead skin cells and oil are exposed to air, oxidizing this debris and turning it black.

Sebaceous filaments are often confused for blackheads.

Does it take a magnifying mirror to see your dark spots? Did you notice tiny blackheads only while looking at a mirror an inch away from your face? Chances are, you're looking at sebaceous filaments.

Sebaceous filaments are a functional feature of our skin. These tiny, hair-like structures transport sebum to the skin's surface, keeping the skin lubricated and supple. They tend to be concentrated across the forehead and nose but can be found anywhere on the body. While they may resemble blackheads, they are not clogged pores and cannot be eliminated entirely. 

What many people mistake for blackheads are sebaceous filaments, a normal part of the skin's anatomy.

Sebaceous filaments should never be popped. While the pore may discharge a white or yellow worm-like substance, these extractions can cause permanent damage. Whenever the skin is squeezed, there is a risk of breaking the surface and causing an infection or scarring. Manipulating sebaceous filaments breaks down collagen around the pore, permanently widening the area and making it more visible than before. Habitually extracting sebaceous filaments can make pores significantly more visible than before.

Unsure if you have blackheads or sebaceous filaments? See a board-certified dermatologist.

Board-certified dermatologists are experts in skin conditions. Acne is the most common skin condition, affecting 85% of Americans at some point in their lifetimes. An accurate diagnosis for your concern is the first step towards healthy, clear skin. 

Because blackheads are a type of acne, they will likely require prescription medication to clear, especially if they've been present for 12 or more weeks or have not responded to over-the-counter products.

While sebaceous filaments are not a disease or condition that requires medical intervention, prominent filaments are a nuisance. 

Treatment plans will depend on your diagnosis, the products you've previously tried, your lifestyle, and other concerns. Because everyone's skin differs, prescriptions and recommended products can vary greatly.

Treating Blackheads

Because blackheads are a form of acne, treatment plans typically address the following:

  • Eliminating the substances clogging pores
  • Killing the bacteria causing inflammation
  • Keeping the skin clean

Prescriptions often include a retinol like Retin-A or Tretinoin to prevent dead skin cells from clogging pores. A topical or oral antibiotic may be recommended to combat bacterial infections and inflammation. Salicylic acid, azelaic acid, and cleansers are included to keep skin clean and reduce oil. While everyone should apply sunscreen daily, it's essential for patients using retinol. Retinols increase skin cell turnover, making users more prone to sun damage. Additionally, UV exposure can cause blackhead lesions to darken and scar, leaving otherwise healed patients with post-inflammatory hyperpigmentation. 

Reducing the Appearance of Sebaceous Filaments

Adding chemical exfoliators to your skincare routine will limit the visibility of sebaceous filaments. 

Products to consider:

  • Alpha Hydroxy Acids (AHAs): glycolic and lactic acids break up skin cells and exfoliate the skin, removing any debris that may sit on top of sebaceous filaments.
  • Beta Hydroxy Acids: Products containing salicylic acid penetrate deep into pores, dissolving oil plugs and congestion. 
  • Over-the-Counter Retinols: Products containing adapalene, like La Roche-Posay Efflcar or Differin gel, inhibit oil production and increase cell turnover. It's important to start slowly with these products, applying every 2-3 nights. You must wear sunscreen when using a retinol.
  • Cleansers: Choosing a cleanser that works with your skincare routine will keep skin free from debris and remove lingering products and makeup. Pay attention to labels, ensuring you're not doubling up on salicylic acid - a common ingredient in purifying or oil-fighting face washes. 

Your dermatologist can help you build a routine that maximizes skin health while minimizing the appearance of sebaceous filaments.

Your skin is unique. What works for your friend or family member may not work for you. If you're struggling with blackheads, unsure if you have blackheads or sebaceous filaments, or need advice on products that will improve your skin and restore your confidence, DermatologistOnCall is here to help. Our board-certified dermatologists will assess your skin, make a diagnosis, prescribe medications (if necessary), and create a skincare habit that addresses your concerns and goals.