Blackheads in your ear: causes and safe care

Most acne advice covers the face, chest and back, so blackheads in the ear can come as a surprise. They are the same clog as a blackhead on the nose: oil and dead skin cells packed into a pore that stays open, with a top that turns dark in air. What makes the ear different is where they sit. The bowl of the outer ear is hard to see, and it leads straight into the ear canal, where the NHS warns against putting fingers or objects. This guide explains why ear blackheads form, how to treat them safely, and which ear bumps need a doctor. For blackheads in general, start with how to get rid of blackheads.

What the medical sources say about ear blackheads

Few studies look at blackheads in the ear. The NHS says acne "usually affects your face, chest and back." Dermatologists do treat blackheads in the ear as well.

The clearest sign comes from a 2015 letter in the Journal of the American Academy of Dermatology titled "Pen punching: An innovative technique for comedone extraction from the well of the concha." Comedone is the medical word for blackheads and whiteheads. The concha is the bowl-shaped hollow of the outer ear that leads into the ear canal. A letter on how to remove comedones from that exact spot shows that dermatologists see them there.

Everything the American Academy of Dermatology (AAD) says about how a blackhead forms applies in the ear. A blackhead "develops when excess oil and dead skin cells build up inside a pore. As the buildup accumulates, it widens the opening of the pore and you see a blackhead." The dark top comes from the plug reacting with oxygen, and the AAD says "Many people mistakenly believe the black speck is dirt." The guide what causes blackheads explains the process in full.

Why blackheads form in the ear

The sources give general causes of clogged pores that fit the ear:

• Oil and dead skin cells in pores, the basic cause of every blackhead.
• Hair products. The AAD says oils in shampoos, conditioners and styling products "can cause tiny breakouts along your hairline and forehead," and bumps along the back of the neck. The ears sit next to the hairline, and rinse water runs over them.
• Residue on things that touch your head. The AAD says hair product residue "can stick to just about anything," and advises washing pillowcases, sheets, caps, hats, headbands and visors.
• The shape of the ear. The concha is a hollow. Include it, and the folds around it, when you wash your face.

How to treat blackheads in the outer ear

Treat only the outer ear that you can see. Nothing in these steps goes inside the ear canal.

1. Wash the outer ear gently. Use a mild cleanser on your fingertips, rinse with lukewarm water and pat dry. The AAD says scrubbing "can irritate your skin, causing acne to flare."
2. Consider a pore-clearing product. The AAD recommends a retinoid for blackheads and says: "You can buy one retinoid, adapalene, without a prescription." The adapalene 0.1 percent label says to use it once a day in a thin layer. The label lists the eyes, lips and mouth as places to keep it away from and does not mention ears. Apply only a small amount with a fingertip to the outer bowl, and keep it well away from the opening of the ear canal.
3. Expect dryness at first. The adapalene label says redness, itching, dryness and burning are more likely in the first few weeks. If the skin of your ear becomes sore, stop and ask a pharmacist or doctor.
4. Give it six to eight weeks. The AAD says "Give treatment six to eight weeks to work. If you still see blemishes, you may want to see a dermatologist."

A salicylic acid cleanser is another choice for blackheads. The AAD says salicylic acid "works best on whiteheads and blackheads." Use one acne product at a time. The adapalene label says irritation is more likely when you use more than one acne medicine on the skin. If you are unsure whether a product suits the skin of your ear, ask a pharmacist first.

Keep fingers and tools out of the ear

The ear canal is a narrow tube that leads to the eardrum. The NHS earwax page says: "Do not use your fingers or any objects like cotton buds to remove earwax. This will push it in and make it worse." The same care applies to a blackhead near the opening of the canal.

Squeezing a blackhead in the ear carries the same risks as anywhere else. The AAD says "squeezing a blackhead can cause an infection or permanent scar." Its skin care habits page explains that squeezing pushes material "deeper into your skin," which increases inflammation. In the folds of the ear, you also cannot see what you are doing without a mirror at an awkward angle. Metal tools add to the risk, which the guide comedone extractors explains.

Big blackheads and lumps in the ear

Some large dark spots in the ear are something other than an ordinary blackhead.

A dilated pore of Winer. A StatPearls review, published through the U.S. National Library of Medicine, describes this as "an asymptomatic, solitary, enlarged pore with a keratin plug and normal surrounding skin." Asymptomatic means it causes no pain or itch. Keratin is the protein in skin cells. It is harmless, and "Removal can be performed via excision," which means a doctor cuts it out. A 2001 case report in the journal Auris Nasus Larynx described one in the ear canal of a 51-year-old woman whose ear had been discharging for six months. Her doctors warned that such a growth can be mistaken for more serious conditions.

An epidermoid cyst. MedlinePlus describes this as a small lump under the skin that "will often have a tiny hole or pit in the center." The NHS says skin cysts "sometimes have a small, dark spot in the middle." The NHS also says: "Do not squeeze a skin cyst. If it bursts it could become infected."

When ear blackheads are something else

A rare skin disease can look like blackheads in the ear. A 2020 letter in JAAD Case Reports described a woman with itchy, red-brown, thickened patches on both ears, "with open comedones and atrophic scarring." Open comedones are blackheads. Atrophic scarring is scarring that sinks below the skin. Tests showed a form of lupus, a condition in which the immune system attacks the body's own tissues. The authors said only 13 cases of this variant had been reported, that it "is easily mistaken for acne vulgaris," and urged caution with "acnelike lesions that are not responsive to acne therapy."

This is uncommon. It is still the reason to see a doctor if blackheads in your ear come with itchy, scaly or thickened skin, scarring, or no response to acne treatment.

How a dermatologist removes ear blackheads

The AAD says acne extraction uses "sterile instruments to get rid of blackheads and whiteheads," and that it is a safe way to remove them when a dermatologist does it. The AAD adds that blackheads "can return, so you'll need to follow a skin-care plan to prevent new blemishes." A dilated pore of Winer or a cyst can be removed in the office. The guide how a dermatologist removes blackheads explains what to expect. If you also get blackheads on your back or shoulders, the guide blackheads on the back covers that skin.

Keep them from coming back

Ear blackheads can return after they clear or after a dermatologist removes them. The AAD says to keep using acne treatment after your skin clears, because "This helps to prevent new breakouts." For the ears, that means three habits: include the outer ear when you wash your face, rinse shampoo and conditioner off your ears, and wash pillowcases and hats often. If you use a hair product such as pomade, the AAD says to look for one labeled non-comedogenic, oil free or "won't clog pores."

When to see a doctor

See a doctor for any blackhead or bump in the ear that hurts, is red or swollen, drains fluid, keeps growing, or comes with hearing changes. The NHS says to ask for an urgent GP appointment for "a sore or red lump on your skin," and to see a GP about "a lump on your skin and you do not know what it is." See a dermatologist for ear blackheads that have not improved after six to eight weeks, or that come with itchy, scaly patches or scars. Skinli gives general education and is not a doctor. Skinli's free acne plan covers acne on the face.