How a dermatologist removes blackheads

The AAD says many people can control acne with treatment they can buy without a prescription. Some blackheads still sit deep, come back in the same pores, or crowd the nose and chin after months of care. That is where a dermatologist, a medical doctor who specializes in skin, adds options you cannot get at a drugstore. This guide explains when to book a visit, what a dermatologist can do for blackheads, what each option involves, and what results to expect. For the steps to try at home first, see how to get rid of blackheads.

When to see a dermatologist for blackheads

The American Academy of Dermatology (AAD) gives a clear point on its page about acne types: "Give treatment six to eight weeks to work. If you still see blemishes, you may want to see a dermatologist. A procedure like comedo (medical term for blackheads and whiteheads) extraction may help. Prescription-strength acne treatment is another option."

Other reasons to book a visit:

• Deep or painful lumps. The AAD's adult acne page says "If you have large, painful pimples that sit deep in your skin or acne that leaves a scar when it clears, you'll need to see a dermatologist for treatment."
• Dark spots after acne clears. The same page says this is also "time to see a dermatologist."
• Acne that has not cleared with products sold without a prescription. The AAD lists this among reasons to see a dermatologist.
• Scarring, or two failed courses of treatment. NICE, the UK guideline body, says to consider referral for acne "that has not responded to 2 completed courses of treatment" or "acne that is leading to scarring."

You do not need to wait. The AAD's adult acne page quotes a dermatologist: "there is no acne that is too mild to potentially benefit from seeing your dermatologist."

What happens at the first visit

The AAD says a dermatologist can diagnose acne "by looking at the breakouts," noting "what types of acne you have and where the breakouts appear on your skin." That matters because "Different types of acne often require different treatment," and because some conditions look like acne. The AAD names hidradenitis suppurativa, perioral dermatitis and folliculitis, a skin infection of the hair follicles, as conditions that can be mistaken for acne.

Bring a list of the products you have used, how long you used each one, and any photos of how your skin has changed. The guide how to track acne progress with photos explains how to take them.

Treatments a dermatologist can offer

Option	What it does	What the sources say
Acne extraction	Removes blackheads and whiteheads with sterile instruments	Safe when a dermatologist does it; blackheads can return (AAD)
Prescription retinoid	Clears pores from inside	Tretinoin, tazarotene and trifarotene are the prescription options (AAD)
Chemical peel	Removes dead skin cells and oil that clog pores	A light peel heals in 1 to 7 days; 3 to 5 peels may be needed (AAD)
Photopneumatic therapy	Light plus gentle suction to clear oil and dead skin from pores	FDA-approved for blackheads, whiteheads and some pimples (AAD)
Isotretinoin	A prescription pill for severe acne	Strongly recommended for severe or scarring acne (2024 AAD guideline)

Acne extraction

The AAD describes acne extraction as a technique "which involves using sterile instruments to get rid of blackheads and whiteheads." It says: "During acne extraction, a dermatologist uses sterilized equipment to clean out your pores. You may need to have your skin exfoliated first." Exfoliating means removing the top layer of dead skin. The AAD's treatment page adds: "To avoid scarring and infection, this surgery should only be performed by a board-certified doctor who is trained and skilled in performing acne surgery."

Extraction has limits. The AAD says it is "rarely a first choice because it takes time and can be expensive." A 2024 trial in Lasers in Medical Science said the comedone extractor "has been widely employed by dermatologists, but the effect is temporary and may cause irritation." In that trial, four extraction sessions two weeks apart reduced comedones by 46.36 percent. The guide comedone extractors covers the trial and the risks of home tools.

Prescription retinoids

A retinoid is a medicine made from vitamin A. The AAD says a retinoid applied to the skin "works to clear your pores, and can treat blackheads, whiteheads, and some pimples." Adapalene is sold without a prescription. The prescription retinoids the AAD lists for acne are tazarotene, tretinoin and trifarotene. The AAD says dermatologists may also recommend a retinoid "as a maintenance treatment" to keep skin clear once acne is under control. The guide prescription retinoids for acne compares them.

Chemical peels

The AAD says "When applied to acne, a chemical peel helps remove dead skin cells that are clogging your pores and excess oil. This can help clear acne." Its chemical peel page says a light peel heals in "1 to 7 days. Skin will be red. After the redness disappears, scaling may develop, which lasts 3 to 7 days." It adds that "3 to 5 peels may be necessary" and that "These peels may be repeated every 2 to 5 weeks." People with brown or black skin "can safely have a chemical peel," the AAD says, but should see a dermatologist with expertise in darker skin tones, because without that expertise they "can develop permanent pigment problems."

Light and laser treatments

The AAD's page on lasers and lights is specific about blackheads. Blue and red light "can treat pimples" and "Visible light is not effective against blackheads, whiteheads, acne cysts, or nodules." Infrared light "cannot treat blackheads, whiteheads, cysts, or nodules." Photopneumatic therapy, which combines light with a gentle vacuum, "works by removing excess oil and dead skin cells from clogged pores. It is FDA-approved to treat blackheads, whiteheads, and some pimples." The AAD says redness and swelling are common afterward, and that "patients often need follow-up treatments once or twice a year."

Isotretinoin

Isotretinoin is a prescription pill once sold under the brand name Accutane. The AAD says dermatologists prescribe it "to treat nodular acne that hasn't responded to other acne treatments." The 2024 acne guideline from the Journal of the American Academy of Dermatology strongly recommends it "for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy." For blackheads alone, it has a limit. A 2011 report in the Journal of Clinical and Aesthetic Dermatology says: "Macrocomedones are traditionally resistant to treatment with isotretinoin alone." Macrocomedones are large blackheads and whiteheads. The report describes dermatologists extracting them during treatment.

Deep and giant blackheads

A single dark plug that is much larger than the rest may be a dilated pore of Winer. A StatPearls review describes it as "an asymptomatic, solitary, enlarged pore with a keratin plug and normal surrounding skin." It is harmless and most often appears on the head and neck of middle-aged and older adults. "Removal can be performed via excision," which means the doctor cuts it out. Large plugs in the bowl of the ear have their own guide, blackheads in the ear.

What results to expect

• Extraction empties pores on the day. The AAD says "Blackheads and whiteheads can return, so you'll need to follow a skin-care plan to prevent new blemishes."
• Retinoids take weeks. The adapalene label says results may take up to 3 months of daily use.
• Peels may take a series of 3 to 5 sessions, the AAD says.
• Light treatments may need follow-up sessions once or twice a year.

Finding a dermatologist

The AAD runs a "Find a dermatologist" search on its website, where you "can search by location, condition, and procedure." It describes a dermatologist as "a medical doctor who specializes in treating the skin, hair, and nails." When you book, say that you want help with blackheads or clogged pores, and ask whether the clinic offers extraction and chemical peels. If cost matters, ask for prices before the visit, since the AAD says extraction "takes time and can be expensive."

Before your visit

Start the treatment the AAD recommends while you wait for an appointment: "To unclog pores, dermatologists recommend using a retinoid. You can buy one retinoid, adapalene, without a prescription. You'll also want to use a benzoyl peroxide wash." Stop picking, so the dermatologist sees your skin as it is. The guides blackheads on the nose and closed comedones cover the home steps for the nose and for small closed bumps.

Skinli gives general education and is not a doctor. If you want a home plan to follow before or alongside a dermatologist visit, the free Skinli acne plan builds one from a photo of your skin.