Blackheads in kids: what to do and when to get help

What do blackheads look like?

Blackheads are small black or brown spots that are usually flat but can be raised. Whiteheads are small skin coloured bumps. Both are called comedones, meaning blocked pores. Acne can include either type without every spot being red or filled with pus. Larger, deeper, painful lumps are a different level of acne and deserve medical attention.45

Why does a child get blackheads?

Oil and dead skin cells collect in pores and form plugs. Hormones affect the skin's oil glands, which helps explain why acne usually starts around puberty. Blackheads do not mean a child has failed to wash properly. Extra scrubbing does not address the cause and can irritate skin and worsen acne.45

Chocolate and greasy foods are often blamed, but there is little evidence that food has much effect on acne in most people. Stress does not cause acne, although it can make existing acne worse. A child's blackheads are not a reason to assign blame to their diet, cleanliness or habits.1

Does the child's age matter?

Tell the clinician if a younger child also has unusually fast growth, early sexual development or unusual hair growth. These details help decide whether hormone investigations are needed. Most children with acne do not need further tests. Blackheads alone do not let you diagnose a hormone problem at home.2

How should you care for an older child's skin?

Choose skincare labelled oil free or noncomedogenic, meaning designed not to clog pores, rather than giving every bottle in the acne aisle a job. Oily moisturizers and greasy hair products can cause or worsen acne, so check products that reach the affected skin as well as the face wash.5

1. 1Wash gently with a gentle cleanser morning and evening. Do not scrub.
2. 2Apply any agreed acne treatment as directed. Many treatments go over the affected area, not just individual blackheads.
3. 3Use a suitable oil free moisturizer as part of the routine, especially when treatment makes skin sensitive.
4. 4At the end of the day, remove any makeup the child wears.

Makeup should also be noncomedogenic, because its job is coverage, not an additional skincare complication. Keep picking and squeezing out of the routine: both can cause scars.4

Which treatments can help?

For an older child approaching puberty, ask a pharmacist or clinician which treatment is appropriate for the child's age. General acne options include salicylic acid and benzoyl peroxide. Prescription treatments include adapalene and tretinoin, which reduce oiliness and inflammation and help prevent spots. These options are not instructions to use an adult acne product on a baby or young child.4

Benzoyl peroxide comes as a wash, gel or lotion and can be used for mild acne. If a clinician recommends it for sensitive skin, a 2.5% concentration is a lower strength starting option; higher concentrations are more likely to cause dryness and irritation. Apply it across the affected area according to the product directions.2

Adapalene and tretinoin are topical retinoids, medicines related to vitamin A that are applied to the skin. They treat the whole affected area. Treatment often starts two to three times weekly and increases toward daily use as tolerated. Follow the child's prescribed schedule rather than increasing applications because blackheads remain visible.2

How long does treatment take?

Expect weeks rather than days: significant improvement takes at least one to two months, and most acne treatments take two to four months to reach their full effect. Some topical treatments, including retinoids, can make acne worse for a few weeks before improvement. Treatments help prevent new spots and reduce scarring; they are not a permanent cure.25

Some treatments irritate skin. A clinician can advise testing a small affected area first and building up use gradually. If irritation continues despite applying the treatment less often, contact the clinician rather than pushing through it.5

What if the child is a baby?

Wash a baby's skin gently with lukewarm water, avoid scrubbing and stop oily or greasy skincare products. Do not use an acne wash or medicine unless the baby's pediatrician or dermatologist recommends it. Newborn acne rarely scars and usually disappears within weeks to months.3

Infantile acne usually affects the cheeks and sometimes the forehead and chin. Acne starting after 6 weeks needs assessment because eczema or an infection can look similar, skincare products can contribute, and infantile acne can leave permanent scars. A clinician can also check for an underlying health problem. Clearing often takes about six months to a year, although some cases last longer.37

When should you get medical help?

• Arrange assessment for acne that starts after 6 weeks of age and before puberty, especially in children aged 1 to 6.
• See a clinician for numerous spots, deep painful lumps, scarring or acne that is not improving with treatment.
• Get medical advice for hot, swollen or red skin that could indicate infection. Redness can be harder to see on brown and black skin.
• Seek support if acne is affecting the child's mood, confidence or mental health.
• Have unusual bumps checked rather than assuming every bump is a blackhead; childhood skin conditions can look alike.