Deep blackhead on DS's forehead. Ideas for removal

[sunshinechaser]

My DS is 14 and has started getting bumpy, slightly spotty skin as he's going through puberty. He had a raised bump on his forehead which has now fallen off but it's left a really deep black mark that I presume is a blackhead. He's a bit self conscious about it so I wondered if anyone had recommendations for skincare for teens that might help.
He currently uses Cerave blemish face wash that contains salicylic acid and niacinamide and applies salicylic acid lotion twice daily. This usually keeps his skin in good condition but not sure how long this will continue to work as his skin gets spottier with age.

Agreed.
GP or dermatologist will in ME only prescribe Roaccutane for quite serious and prolonged skin conditions as it impacts on the liver so you have to monitor liver function and only use it for a limited time.
So many people on here itching to squeeze!! I understand the urge, but I don't think it's a good strategy except for exceptional (i.e. big, stubborn) blackheads. He could end up making a mess of his face.
My daughter (who had bad skin for many years) swears by a dab of toothpaste. I assume that it helps by drying out the spot.

For what it’s worth when my daughter was a teenager. She had a similar thing on upper chest between her breasts. I eventually took her to the doctor since we couldn’t do anything with it, and it actually ended up being a very small cyst that the doctor was able to remove in the office and cauterize. I am not saying this is what your son has. I’m just saying it’s another possibility. I thought my daughter’s was a blackhead for a few months before I finally took her in.

You need to stab it not scratch the surface. Stab it in the middle and if it doesn't bleed it's a black head. The take the needle around the outside of the blackhead and inside of the skin a little way in to break the seal and squeeze down. My son had a deep blackhead down the side of his nose that for love nor money I couldn't squeeze out until I stabbed it, then eased round the rim with the needle. Came out so easily then, was huge and satisfying.

Yes, some blackhead type thingies get a thin layer of skin over them which might need piercing (safely)

Acid twice a day along with an acid face wash is really overkill and harmful to his skin barrier. Add a non-clogging moisturiser and use the acid every other day!

Note, edited after reading others posts because there is truly some horrible advice here (sunbeds?!)

Get him a facial with a reputable provider who specialises in extractions and see a private dermatologist (if you have the resources) if you are worried about his skin long term. Showed my sister this thread (who is a dermatologist) and she was beside herself. Doing it yourself could lead to scarring and infection, and she also noted that if it is really stubborn it could actually be a melanoma. Facials do not have to be expensive, but make sure you go to a decent clinic, they will give you advice on products too.

For safety I’d recommend you’d try a Hydrocolloid patch first. They will draw out any infection or ‘other’ in there - they are amazing. As others have said if that doesn’t work go to the GP, they can tell you if it’s a verruca or wort (unlikely but not unthinkable) or standard deep blackhead, which they will advise on removal of. I was on roaccutaine myself at 22 and it was incredibly effective but brutal, I’d spent a lot of time suffering! Definitely a last resort. Good luck!

Thanks. I'll maybe try the hydrocolliid patch as nothing else is working unfortunately.
@horrorcicada his skin tolerates twice daily acid (salicylic acid 10%) and acid face wash really well currently-he's been doing that for the last couple of months without any issues. No dry skin at all in fact we probably need to step things up as he's developing these deep blackheads around his nose and on his forehead so this regime probably isn't enough.
I don't think he's at the stage of needing a private dermatologist but will get him started with a prescription Dermatica treatment to try and prevent more issues occurring. He's definitely not at the Roaccutane sage yet at all but I would be happy with him taking this if he had severe acne.
I just can't take him to the GP with this. I'd be too embarrassed.
There's is only one beautician near me that promotes blackhead extraction. I've messaged her to see if she would treat a 14 year old but she hasn't got back to me so I'm presuming it's a no.

Yeah, at this point a professional facial is your best bet. But per the pp whose sister is a dermatologist, I'd get it looked at.

I have a scar from using Hero Mighty patches on a spot (the red and white box) so definitely wouldn’t recommend that.

@Peachy2005 aww really? That's awful. I've just ordered him Dots for Spots from Amazon so hope these won't cause a scar.

Have you tried facial steaming yet? It was the only thing that really cleared my pores, and pore strips really got into the deepest darkest acne.

Just a random tip that's come back to me from my (very long, very serious) acne years: buy a bunch of cheap cotton pillowcases and change them every day/every other day. Wash on a high temp. Obviously by no means a cure but from what I remember it helps.

Thanks Cesarina

ive discovered that unfortunately. I’ve had it a long time and as you say it refills. 🤢

Panoxyl. It's a US product so a bit pricy to get online in the UK but really works.
The 10% face wash to be used every 2 weeks for maintenance and the milder 4% face wash every 2 days.

The active ingredient is benzoyl peroxide so he'll need to use a white wash cloth to prevent bleaching your towels. Also look into Korean skincare.

Thanks @WantOutOfMyHouse there's UK equivalent ones on Amazon (Acnecide face wash with BP at 5%) but I think I'd prefer something that stays on his skin for max efficacy rather than a face wash.
I might order the face gel or start with Dermatica treatments. He's got lots of blackheads now so think he needs something stronger than he's currently using.

Roacutane can have horrific side effects including suicidal thoughts use with caution and as a last resort

Roacutane can have horrific side effects including suicidal thoughts
Is this only with systemic use, or does it apply to topical use?
Thank you all for an interesting and helpful set of posts.

I thought Roaccutane is only available as tablets but could be wrong.

A Dermatologist told me that in all his time he has never seen it cause mental health side effects for any of his patients, but he did say that acne itself can lead to depression. He said Roaccutane is not a treatment, it’s a cure. It’s a fairly severe instrument and has lot a side effects alright but he said that a lot of those previous extreme side effects are now proving to be not true in his experience.

I would still only use it as a last resort though as that is just one persons opinion! I hope the blackhead is gone now anyway. Good luck.

He's absolutely nowhere near needing roaccutane at the moment. He has clear skin bar a few deep blackheads. If his skin worsens and he tries other products that don't work I will chase roaccutane for him though. My best friend and my nephew both used it and it was amazing for them. My friend did get psychiatric side effects (depression) but these stopped when her course was complete and she is still glad she did it.
Update-the deep blackhead is still there. I've stopped poking about with it as his forehead is now red and dry. We've tried Biore pore strips, salicylic acid, steaming, hydrocolloid spot stickers, tretinoin (only for a few nights), charcoal face masks so I'm out of ideas. I'm contacting beauty therapists to see if they can see him and when I get a sec we'll get him set up with Dermatica for a prescription treatment.

Sometimes it just needs time to come up to the surface. I’ve had a couple of spots like that (but not blackheads), where there is evidently something there but no amount of squeezing and skin products brought it out. My beautician couldn’t get rid of it two times I saw her.

I would basically give it a little squeeze most days and leave it, and then one day I woke up to feel that it was raised. Gave it a squeeze and it came out no bother.

So it is really frustrating, but maybe you just need to wait.

I experienced the sudden extreme depression on Roaccutane as a teenager and had to discontinue it, luckily It had already worked. It was like nothing I've experienced before or since. I have my doubts about a dermatologist who claims to have never encountered this as it is very well known. When it happened to me it was before the internet was in such widespread use and I had not googled it (i.e. it wasn't as a result of googling then imagining it- Google didn't exist!).

I don't understand why anyone would even have roaccutane on their radar on the basis of a few teenage blackheads. It's not something you can 'chase', it will only be considered in people with severe acne and after prescription treatments have been exhausted. It may also require a psychiatric assessment. It took me several years to get a prescription for it, and my acne was so bad that I had more acne than skin and couldn't lie on a pillow without pain. Most people with severe acne are willing to go through the side effects if it means finally getting relief, but the side effects are no joke and there's a risk of permanent skin damage if you forget to wear sunblock, even on a cloudy day. You have to have regular blood tests because it can affect your liver and levels of cholesterol. My skin was peeling off. My chin got so dry that areas of skin cracked and weeped. My eyes got so dry that I got ulcers on my eyelids. My nose was so dry that I frequently had nosebleeds. My bones ached. Even the slightest knock to my skin caused it to tear and bleed. Even after you stop treatment these side effects continue to an extent for months afterwards. All worth it for me, but horrible nonetheless. I'm not sure some posters are aware of the reality of this drug and what is involved in obtaining a prescription.

And in people under 18, two prescribers have to be in agreement before roaccutane/isotretinoin is approved:

https://www.gov.uk/government/news/treatment-with-isotretinoin-for-patients-under-18-must-be-approved-by-two-prescribers-under-new-mhra-rules

For patients aged 12 to 18 years old, a second healthcare professional, in addition to a specialist in dermatology who acts as the Lead Prescriber, must independently assess the patient and determine whether isotretinoin is the only appropriate effective treatment. This means that, before isotretinoin is prescribed to anyone under 18, two independent healthcare professionals must agree that the acne is severe and that it has not responded to adequate courses of standard therapy. The roles and responsibilities of the two prescribers are fully described in the final report.

Just to mention but the longer you wait, the more difficult it will be to shift the blackhead. You are saying thathis usual routine keeps the overall skin OK but it's not touching the blackhead. GP is the only one or dermatologist.

Just updating for those that had an interest in my DS's deep blackhead 😂
It's still there! We have tried everything. I took him to a beauty therapist who came highly recommended and she tried on two appointments and she said it's just not budging so she doesn't want to play about with it any more in case it becomes infected.
We've tried salicylic acid lotion each day, SA face wash, pimple pads, face masks, steaming, tretinoin cream-nothing is working. I'm worried us going to stretch his pore permanently. It's right in the middle of his forehead so it's quite noticeable.
I've got Acnecide gel so I'll maybe try that but worried it will dry up the surrounding skin which is basically clear.