Have you ever wondered what those double headed blackhead looking things are that you have near your HS?
They seem to be HS’ best friends—blackheads. These aren't your typical blackheads; they are actually called DEPs (double-ended pseudocomedones). If you take a look at them, they seem to appear in pairs (and sometimes in threes), hence the “double ended” part of the name. DEPs are keratin-filled, interconnected multi-pores. They are often considered the first sign of HS and are usually overlooked.
So what do you do with them?
DEPs are best left alone. If you feel the need to do something about them, the best approach is to encourage them to come to the surface naturally or work with your dermatologist on safe removal methods. Since HS is a follicular occlusion, using tools, picking, scratching, or trying to squeeze or dig them out can worsen the situation. In some cases, it can trigger a flare, contribute to tunneling, or make your HS worse.
A Few Options to Try:
Exfoliation:During or after a warm/hot bath or shower, when the skin is still soft, lightly exfoliate the area. Make this a regular part of your shower routine.
Baking Soda:Create a thick paste using 2-3 teaspoons of baking soda and 1 teaspoon of water. Apply the paste to the blackheads and gently massage for 3-4 minutes. Once it dries, after a few minutes, rinse it off. Repeat this process several times per week.
Honey:Dab raw, filtered honey on the area affected by DEPs. The dabbing motion combined with the stickiness of the honey can help remove the DEPs. Repeat this method several times per week.
Milk and Gelatin Mask (use caution in areas without hair):Mix 1 tablespoon of Knox Unflavored Gelatin with 1.5 teaspoons of milk and microwave the mixture for 10-15 seconds. Quickly apply it to the affected area—it hardens fast! Once the mask has dried, usually in about 15 minutes, peel it off. Repeat this several times per week.
Consult a Dermatologist:Discuss your concerns about DEPs with your dermatologist, who can help you figure out how to safely remove them.
The Science-y Stuff Behind DEPs:
Under dermoscopy, DEPs appear as paired, deep hollows with a keratin mass at each end, sometimes connected by a bluish tract visible through translucent, scarred tissue. Most DEPs result from the healing of previous inflammatory lesions, as confirmed by their presence within scar tissue. DEPs may form from the keratinization of the residual stump of adjacent follicles. Studies using dermoscopy have shown the presence of scars with varying depths, suggesting a prolonged, waxing-and-waning tissue repair process, as observed in all patients. This evidence suggests that mechanical stress (such as friction) may hypothetically trigger these recurring inflammatory processes involving DEPs and HS.
Histopathological (study of diseases of tissues under a microscope) examination of DEPs reveals cavities lined by normal multilayered epithelium and filled with corneal lamellae, cellular debris, and amorphous material. The hair follicles, destroyed by the inflammatory process, are no longer detectable. As a result, no hairs are typically observed during clinical and dermoscopic evaluation. Both clinically and under dermoscopy, DEPs present as superficial, follicular papules with a central, rounded opening filled with a keratotic plug. Depressed scars from previous lesions may also be present.
For more information about follicular occlusion, read here.
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