If you’ve noticed small, blackhead-like spots around areas affected by Hidradenitis Suppurativa (HS), you’re not alone. These aren’t your typical blackheads; they’re called double-ended pseudocomedones (DEPs) and are a unique feature of HS. Often appearing in pairs (and sometimes trios), these interconnected pores are often overlooked but can actually be one of the earliest signs of HS.
What Are These Blackhead-Like Spots?
DEPs are keratin-filled, multi-connected pores that form under the skin and emerge as paired blackhead-like structures. Unlike regular blackheads, they’re part of HS and are often found near scar tissue or areas with chronic inflammation. DEPs form when hair follicles are damaged by the inflammatory process of HS and later heal incompletely, leaving behind these tiny plugs.
Should You Remove Them?
The best way to manage DEPs is usually to leave them alone. Picking, squeezing, or trying to dig them out can lead to further irritation, potential flares, or even tunneling under the skin. If you’re concerned about them, consult a dermatologist who can recommend safe ways to address them.
Gentle and Safe Options to Manage DEPs
Here are a few ways to care for these spots without causing harm:
Gentle Exfoliation:
After a warm shower, lightly exfoliate the area to encourage DEPs to come to the surface naturally.
Baking Soda Paste:
Mix 2–3 teaspoons of baking soda with 1 teaspoon of water to make a paste. Gently massage it onto the area for a few minutes, then rinse. Repeat a few times a week.
Honey Treatment:
Dab raw honey on the affected area. The stickiness can help lift DEPs, and its natural antibacterial properties soothe the skin.
Milk and Gelatin Peel:
Mix 1 tablespoon of unflavored gelatin with 1.5 teaspoons of milk. Heat the mixture briefly in the microwave, apply it to the area, and let it dry for about 15 minutes. Once hardened, gently peel it off.
Consult a Professional:
A dermatologist can provide advice and treatments tailored to your specific needs.
The Science Behind These Spots
Under a dermoscope (a tool for examining skin in detail), double-ended pseudocomedones (DEPs) appear as small, paired openings filled with keratin, often connected by a bluish tract under the skin. These formations typically develop within scar tissue as a result of HS’s chronic inflammation and healing process.
Histopathological studies—those examining tissues at the microscopic level—reveal that DEPs consist of cavities lined with normal multilayered epithelial tissue, filled with keratin debris, dead cells, and amorphous material. The inflammatory process in HS often destroys the hair follicles in these areas, leaving no hairs visible in or around the DEPs.
DEPs form as part of a prolonged, irregular repair cycle. Mechanical stress, such as friction from skin rubbing against itself or clothing, is thought to trigger recurring inflammatory episodes, leading to incomplete healing. Over time, this process causes the follicular structures to break down and become plugged with keratin, creating the distinctive double-ended openings.
In simpler terms, DEPs are not just random blackheads—they’re part of the body’s reaction to inflammation and damage caused by HS. Their connection to past lesions highlights the importance of managing inflammation and preventing further irritation in affected areas.
This technical understanding underscores why DEPs are best left to natural exfoliation or professional treatment to avoid further complications.
Final Thoughts
While DEPs might look like blackheads, they’re actually a sign of HS and a result of how your skin heals after inflammation. Instead of trying to remove them yourself, focus on gentle skincare routines and professional advice. With patience and care, you can manage them without aggravating your HS.
By understanding what these spots are and how they form, you can take a safer, more informed approach to caring for your skin.
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