Fundamental treatment of nasal black heads requires knowledge of the mechanism in which black heads form in the nose.

Nasal black heads is the most extreme manifestation of open comedone. Sebaceous glands are the most active in the nose and produce larger amounts of sebum. Proliferation of P. acnes in sebaceous glands increases production of free fatty acid and free fatty acid lowers the pH of the follicle opening to below normal. This changes the density of calcium ion and results in delayed loss of keratin and dyskeratinization. The follicle opening widens and is filled with lamellar keratinous mass impregnated with lipid which appear as black head.

 

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Figure 1. Pathologic findings of open comedone.

 

Therefore, the fundamental cause of black head is sebaceous gland hyperplasia. When this is reduced, black heads will naturally disappear. Nose strips or extraction will only be a temporary solution if fundamental cause of the black heads is not treated.

 

-To be continued-

 

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