Mitesser

Mitesser, in German, refers to a type of comedo commonly known in English as a blackhead. It forms when a hair follicle becomes clogged with sebum and keratin. An open comedo has a visible opening at the surface, where sebum oxidizes and turns dark; a closed comedo, or whitehead, lacks the opening.

Causes include excess sebum production, irregular shedding of skin cells, hormonal changes (such as puberty), and the use of occlusive or comedogenic skin products. Bacteria and inflammation can worsen symptoms if an open comedo becomes irritated or infected. External factors such as sweating, friction from tight clothing, and certain medications can also influence occurrence.

Mitesser typically appear on the face, especially the nose, chin, and forehead, but can occur on the chest and back. Diagnosis is clinical, based on appearance. While they are usually harmless, they can progress to inflammatory acne if bacteria invade the clogged follicle.

Treatment aims to reduce blockage and sebum production. Mild cases may respond to over-the-counter products containing salicylic acid or benzoyl peroxide, and topical retinoids. Professional extraction by a dermatologist or trained esthetician can remove blackheads safely. For persistent or widespread lesions, prescription options include stronger topical retinoids, azelaic acid, antibiotics, or hormonal therapy in appropriate patients. In rare cases, isotretinoin is considered when other treatments fail.

Prevention focuses on gentle cleansing, non-comedogenic moisturizers and sunscreens, avoiding heavy or oil-based cosmetics, and not squeezing or picking lesions. Regular exfoliation with appropriate chemical agents can help maintain follicular turnover and reduce recurrence.