Before you squeeze the dots on your nose, find out what they are

You lean in to the mirror and see them across your nose: small dark dots, and a feeling that they must be dirt, or a clog you can get out. The urge is to squeeze, scrub or strip them. The Cleveland Clinic, a US medical centre, says they can be confused for blackheads when they are something else.

The small dark dots on your nose may be sebaceous filaments, which the Cleveland Clinic calls “a normal, healthy element of your skin”, so before you squeeze, strip or scrub them, find out which kind of dot you have.

Some people said the dots they took for blackheads are often sebaceous filaments, which cannot be removed for good, only made less noticeable, and that aggressive extraction can make the dots look worse. The Cleveland Clinic says sebaceous filaments help move oil from the skin’s oil glands to the surface. It says everyone has them, that they are most obvious on the nose, forehead, chin and cheeks, and that they are not a type of acne.

Telling them apart

The Cleveland Clinic says blackheads are a type of acne: open, dark-coloured bumps that fill with oil and dead skin, with a plug of oil at the surface. Sebaceous filaments have no plug, so oil travels freely to the surface. It says obvious ones look like dark spots but are usually smaller, flat and lighter in colour, typically grey, light brown or yellow, and that if you squeeze them a waxy, threadlike structure may come out. It says you do not necessarily need a healthcare professional to diagnose them. This page cannot tell you which you have. If you are unsure, a pharmacist, doctor or dermatologist can look.

What squeezing does

The Cleveland Clinic says: “You should avoid squeezing your sebaceous filaments.” It says that if you do squeeze out oil, “your pores will fill up again within 30 days”, and that if you use your nails to press hard you can irritate or seriously damage your skin. In the UK, the NHS says for acne: “do not pick or squeeze spots because this can cause scars”.

Scrubbing

Here the authorities do not fully agree. The AAD says of blackheads: “The black dots aren’t dirt, so resist scrubbing. It will only worsen your acne.” The NHS says: “do not scrub your skin as this can irritate it and make acne worse”. The Cleveland Clinic, on sebaceous filaments, lists exfoliating facial scrubs as one part of a routine that can make them smaller, and says to massage for up to 30 seconds and rinse. Some people say to avoid hard physical scrubs on the face. The difference may be what you have, acne or filaments, and how your skin reacts. If your skin is red, sore or breaks out, the AAD and NHS lines point to leaving the scrub out. The choice is yours.

Kitchen products

Some people say lemon juice, baking soda and salt scrubs on the face cause irritation or tiny scratches, and one person says baking soda is too alkaline for skin. This page did not find a dermatology page that tests those on filaments. The Cleveland Clinic’s page on pimples does say not to put toothpaste on a pimple, saying that toothpaste can contain ingredients such as alcohol or baking soda that may dry out a pimple, but that using it “could possibly irritate your skin”, and lists among “home remedies” to keep away from your face: apple cider vinegar, hydrogen peroxide, lemon juice, glass cleaner, rubbing alcohol and honey.

What the authorities suggest instead

The Cleveland Clinic lists, for making filaments less noticeable: washing your face daily with warm water and a mild facial cleanser, using moisturizer routinely, using “noncomedogenic” products and taking makeup off each evening, and keeping your hands away from your face. It also lists salicylic acid, sold without a prescription as a cleanser or lotion, and retinoids, which it says can cause peeling and a change in skin colour; it says to use them every other day or with a moisturizer to reduce that. It says washing too much, or too much time in the sun, can dry skin so the oil glands work harder and the filaments look larger. Some people suggest a chemical exfoliant such as salicylic acid over physical scrubbing. The NHS says salicylic acid or benzoyl peroxide are treatments to put on the skin and that you can speak to a pharmacist for advice. The AAD says a retinoid called adapalene can be bought without a prescription in the US, and to give a treatment six to eight weeks to work. The US Drug Facts label for adapalene gel 0.1% sold without a prescription, on the FDA’s site (2017), says to ask a doctor before use if you are pregnant or breast-feeding, to stop and ask a doctor if you become pregnant or plan to, to limit sun exposure and use sunscreen outdoors, and that it may take up to 3 months of once-daily use to see results. This page does not say which product is right for you; a pharmacist can.

The Cleveland Clinic also says that pore size is mostly decided by genetics, that you cannot permanently shrink pores, and that an ice cube or chilled roller tightens skin for only a few minutes. One person says steaming the face does not open pores.

When to see someone

The NHS says to see a GP if you have acne and: “you’ve tried treating it yourself but it’s not getting better”; “you have lots of spots, or the spots are deep, painful or causing scars”; “you have signs of a skin infection, such as hot, swollen and red skin”; or it is affecting your mental health. In the US, the same questions go to a doctor or a dermatologist.

One more thing, because the nose is in the sun. The NHS says to see a GP if you have a growth on your skin that is getting bigger or has changed colour or texture, or an area of skin that “hurts, itches, bleeds, crusts or scabs for more than 4 weeks”. That is not the same as a dot. The NHS also says a new mole or a change in an existing mole may be a sign of melanoma, a more serious type of skin cancer. In the US, the same changes go to a doctor or a dermatologist.

Who this page is not for

If your skin has deep, painful or scarring spots, this page is the wrong tool: the NHS and AAD lines above are about acne, and a doctor can treat it. If you want the dots gone for good, the Cleveland Clinic says that is not possible, only smaller. If you are happy to leave them, you have nothing to do.

The dots may be skin doing its job. Leaving them alone costs nothing.