Big, ugly pores? You’re not alone, friend. Let’s get that fixed.
Let’s start with the most basic question: what is a pore? A pore is essentially the hair follicle, including the hair itself, and its connected oil gland.
There are many things that may contribute to our pore size, including our gender, genetics, aging, sun exposure, having acne and oily skin, but there are three things that are thought to be the main reasons for large pores. These include the following:
ONE: Oily skin
The areas of our face that are most oily are the nose and the cheeks — and this explains why larger pores tend to happen in these locations. Skin oiliness can be a result of a number of things, including our hormones. For females, oiliness tends to be worst around our menses, which is thought to be a result of progesterone and two other hormone stimulators called LH and FSH. This may also explain why we have acne flares around our periods.
TWO: Reduced support, or elasticity, around the pore
Normally, our hair follicle is supported by two key components, including collagen and elastin. With aging, elastin tend to be less strong because of decreased expression of components that we need to make a strong version of it. This leads to less support for the hair follicle, which may result in a more expanded, and less tight version—which translates into a larger looking pore. Sun damage also contributes because it causes break down of our collagen; as our skin heals after sun exposure, the new collagen that is built tends to be a weaker version, called type III collagen.
THREE: Larger pore volume
Pore volume includes the hair follicle itself, including the hair and the base of the hair follicle called the dermal papilla, and the connected oil gland. If you have thicker hair at baseline, the pore volume inherently is bigger, and your pores will get bigger. Our hormones act on the base of the hair follicle, called the dermal papilla, and can result in increased follicle size.
Please note that having a history of inflammatory acne can also enlarge pores because it scars the hair follicle/pore, making it more prone to getting plugged in response to hormones, and more likely to have a larger pore volume.
Okay, so now that we understand the main reasons behind why our hair follicles or pores tend to get enlarged, how do we fix them? First and foremost, we have to understand your specific reason for having large pores. Do you tend to have oily skin? Are you older, or have you had a lot of sun damage in your life? Or do you tend to have thicker hair? For some of us, more than one of these reasons could be at play. We can then tackle one or more of the underlying issues. Note that none of these proposed solutions have been studied extensively in evidence-based studies, but if we’re addressing the 3 underlying issues, theoretically, this will help.
Step 1: Reducing oil
For one, changing your diet will help with this! The most important changes are to eat foods that are low glycemic index (or low in sugar) and to avoid dairy. I encourage you to check out our recent podcast on acne and diet, as I go into a lot of detail there.
There aren’t a lot of the counter options that can help with this, though there is some evidence that topical niacinamide 2% may help reduce shininess, as may a topical leaf extract from Java tea. Choosing face washes and moisturizers that are low in oil and fats and are labeled as “non-comedogenic,” meaning they won’t plug your pores, is also key.
You can otherwise consult with your dermatologist or doctor about prescription treatments, including pills like spironolactone and combination oral contraceptives for their ability to block our hormones from triggering our oil glands to make more oral. A pill that we commonly use for acne, called isotretinoin or accutane, can also be useful as it essentially shrivels up our oil glands. Theoretically, a newer topical medication on the market called Winlevi may also be helpful because it blocks the action of hormones on our oil glands.
Chemical peels, like salicylic acid peels, and laser treatments that target the oil glands, like photodynamic therapy, diode lasers, and non-ablative radiofrequency devices may be helpful, as may be botox injections.
Step 2: Increasing support around the hair follicle
The most basic way to increase support around our hair follicles includes a topical retinoid, like tretinoin or Retin-A. This topical form of vitamin A helps prevent the breakdown of collagen and stimulates our skin to make more collagen as well.
Using strict sun protection is also key, because this will help reduce further loss of the support around your pores. You want to choose sunscreens that are broad spectrum, contain SPF30 or above, and ideally have zinc oxide or titanium dioxide as the active ingredients, as these are the only 2 ingredients deemed safe by the FDA. Avoiding sun during peak hours from 10-2, wearing a broad rimmed hat are other good idea.
There are a lot of lasers that can also be helpful here, including fractional erbium laser (particularly for those with darker skin), non-ablative fractional diode lasers, fractional bipolar RF, and IPL.
Step 3: Reducing hair
Laser hair removal, including with ruby, alexandrite, pulsed diode, NdYag may be helpful for removing hair, thus making the follicle less bulky or voluminous. Theoretically, I would speculate that medications that will otherwise block the action of hormones on the hair follicle, like spironolactone, would also be useful.
One final thought — what about things like Biore strips? These are unlikely to help with pore size, as they’re not addressing one of the main mechanisms resulting in large pores. Instead, they’re trying to target blackheads, or clearing out the contents of the pore.
Reference
Lee, SJ et al. Facial pores: definition, causes and treatment options. Dermatology Surg 2016; 42: 277-285.
(Photograph reference Lee SJ et al. Facial Pores: Definition, Causes, and Treatment Options. Dermatol Surg 2016; 42:277-85)