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You’re making a mountain out of a molehill. It may sound like an outdated saying, but it may be the most accurate way to describe how we feel about our own acne. Feeling the inflammation makes that pesky pimple seem far bigger than it actually is when in reality, most people won’t remember that you even had one.
If you needed more proof that breakouts are totally normal and something other people likely don’t notice, you should know that an estimated 85% of people experience acne, also referred to as acne vulgaris, at some point in life (Chiu, 2003). Acne is also the most common skin condition in the United States, affecting 40–50 million people at any one time (AAD, n.d.). Acne vulgaris is a chronic inflammatory condition that affects the skin’s oil glands and hair follicles. When these glands and follicles become plugged with a buildup of bacteria, dead skin cells, and oil, spots and pimples may occur. Unfortunately, they’re not limited to your face, either. Acne can show up anywhere, including your face, neck, chest, shoulders, and back.
- Acne affects 40–50 million people at any one time in the United States alone.
- Whiteheads and blackheads are two variations of the same type of acne, called comedonal acne.
- While they’re both the result of clogged pores, the pore is open with a blackhead but closed with a whitehead.
- Topical treatments may help decrease and prevent future comedones of both kinds.
- Extraction may be necessary if the appearance of blackheads bothers you.
Cases of acne can range from mild to severe depending on the person, but individual cases can also worsen or improve over time. Some people suffer from longer and more severe breakouts. There are multiple types of blemishes, too, including whiteheads, blackheads, pimples, papules, pustules, and cysts. But what’s the difference between these blemishes, anyway?
What are blackheads?
It’s easy to think of blackheads as the least annoying of the pimples. Also called comedones, blackheads form around clogged hair follicles. They look like small, black dots just beneath the skin, and you may get them on your face, back, shoulders, and even chest. Although they’re considered a mild form of acne, their dark appearance may bother people.
Each hair follicle has a sebaceous gland that secretes oil, called sebum, to protect the skin and keep it hydrated and soft. The sebum, along with dead skin cells, can collect in the pore, clogging it. This creates a bump called a comedone. When the bump opens to the skin’s surface, compounds in the buildup that create the clog oxidize and turn it a dark color. This is what gives blackheads their characteristic black color. Although they’re easy to spot, they aren’t inflamed or red.
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What are whiteheads?
Whiteheads are formed mostly the same way as blackheads. The hair follicle gets clogged with sebum, dead skin cells, and bacteria, but the resulting bump that forms in the pore doesn’t open. Whiteheads are closed comedones. These common blemishes, which are another mild form of acne, are white in color and most commonly appear on the face, back, shoulders, and upper arms—although they have been noted in places where something causes friction on your skin, such as backpacks and tight shirt collars (Mayo Clinic, 2020).
It’s important to note that there are other forms of acne, some of which may be mistakenly called whiteheads. Pimples, for instance, are papules (small red, tender bumps) that have pus at their tips. Those painful bumps under your skin that may eventually release pus are cystic lesions, not deep whiteheads.
One of the biggest differences when it comes to whiteheads vs. blackheads is the treatment options. Although they share some treatments you should consider, such as salicylic acid, blackheads generally require fewer interventions than whiteheads.
Treatments for blackheads
When it comes to addressing those annoying black spots when they’ve already formed, your best set is a facial treatment that includes extractions. This part of the treatment will remove the buildup from your pores, eliminating the material that has turned black. If you insist on doing this at home, discuss the best method with your dermatologist, who can advise you on how to remove the buildup without damaging your skin in the process. It’s important to clean the area as you work since bacteria from your hands can collect in your pores as you clean them.
Once your pores have been cleaned, you can focus on treatments for blackheads that may help prevent the buildup from happening again. These treatment options include (Zaenglein, 2016):
- Salicylic acid: Although clinical trials are limited, some studies show that salicylic acid helps to unclog pores and prevent future lesions. This treatment doesn’t affect sebum levels or kill bacteria, however. You’ll find salicylic acid in facial cleansers as well as topical creams, gels, and serums.
- Retinoids: Retinoids are effective at treating comedonal acne, which includes both blackheads and whiteheads. People who have mild acne that includes only blackheads and whiteheads may be able to use retinoids alone. Using retinoids together with antimicrobials may be best, though, for people who have both non-inflammatory and inflammatory blemishes. For mild acne such as blackheads, an over-the-counter product such as Differin may be all that’s needed.
- Non-comedogenic moisturizer: A moisturizer that’s non-comedogenic is simply one that won’t clog your pores. If you already have high oil production, moisturizers with added oils may exacerbate how often your pores get clogged, leading to blackheads and whiteheads.
Treatments for whiteheads
You’re probably not going to like this, but the frontline of treatment for that pesky whitehead is to leave it alone. Translation: no picking or popping, especially if you don’t have an extractor on-hand. An esthetician or dermatologist may be able to pop and clear the whitehead for you. Doing it on your own, though, may lead to skin damage—which could leave a scar—or, in rare cases, a skin infection from the spread of bacteria that had been in the blemish.
The good news is, there are effective treatments that will help banish your blemish, so you don’t have to resist the urge to pop them for long. These treatments include:
- Benzoyl peroxide: This topical treatment helps clear acne and prevent future breakouts by attacking and reducing the C. acnes (formerly P. acnes) bacteria that live on the skin. Benzoyl peroxide is available in various forms—such as foams, gels, facial washes, and creams—as a topical treatment that ranges in strength from 2.5% to 10%. It may be used alone or in combination with other topical or oral treatments, and may even help reduce acne in as little as five days. Benzoyl peroxide may cause side effects, including skin irritation, allergic reactions, and staining of fabric (Zaenglein, 2016).
- Salicylic acid: This acne treatment may also help treat and prevent whiteheads, though more research is necessary. It works as a keratolytic agent that dissolves the cement between skin layers in order to sweep away dead skin cells that could have clogged pores (Fox, 2016).
- Retinoid: Depending on the severity of your acne, your dermatologist may suggest a prescription-strength topical retinoid, such as Retin-A or Tazorac. These aren’t spot treatments and should be used on the entire face. Skin irritation is a common side effect but may be prevented by using a (non-comedonal moisturizer) after the application of the medication (Cleveland Clinic, 2017). Retinoids are stronger retinols, a larger group of drugs that also includes retinol, or vitamin A. Several retinoids have been shown to be effective topical treatments for acne, including tazarotene and tretinoin (Mukherjee, 2006). There’s also some evidence that low-dose oral vitamin A in the form of isotretinoin helps treat mild to moderate acne (Kotori, 2015).
- Tea tree oil: Older research suggests that 5% tea tree oil is just as effective as 5% benzoyl peroxide treatment for comedonal acne—but that tea tree oil takes longer to work (Bassett, 1990). Newer research is confirming that tea tree oil may be an effective treatment for clear skin, especially since some types of bacteria that cause blemishes are becoming resistant to antibacterial treatments. A combination treatment that included propolis (a compound produced by bees), tea tree oil, and aloe was more effective at reducing the severity of acne and number of lesions than erythromycin cream, a common topical treatment for acne vulgaris, in one 2018 study (Mazzarello, 2018).
- Witch hazel: If you have oily skin, treatments such as toners with witch hazel may be an effective way to combat zits. Witch hazel is an anti-inflammatory botanical that is also astringent that helps remove excess sebum (Chularojanamontri, 2014). This may, in turn, help prevent clogged pores that lead to comedonal acne, but more research is needed. Researchers tested the efficacy of a three-step over-the-counter regimen for treating acne that included a witch hazel toner. They found that it successfully reduced the number of whiteheads and blackheads in participants, but this regimen also included benzoyl peroxide, so it’s impossible to separate out the effect of witch hazel alone (Rodan, 2017).
Other treatments for both blackheads and whiteheads
There are some pretty big and persistent myths about zits. One of the biggest is that what causes acne is dirty skin. While washing your face regularly is important for removing excess sebum, excessive cleansing can also cause irritation, which may make acne appear worse (AAD, n.d.). But lifestyle factors may help prevent future breakouts, such as touching your face as little as possible, not picking at blemishes when they do form, and eating a healthy diet. There are also some supplements that may support different aspects of skin health, like these vitamins for skin.