Blackheads with white pus: what are they?

Is it a blackhead, whitehead or pustule?

Several types of acne spots often occur together. Having blackheads nearby does not make every white centred bump a blackhead. Inflamed bumps can look pink or red on white skin and brown or purple on brown and black skin, so redness is not the only clue.45

What is the white material?

A blackhead contains a plug of oil and skin cells, including keratin, the material in those cells. That plug is different from the white or yellow pus in a pustule. Bacteria growing in a blocked follicle, the opening containing a hair and oil gland, can cause inflammation and pus. Neither blackheads nor pimples are caused by dirt, and scrubbing does not solve the blockage.1256

Should you squeeze it?

Do not squeeze a spot to find out what is inside. Squeezing blackheads can cause infection or a permanent scar. Picking, scratching or squeezing pimples can also slow healing and worsen acne. If blackheads remain stubborn despite treatment, a dermatologist can consider professional extraction or prescription treatment instead.137

How to treat the spots

1. 1Wash gently morning and evening with a mild, nondrying cleanser. Avoid scrubbing and repeated washing.
2. 2Choose treatment for the type of spot. For pus filled pimples, an acne wash containing benzoyl peroxide or salicylic acid is an option. For blackheads and whiteheads, a retinoid such as adapalene helps unclog pores; a benzoyl peroxide wash can also help reduce acne bacteria.
3. 3Follow the chosen product's directions carefully and apply it sparingly. Ask a pharmacist to help select an acne treatment if you are unsure which to use.
4. 4Remove makeup before bed, even if the packaging has promised a much more glamorous evening.
5. 5Look for noncomedogenic skincare and makeup, with less attention to how impressively the jar describes itself. Noncomedogenic means formulated not to clog pores.

Acne medicines applied to the skin can cause redness, dryness or excessive peeling. Sensitive skin needs particular attention to those effects, rather than more scrubbing or repeated washing. Benzoyl peroxide can bleach towels and clothing. Application frequency depends on the product directions; cleansing twice daily does not mean every treatment should be applied twice daily.1

How long should you wait for improvement?

Give acne treatment six to eight weeks to show results. An individual acne spot usually lasts less than two weeks, but deeper bumps can persist for months. A spot disappearing is therefore not the same as the treatment controlling new breakouts. If pustules are not improving after six to eight weeks, see a dermatologist.47

When should you get medical help?

Get medical help sooner for deep or painful lumps, lots of spots, worsening acne or developing scars. Hot, swollen and red skin can signal a skin infection; redness can be harder to see on brown and black skin. Persistent large pus filled bumps also need assessment, and a clinician can check for infection. Seek help if acne is affecting your mental health, rather than waiting for it to become physically severe.15