Hard whiteheads on the face: what they are and how to remove them

Are they whiteheads or milia?

Whiteheads are small, raised bumps formed when oil and skin cells collect in a pore. Their medical name is closed comedones. Milia are tiny cysts containing keratin, the protein in skin, and often look pearly white just below the surface. The names sound interchangeable, which is convenient for conversation and less convenient for choosing a treatment.3 4 5

Clue	Whiteheads	Milia
What the bump contains	Oil and dead skin cells plugging a closed pore	Keratin inside a small cyst
Appearance	Raised white or flesh colored bumps	Tiny pearly white bumps beneath the surface
Common facial locations	Forehead and chin, also nose and cheeks	Eyelids, cheeks and forehead
How they feel	Usually not tender or swollen; the bumps can appear to have a solid core	Usually painless; trapped skin cells harden into cysts
Treatment approach	Acne treatments that help unclog pores	Waiting, or professional treatment if removal is wanted

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Hardness alone does not identify the bump. Small red, hard bumps can be papules, meaning inflamed acne bumps without pus. A pimple with a white or yellow center can be a pustule, meaning a pimple containing pus. Deep, tender bumps can be acne nodules or cysts. If you cannot tell what you have, a clinician can examine the bumps before you choose a treatment.1 2 7

Why do the bumps form?

A whitehead forms when excess oil and dead skin cells plug a pore and the opening closes. If the opening stays open, the same buildup can form a blackhead instead. Its dark color comes from a reaction with oxygen, not dirt. Scrubbing does not solve that problem and can worsen acne.2 7

Milia form when dead skin cells become trapped beneath new skin rather than shedding normally. Milia can also develop as skin heals after an injury, burn or blistering rash. Some occur after sun damage or in reaction to a heavy cream or ointment. Most cases cannot be prevented, so developing milia does not mean you missed a cleansing step.1 5

How do you remove hard whiteheads on the face?

For bumps identified as whiteheads, use acne treatment rather than trying to force the contents out.

1Wash gently morning and night, and after exercise. Do not scrub, and remove makeup before bed.
2Choose an acne treatment intended to unclog pores. Dermatologists recommend a retinoid for whiteheads; adapalene is available without a prescription.
3Consider a benzoyl peroxide wash as part of the acne routine. Benzoyl peroxide helps reduce acne causing bacteria on the skin.
4Use a moisturizer and daily sunscreen. Choose oil free, water based products labeled noncomedogenic, meaning formulated not to clog pores.
5Give treatment six to eight weeks before deciding it has failed. If whiteheads persist, see a dermatologist about prescription treatment or professional extraction.

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Other topical options for comedonal acne include salicylic acid, azelaic acid and glycolic acid. These are treatment options, not a requirement to use every ingredient together. Persistent acne can need a prescription plan rather than more products. Professional options include comedone extraction and chemical peels; a clinician can choose an approach based on the bumps and your response to treatment.6 7

What if the hard bumps are milia?

Milia are harmless and do not need treatment unless you want them removed. Wash daily with warm water and gentle soap, pat dry, and use sunscreen outdoors. Adults can discuss exfoliation or adapalene with a healthcare provider. Milia are also called 'milk spots', a second name that contributes nothing to the shopping list.1

For an individual milium, a healthcare professional can make a small opening with a sterile needle or blade and remove the contents. That is an office procedure, not a home technique. Other removal methods include freezing and procedures that destroy or remove the cyst. For widespread milia, topical retinoids may help. Chemical peels, dermabrasion and laser treatment are options reported for very extensive milia, rather than necessary steps for a few bumps.1 5

How long will the bumps take to clear?

For whiteheads, six to eight weeks is a useful point to review whether acne treatment is helping. Comedonal acne can take eight to twelve weeks to show a difference and many months to clear. Adult milia can disappear within weeks to a couple of months, but some persist for months or longer. If milia remain after a few months, worsen, or you want them removed sooner, arrange an appointment.1 5 6

When should you see a dermatologist?

Get help for deep, painful acne bumps rather than waiting through repeated home treatments. Nodules and cysts can cause permanent scars.
Arrange a review if acne treatment is not helping, or let your prescriber know if medication causes side effects.
Have uncertain bumps examined, especially before attempting removal around the eyelids.
Do not pick whiteheads or squeeze milia. Picking whiteheads can cause more whiteheads and scars; squeezing or scraping milia can cause scarring or infection.

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