Little whiteheads on the face: what they are and what helps

Are the bumps whiteheads, milia or pimples?

Closed comedone is the medical name for a whitehead. Whiteheads can occur alongside blackheads and inflamed pimples. Milia are separate from acne, even though both can look like little white dots. If you cannot tell which you have, get the bumps checked before treating them as acne, particularly around the eyelids.124

Why do little whiteheads appear?

Whiteheads form when excess oil and dead skin cells block a hair follicle, the opening where a hair grows. Hormonal changes during puberty, periods, menopause and pregnancy can contribute to acne. Certain medicines and skin or hair products that make skin greasy can also contribute. Whiteheads are common in teenagers, but they can continue into adulthood or first appear then. Milia have a different origin: they contain trapped keratin and can also develop as skin heals after an injury. The same colour does not make them the same problem, despite the naming department's limited palette.256

What treats acne whiteheads?

For confirmed acne whiteheads, a topical retinoid is a main treatment for unclogging pores. Retinoids are vitamin A derivatives that break up whiteheads and help prevent new clogs. Adapalene is available without a prescription in some markets; a pharmacist can help you find locally available options. A benzoyl peroxide wash can also help by reducing acne bacteria. These treatments do different jobs: a retinoid addresses clogged pores, while benzoyl peroxide targets bacteria. If the bumps include inflamed pimples rather than only closed pores, benzoyl peroxide or salicylic acid washes are also treatment options.3

How to look after your face during treatment

1. 1Wash your face morning and evening with a gentle cleanser. Do not scrub: irritation can make acne worse.
2. 2Use your chosen acne treatment following its directions. If a retinoid causes peeling, using it every other day or alongside moisturizer can reduce side effects.
3. 3Use moisturizer routinely. For skin that irritates easily, consider the differences between benzoyl peroxide strengths and wash formulas rather than assuming stronger is better.
4. 4At the end of the day, remove makeup. Choose skincare and makeup labelled noncomedogenic, meaning formulated not to clog pores.
5. 5Keep hair products away from your face, avoid picking, and be careful around the bumps when shaving.

Makeup does not have to be abandoned because of whiteheads, so the makeup bag need not submit its resignation. Product choice and removing makeup each evening are the useful changes.6

How long do whiteheads take to clear?

An individual whitehead can go away by itself, sometimes within about seven days. That is different from treating recurring whiteheads: give acne treatment six to eight weeks to work before deciding whether it is helping. If blemishes remain, a dermatologist can consider prescription treatment or professional extraction of clogged pores. A bump disappearing and a treatment controlling new breakouts are different outcomes. Milia follow a different timetable: they can clear within weeks, but some persist for months or longer.236

What if the bumps are milia?

Milia are harmless and do not need treatment unless they bother you. They occur at all ages and are especially common on the eyelids and cheeks. Leaving them alone is a reasonable option because many clear spontaneously within a few months. Avoid further trauma to the area, which can encourage new lesions. For persistent milia, a clinician can open the cyst with a sterile instrument and remove its contents. That is a procedure to discuss with a professional, not a reason to squeeze the bump at home. Topical retinoids may help widespread milia; more extensive cases can be treated with procedures such as chemical peels or laser treatment. Newborn milia commonly appear on the nose and usually heal within a few weeks of birth.2

Should you squeeze little whiteheads?

Do not squeeze or pick whiteheads. Pressure can damage skin, introduce bacteria and cause inflammation or scarring; a deeper clog might not come out anyway. Picking can also lead to more whiteheads. Professional extraction is an option for stubborn clogged pores, but it is not equivalent to forcing a bump open with your nails.46

After acne clears, a flat coloured mark is not necessarily a scar. These marks can be pink, red, purple, brown or black and eventually fade, although some last a year or longer. True acne scars change the skin's surface, leaving depressions or raised areas. Treating ongoing acne matters because prolonged acne and treatment that is not working increase the risk of scarring.4

When should you get medical help?

• Get help if treatment is not improving the bumps after six to eight weeks.
• See a doctor for lots of spots, deep or painful lumps, or acne that is leaving scars.
• Seek medical help for hot, swollen or red skin that could indicate infection. Redness can be harder to see on brown and black skin.
• Talk to a healthcare professional if acne is affecting your mental health.
• Have uncertain bumps assessed rather than repeatedly treating them as whiteheads.