Pimples with white heads: what they are and how to treat them

Is it a whitehead or a pus filled pimple?

Whiteheads are small, raised bumps formed when oil and skin cells collect in pores. They are also called closed comedones, meaning closed pores, and commonly occur on the face, chest and back. A pustule contains pus rather than just a closed plug. Whiteheads and pustules can both look white at the top, which makes the naming system less helpful than it appears.123

Why do these bumps form?

Acne starts when a hair follicle becomes blocked with excess oil and dead skin cells. Bacteria can grow inside the blockage, causing inflammation and pus. Hormonal changes during puberty, periods, menopause or pregnancy can contribute, as can certain medicines and greasy skin or hair products. You can have several types of acne at once, so a mix of closed bumps and pus filled pimples is possible. Scrubbing does not solve the blockage and can irritate skin and make acne worse.4

Which treatment should you choose?

For pus filled pimples, use an acne wash containing benzoyl peroxide or salicylic acid. Benzoyl peroxide helps reduce acne bacteria. If you have only a few pimples, other treatment options include a retinoid or azelaic acid. A pharmacist can help you choose an acne treatment rather than buying several products with different names and overlapping jobs.134

For closed whiteheads, retinoids help unclog pores. Adapalene is one retinoid available without a prescription in the US. A benzoyl peroxide wash can also help reduce excess acne bacteria. Persistent closed whiteheads can need prescription treatment or professional comedo extraction, a procedure to remove the plugs.1

How to build the daily routine

1. 1Wash gently twice a day. Use a gentle cleanser, or follow the directions on your chosen acne wash. Avoid scrubbing and repeated washing.
2. 2Apply your acne medicine according to its directions. Use it sparingly rather than adding extra in an attempt to clear a bump faster.
3. 3Choose noncomedogenic skincare and makeup. These formulas are intended not to clog pores.
4. 4Remove makeup at the end of the day instead of leaving it on overnight.
5. 5For acne on the chest or back, wear loose, breathable clothing, especially during exercise or sweating.

Noncomedogenic means a formula is intended not to clog pores, which is a lot of syllables for a useful shopping filter.4

What should you watch for?

Acne medicines can cause redness, dryness or excessive peeling. Follow the product directions carefully, particularly if your skin is easily irritated, and avoid adding scrubbing or repeated washing. Benzoyl peroxide can bleach or discolor towels and clothing. The amount, frequency and application instructions should come from the particular product you choose, rather than treating every acne wash, cream and gel as interchangeable.5

Should you squeeze the white center?

Do not squeeze, scratch or pick the bump. Picking whiteheads can lead to more whiteheads and acne scars. Squeezing pimples can also cause infection, slow healing and leave scars. A visible white center is not a reason to empty the bump yourself; professional extraction is an option for stubborn closed whiteheads.35

How long does treatment take?

Give acne treatment six to eight weeks to show a response. This is a treatment assessment window, not a deadline for each individual pimple to disappear. If pustules are not improving by then, see a dermatologist. Persistent whiteheads can also need a different treatment or professional extraction.1

Is the mark left behind a scar?

A completely flat pink, red, purple, brown or black spot after a pimple clears is not the same as a permanent acne scar. These color changes can fade on their own, but some last a year or longer. Darker spots generally take longer to clear. True acne scars can be raised or leave depressions in the skin. Treating ongoing acne matters because prolonged acne, including acne that is not responding to treatment, increases the risk of scarring.3

What about pregnancy and prescription treatment?

Prescription treatment is an option when shop bought acne medicines do not help. Oral isotretinoin is used for some cases of cystic acne with scarring and requires close medical monitoring. It must not be taken during pregnancy because it causes severe birth defects.5

When should you see a doctor?

• Get medical help for lots of spots, deep or painful lumps, worsening acne or developing scars.
• See a doctor for possible infection, including hot, swollen and red skin. Redness can be harder to see on brown and black skin.
• Seek help if acne is affecting your mental health rather than waiting for the spots to become more severe.
• Deep nodules and cysts need a dermatologist's help because they can leave permanent scars. Earlier treatment reduces that risk.