Small whiteheads on the face: what they are and how to treat them

Are the bumps actually whiteheads?

Whiteheads are small, raised bumps that look white or match your skin colour. Their medical name is closed comedones, meaning closed pores. The trapped contents are covered by skin rather than exposed at the surface. A cluster of these bumps is called comedonal acne. The bumps usually are not swollen or tender and often appear on the forehead or chin, although cheeks and the nose can also be affected.245

A white centre alone does not make a spot a whitehead: a pus filled pimple is a pustule and needs treatment suited to that type of acne. You can have several types of acne at once. If you cannot tell what the bumps are, a clinician can examine your skin rather than having you choose treatment from colour alone.356

Why do whiteheads keep appearing?

Excess oil and dead skin cells can block hair follicles, the small openings where hairs grow. Hormone changes during puberty, periods, menopause and pregnancy can contribute to acne. Certain medicines and greasy skin or hair products can also contribute. Bacteria growing inside a blocked follicle can cause inflammation and pus, which is why a clogged pore and an inflamed pimple are not quite the same problem.67

What treats closed whiteheads?

Retinoids, a group of acne medicines, are recommended for unclogging pores when you have whiteheads or blackheads. Adapalene is one option. Access differs by country: adapalene is available without a prescription in the US, while UK treatment pathways include prescription adapalene. Prescription retinoids such as tretinoin also help reduce oiliness and inflammation and prevent spots.36

A benzoyl peroxide wash can accompany a retinoid to reduce acne related bacteria on the skin. Salicylic acid is another acne treatment a pharmacist can help you choose. If the bumps are actually inflamed papules or pus filled pustules, a face wash containing benzoyl peroxide or salicylic acid is an option for those blemishes. Match treatment to the type of spot rather than treating every bump as a whitehead.36

How to build your daily routine

1. 1Wash your face gently in the morning and evening. Use a gentle cleanser and do not scrub.
2. 2Use an acne treatment selected for your blemishes. A pharmacist can help you choose a treatment you apply to your skin.
3. 3Moisturize morning and night with a product labelled noncomedogenic. Oil free, water based options are suitable choices.
4. 4Wear sunscreen daily to protect your skin from sun damage.
5. 5Remove makeup before bed. Cleanse and moisturize after exercise as well.

Noncomedogenic means designed not to clog pores, which is useful information hiding inside a word that appears to charge by the syllable.5

What should you avoid?

Do not pick, squeeze or pop whiteheads. Picking can cause more whiteheads and acne scars. Scrubbing can irritate skin and make acne worse; it does not replace acne treatment. Blackheads are not trapped dirt either: their dark colour comes from the pore contents reacting with oxygen in the air.26

Choose skincare and makeup labelled noncomedogenic, rather than asking attractive packaging to manage your pores.6

How long does treatment take?

Give whitehead treatment six to eight weeks before assessing whether you need further help. Comedonal acne can take eight to twelve weeks to show a noticeable difference, and clearing it can take several months. Improvement is not the same as complete clearance. If blemishes remain after six to eight weeks, a dermatologist can review treatment rather than leaving you to wait indefinitely.35

Can a professional remove stubborn whiteheads?

Professional comedone extraction uses sterile instruments to remove clogs. A dermatologist can consider extraction or prescription treatment for stubborn whiteheads. Leave extraction to a qualified professional: doing it yourself can cause infection, scars and damage that leads to more blocked pores.35

When should you get medical help?

• Seek help if treatment you have tried yourself is not improving the acne.
• See a doctor for numerous spots, deep or painful lumps, or spots causing scars.
• Get medical advice for hot, swollen or red skin that could indicate infection. Redness can be harder to see on brown and black skin.
• Tell your clinician about side effects from acne medicines.
• Seek help if acne is affecting your mental health.

A flat coloured mark left after a spot clears is different from a raised whitehead. These marks can be pink, red, purple, brown or black and are often mistaken for scars. They can fade on their own, although some last a year or longer. Acne scars can be permanent, which is one reason to treat ongoing breakouts rather than repeatedly picking them.2