Whiteheads vs pustules: What's the difference?

How can you tell them apart?

Look at the whole bump, not just its colour. A white centre on an inflamed pimple points to a pustule rather than a closed whitehead. The name whitehead refers to a closed pore, not every white topped spot, because the naming system has declined to be helpful. An inflamed bump without pus is called a papule.14

Whiteheads and pustules can appear together. In darker skin, acne redness can be harder to see, so also consider swelling, tenderness and the pus filled centre. A large, deep, painful lump belongs to a different category, such as a nodule or cyst, rather than an ordinary surface pustule.15

Why do whiteheads and pustules form?

Both start with a blocked pore. Oil and dead skin cells collect inside the hair follicle, the small pocket containing a hair and its oil gland. A closed blockage produces a whitehead. Bacteria that normally live on skin can multiply in the trapped oil and trigger inflammation, meaning swelling and redness. A pimple containing pus is a pustule. Picking and hard scrubbing can make acne worse; neither removes the underlying tendency to develop blocked pores.267

Do they need different treatments?

For whiteheads, a retinoid such as adapalene helps unclog pores; adapalene is available without a prescription in some markets. A benzoyl peroxide wash helps reduce acne related bacteria. For pustules, an acne wash containing benzoyl peroxide or salicylic acid is an option. Retinoids and azelaic acid are also used for pimples, so the treatments overlap rather than belonging to completely separate routines.14

Acne treatments applied to the skin generally go across the affected area, not just onto individual spots, so the routine does not need a separate appointment for every bump.7

1. 1Wash gently with a mild, nondrying cleanser once or twice daily, including after exercise. Avoid scrubbing and repeated washing.
2. 2Apply your chosen acne treatment sparingly and follow its directions. Depending on the treatment, application can be nightly or twice daily.
3. 3If your skin is easily irritated, test the treatment on a small affected area for a few applications. Starting once or twice weekly and gradually increasing use can help establish tolerance.
4. 4Use a moisturizer suitable for acne prone skin and sunscreen. Look for noncomedogenic products, meaning products designed not to clog pores.

How long does treatment take?

Allow six to eight weeks to assess improvement; most acne treatments take two to four months to reach their full effect. An individual surface spot usually lasts less than two weeks, but treating acne also means preventing new spots. Retinoids can initially worsen acne for a few weeks. Acne products can cause dryness, redness or excessive peeling. Persistent irritation despite less frequent application needs medical advice.4567

Should you pop them or see a doctor?

Do not squeeze either type: picking can worsen acne, slow healing and cause infection or scars. See a dermatologist if pustules have not improved after six to eight weeks, or sooner for deep painful lumps, worsening acne, scarring or emotional distress. An unusual rash also needs assessment because not every spot is acne.467