table of contents
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Have you ever held your face up to the mirror to get a better look at your pores? If so, you may have seen a blackhead, whitehead, or both. When it comes to clogged pores and the difference between a blackhead vs. a whitehead, it all comes down to whether the pore is open or closed. With blackheads, the clogged pore is open. With whiteheads, it’s closed.
Regardless of whether you have blackheads or whiteheads, there are treatment options available. Read on to learn more.
What are pimples?
Medical providers refer to pimples (also called breakouts, zits, comedones) as acne or acne vulgaris. It is the most common skin condition in the United States, affecting 40–50 million people at any one time. And it’s not just for teens—adults can also get acne (AAD, n.d.; Skroza, 2018).
Acne affects the skin’s oil glands and hair follicles. Spots and pimples may occur when these glands and follicles become plugged with a buildup of bacteria, dead skin cells, and oil. Unfortunately, they’re not limited to your face, either. Body acne can appear anywhere, including your face, neck, chest, shoulders, and back (Sutaria, 2021).
Cases of acne can range from mild to severe depending on the person, but individual cases can also worsen or improve over time. Some people suffer from longer and more severe breakouts. There are multiple types of blemishes, too, including blackheads and whiteheads.
What are blackheads?
It’s easy to think of blackheads as the least annoying of the pimples. Like other comedones, blackheads form around clogged pores. They look like small, black dots just beneath the skin, and you may get them on your face, back, shoulders, and chest. Although they’re a mild form of acne, their dark appearance may bother people (Sutaria, 2021).
How do blackheads form? Well, your skin has sebaceous glands that secrete oil, called sebum, to protect the skin and keep it hydrated and soft. The sebum, along with dead skin cells, can collect in the pore, clogging it. This creates a pimple called a comedone. When the pimple opens to the skin’s surface, compounds in the clogged pore oxidize and turn a dark color—this gives blackheads their characteristic black color. Although they’re easy to spot, they aren’t inflamed or red (Sutaria, 2021).
What are whiteheads?
Whiteheads are formed the same way as blackheads. A pore gets clogged with sebum, dead skin cells, and bacteria. But in this case, the resulting bump stays covered with skin and is not open to the air. Whiteheads are closed comedones (Sutaria, 2021).
Another mild form of acne, these common blemishes are white and most commonly appear on the face, back, shoulders, and upper arms. You may see them in places where something causes friction on your skin, such as backpacks and tight shirt collars.
It’s important to note that there are other forms of acne, some of which may be mistakenly called whiteheads. Papules or pustules are small red, tender bumps. These are essentially pimples that have pus at their tips, a sign of inflammation and sometimes infection. Deep painful bumps under your skin are likely nodules or cystic acne lesions (Sutaria, 2021).
Causes of blackheads and whiteheads
The causes of the different types of acne are pretty much the same. It all comes back to those clogged pores. But certain factors may make you more prone to developing acne, including (Thiboutot, 2021):
- Hormonal changes, like menstruation, pregnancy, etc.
- Skincare habits, like harsh scrubbing while cleansing
- Clothing or other items rubbing your skin
- Medical conditions, like polycystic ovary syndrome (PCOS)
- Medications, like corticosteroids
- Masks (aka “maskne”)
If you have questions, talk to your healthcare provider about the possible causes of your acne and potential treatments.
Treatments for pimples
One of the biggest differences when it comes to whiteheads vs. blackheads is the treatment options. Although they share some acne treatments you should consider, such as salicylic acid, blackheads generally require fewer interventions than whiteheads.
Treatments for blackheads
When addressing those annoying black spots when they’ve already formed, your best bet is a facial treatment that includes extractions.
This part of the treatment will remove the buildup from your pores, eliminating the material that has turned black. If you insist on doing this at home, discuss the best method with your dermatologist, who can advise you on removing the buildup without damaging your skin in the process.
- Salicylic acid: Although clinical trials are limited, some studies show that salicylic acid helps unclog pores and prevent future lesions. This treatment doesn’t affect sebum levels or kill bacteria, however. You’ll find salicylic acid in facial cleansers as well as topical creams, gels, and serums.
- Retinoids: Retinoids are effective at treating comedonal acne, which includes both blackheads and whiteheads. People who have mild acne that includes only blackheads and whiteheads may be able to use retinoids alone. Using retinoids together with antimicrobials may be best, though, for people who have both non-inflammatory and inflammatory blemishes. For mild acne like blackheads, an over-the-counter retinoid, such as adapalene (brand name Differin), may be all that’s needed.
- Non-comedogenic moisturizer: A non-comedogenic moisturizer is simply one that won’t clog your pores. If you already have high oil production, moisturizers with added oils may exacerbate how often your pores clog, leading to blackheads and whiteheads.
How does stress cause acne?
Treatments for whiteheads
You’re probably not going to like this, but the frontline of treatment for that pesky whitehead is to leave it alone. Translation: no picking or popping, especially if you don’t have an extractor on-hand. A dermatologist may be able to pop and clear the whitehead for you. Doing it on your own may lead to skin damage—which could leave a scar—or, in rare cases, a skin infection from the spread of bacteria that had been in the blemish.
The good news is, there are effective treatments that will help banish your blemish, so you don’t have to resist the urge to pop them for long. Some acne treatments include:
- Benzoyl peroxide: This topical treatment helps clear acne and prevent future breakouts by attacking and reducing the C. acnes (formerly P. acnes) bacteria that live on the skin. Benzoyl peroxide is available in various forms—such as foams, gels, facial washes, and creams—as a topical treatment that ranges in strength from 2.5% to 10%. You can use it alone or in combination with other topical or oral treatments, and it may even help reduce acne in as little as five days (Zaenglein, 2018).
- Salicylic acid: This acne treatment may also help treat and prevent whiteheads, though more research is necessary. It helps to unclog pores and has a minor anti-inflammatory effect (Fox, 2016).
- Retinoids: Depending on the severity of your acne, your dermatologist may suggest a prescription-strength topical retinoid, such as tretinoin (brand name Retin-A; see Important Safety Information). These aren’t spot treatments and should be used on the entire face. Skin irritation is a common side effect, but you may be able to prevent it by using a non-comedonal moisturizer after applying the medication. In more severe cases of acne, your dermatologist may recommend an oral retinoid like isotretinoin (brand name Accutane) (Sutaria, 2021).
- Tea tree oil: Older research suggests that 5% tea tree oil is just as effective as 5% benzoyl peroxide treatment for comedonal acne—but that tea tree oil takes longer to work (Bassett, 1990). Newer research suggests that tea tree oil may be an effective treatment for clear skin, especially since some bacteria that cause blemishes are becoming resistant to antibacterial treatments. One study showed that a combination treatment that included propolis (a compound produced by bees), tea tree oil, and aloe was more effective at reducing the severity of acne and number of lesions than erythromycin cream, a common topical treatment for acne vulgaris (Mazzarello, 2018).
- Antibiotics: These are generally reserved for people with signs of infection and/or inflammation, like papules and pustules. Antibiotics can be topical (creams) or oral (pills). Common examples include doxycycline and erythromycin (Zaenglein, 2018).
How to get rid of acne scars
Other treatments for both blackheads and whiteheads
There are some pretty big and persistent myths about zits. One of the biggest is that acne is due to dirty skin. While washing your face regularly is part of a healthy skincare routine, excessive cleansing can also cause irritation, which may make acne appear worse.
But lifestyle factors may help prevent future breakouts, such as touching your face as little as possible, not picking at blemishes when they do form, and eating a healthy diet. If you have concerns about your acne or want to explore some of the medications above for treating blackheads and whiteheads, talk to your healthcare provider.
- American Academy of Dermatology (AAD). (n.d.). Skin conditions by the numbers. Retrieved October 26, 2021 from https://www.aad.org/media/stats-numbers
- Bassett, I. B., Barnetson, R. S., & Pannowitz, D. L. (1990). A comparative study of tea‐tree oil versus benzoyl peroxide in the treatment of acne. Medical Journal of Australia, 153(8), 455-458. doi: 10.5694/j.1326-5377.1990.tb126150.x. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.5694/j.1326-5377.1990.tb126150.x
- Fox, L., Csongradi, C., Aucamp, M., Plessis, J. D., & Gerber, M. (2016). Treatment modalities for acne. Molecules, 21(8), 1063. doi: 10.3390/molecules21081063. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6273829/
- Mazzarello, V., Donadu, M., Ferrari, M., Piga, G., Usai, D., Zanetti, S., & Sotgiu, M. A. (2018). Treatment of acne with a combination of propolis, tea tree oil, and Aloe vera compared to erythromycin cream: Two double-blind investigations. Clinical Pharmacology: Advances and Applications, 10, 175-181. doi: 10.2147/cpaa.s180474. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298394/
- Skroza, N., Tolino, E., Mambrin, A., Zuber, S., Balduzzi, V., Marchesiello, A., et al. (2018). Adult acne versus adolescent acne: a retrospective study of 1,167 patients. The Journal of Clinical and Aesthetic Dermatology, 11(1), 21–25. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29410726/
- Sutaria, A. H, Masood, S., & Schlessinger, J. (2021). Acne vulgaris. [Updated Aug 9, 2021]. In: StatPearls [Internet]. Retrieved on Nov. 4, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK459173/
- Thiboutot, D., & Zaenglein, A. (2021). Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris. In UptoDate. Levy, M. L, Owen, C., and Ofori, A. O. (Eds.). Retrieved from https://www.uptodate.com/contents/pathogenesis-clinical-manifestations-and-diagnosis-of-acne-vulgaris
- Zaenglein, A. L. (2018). Acne Vulgaris. The New England Journal of Medicine, 379(14), 1343–1352. doi: 10.1056/NEJMcp1702493. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30281982/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.