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If you feel like you’re in a constant battle with your whiteheads and other acne blemishes, you’re not alone—about 50 million people in the United States struggle with this common skin condition. While we often think of acne as something that plagues hormonal teenagers, many people continue to develop breakouts throughout their adult years (Zaenglein, 2016).
Clear skin is possible, but it can be hard to know where to start when faced with the endless options at the drugstore. You don’t want to waste your time (or money) on products that don’t work. Here’s what dermatologists recommend to get whiteheads under control and prevent future breakouts.
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What are whiteheads?
Whiteheads (also called closed comedones) occur when oil and dead skin cells build up and clog your pores. The oil and dead cells become trapped under your skin and form small flesh-colored or white bumps (Masterson, 2018).
Similarly, blackheads (open comedones) are also clogged pores, but they remain open at the surface, unlike whiteheads. Because the pore is open, the oil reacts with oxygen in the air and gives blackheads their dark color (Masterson, 2018).
What causes whiteheads?
Several factors contribute to the development of whiteheads and other acne blemishes, including (Oge, 2019):
- A build-up of dead skin cells in the hair follicle
- Excess oil (sebum) production
- The presence of certain bacteria, including Cutibacterium acnes (C. acnes), within hair follicles
Hormones, genetics, stress, and smoking may all increase your risk of developing acne. Some studies have even shown that certain foods and drinks can make acne worse. You may find that sugary drinks, starchy foods, highly processed foods, or skim milk cause you to break out, so be mindful of your diet choices if these items affect you (Oge, 2019).
How to get rid of whiteheads
With so many anti-acne products to choose from, it’s hard to know where to start. There are prescription and non-prescription products available. Let’s first look at non-prescription options. Look for the two non-prescription ingredients dermatologists recommend the most: adapalene (a retinoid) and benzoyl peroxide. Various other products are available if you can’t tolerate these medications, but they may be less effective.
Topical retinoids are medications that come from vitamin A. Dermatologists recommend these products as a preferred treatment since they help get rid of existing whiteheads, prevent future breakouts, and have anti-inflammatory effects (Zaenglein, 2016). While most topical retinoids require a prescription, a lower-strength retinoid, adapalene 0.1% gel (brand name Differin), is now available over-the-counter.
Topical retinoids may cause dryness, peeling, redness, or irritation. You can limit these side effects by reducing how often you apply them. Avoid other topical acne treatments that contain sulfur, resorcinol, or salicylic acid while using retinoids. Watch out for harsh soaps, toners, or astringents (such as witch hazel), which can also worsen irritation. Retinoids can make your skin more sensitive to the sun, so be sure to wear sunscreen and protective clothing anytime you’re outside (Galderma Laboratories, L.P., 2007).
Many prescribers don’t recommend retinoids during pregnancy. If you’re pregnant or planning to become pregnant, discuss your acne treatment options with your healthcare provider before starting any regimen (Zaenglein, 2016).
How to get clear skin: 13 tips, products, and tools
Benzoyl peroxide works primarily by killing the bacteria that contribute to acne. It comes in many strengths and preparations, including washes, foams, gels, and creams, but leave-on products tend to work better than those that wash off. Some people may start to see improvements in their acne as early as five days after beginning treatment, but like most acne medications, the full effects may take months. You can use benzoyl peroxide alone, but dermatologists recommend using it with a retinoid product for the best results (Zaenglein, 2016).
Some people experience burning, dryness, stinging, redness, or peeling from benzoyl peroxide. If your skin is sensitive, try using a lower-strength wash-off product. Benzoyl peroxide can also bleach your hair or clothes. Avoid contact with your hair or eyebrows, and be sure to let the product dry completely before getting dressed (Oge, 2019; Zaenglein, 2016)
- Difficulty breathing
- Feeling faint
- Hives or itching
- Swelling of the eyes, face, lips, or tongue
- Throat tightness
While there is not as much evidence for using salicylic acid to treat whiteheads, it can be used as an alternative if you cannot tolerate a retinoid or benzoyl peroxide (Zaenglein, 2016). Salicylic acid comes in several strengths and formulations, including gels, lotions, solutions, cleansers, pads, and masks.
Like benzoyl peroxide, salicylic acid has also been rarely associated with severe allergic reactions and can cause (FDA, 2016):
- Difficulty breathing
- Feeling faint
- Hives or itching
- Swelling of the eyes, face, lips, or tongue
- Throat tightness
Seek medical care urgently if you think you are experiencing a severe reaction.
Tea tree oil
Tea tree oil is an essential oil extracted from the Australian Melaleuca alternifolia tree with antimicrobial and anti-inflammatory effects. It has been used as an alternative treatment for acne, though evidence from clinical trials is limited. One study comparing tea tree oil to benzoyl peroxide found similar improvements in acne symptoms. Participants tolerated the tea tree oil better with fewer side effects, but it took longer to work than benzoyl peroxide (Bassett, 1990).
You might consider tea tree oil if you’re interested in a natural remedy or haven’t tolerated other acne treatments. Tea tree oil is available as a pure oil or as an ingredient in other products. Tea tree oil should only be used topically (on the skin) and never swallowed. Swallowing tea tree oil can cause serious symptoms, including confusion, loss of muscle coordination, breathing problems, and coma (NCCIH, 2020).
How to build a skincare routine: basics, steps, products
Despite your best efforts, over-the-counter products may not work. In that case, several prescription-strength options are available to help clear your skin. Here are some of the most common ones dermatologists recommend (Zaenglein, 2016):
- Topical antibiotics: Topical antibiotics, such as clindamycin solution or gel, help kill acne-causing bacteria and reduce inflammation. Your dermatologist will likely also prescribe benzoyl peroxide since topical antibiotics can cause bacterial resistance (hard-to-treat bacteria) when used alone. Combination products containing an antibiotic and benzoyl peroxide are available for convenience.
- Topical retinoids: While you can purchase adapalene 0.1% over-the-counter, several other prescription-strength topical retinoids are available, including adapalene (brand name Differin) 0.3%, tretinoin (brand name Retin-A; see Important Safety Information), and tazarotene (brand name Tazorac). Some products also contain benzoyl peroxide or an antibiotic (ex. clindamycin) for added benefit.
- Oral antibiotics: Dermatologists sometimes prescribe oral antibiotics, such as doxycycline and minocycline, to help treat people with moderate to severe acne that involves inflammation. For most people, oral antibiotics should only be used for 3–4 months. They should always be prescribed with topical benzoyl peroxide or a topical retinoid to prevent antibiotic resistance.
- Hormonal agents: Oral birth control pills and spironolactone (brand name Aldactone) both treat acne by decreasing levels of androgens. Androgens are a group of hormones (including testosterone) that can worsen acne by increasing the amount of oil your skin produces. These medications are only used to treat acne in people with ovaries since people with testicles can experience unwanted side effects.
- Isotretinoin: Isotretinoin (brand name Accutane) is an oral retinoid used to treat severe, resistant acne. Because isotretinoin can cause serious birth defects, both men and women taking this medication must enroll in a program called iPLEDGE and adhere to the guidelines for preventing pregnancy. Two forms of contraception (e.g., condoms and birth control) are required every time you have sex, and women must have a monthly pregnancy test performed at a lab site.
Retinol: what is it, uses, benefits, results
How to prevent whiteheads
After you’ve found a skincare routine that works for you, you’ll want to develop good habits to help keep your skin clear. Follow these tips from the American Academy of Dermatology to keep your breakouts at bay (AAD, n.d.):
- Use a gentle skin cleanser to wash your face twice daily (in the morning and at night) and after sweating. Washing more often can irritate your skin and make acne worse.
- Avoid harsh scrubs or exfoliating products. Acne-prone skin is sensitive, so scrubbing with rough products can make symptoms worse.
- Choose skincare products, moisturizers, and make-up that are less likely to cause acne. Look for labels that say “oil-free,” “won’t clog pores,” or “non-comedogenic.”
- Keep your hands away from your face. Touching your face often can add unwanted oil and bacteria to your skin.
- Resist the urge to pop or pick at your zits—doing so can worsen acne and potentially lead to acne scars.
- Apply your acne medication on all your acne-prone skin, not just the areas where you have blemishes (spot treatment). This helps treat your current breakouts and prevent new ones from forming.
- Wash your pillowcases, hats, and other items that touch acne-prone skin often. Dead skin cells, oil, and bacteria can build up on these items and clog your pores.
When to see a dermatologist
Acne treatments take time to work, so try your best to be patient. Most people can achieve clearer skin once they find the right regimen. If you haven’t gotten the results you were hoping for after three months, a dermatologist will likely be able to help. Many prescription acne treatments are available that target hard-to-treat acne. Let your dermatologist know about all the previous treatments you’ve tried and any reactions you’ve experienced. Together, you will come up with a skincare plan that gets you looking and feeling your best.
- American Academy of Dermatology (AAD). (n.d.) 10 things to try when acne won’t clear. Retrieved on Sept. 21, 2021 from https://www.aad.org/public/diseases/acne/DIY/wont-clear
- Bassett, I. B., Pannowitz, D. L., & Barnetson, R. S. (1990). A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. The Medical journal of Australia, 153(8), 455–458. doi: 10.5694/j.1326-5377.1990.tb126150.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/2145499/
- Galderma Laboratories, L.P. (2007). Differin (adapalene gel) gel, 0.1%. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/020380s004lbl.pdf
- Masterson, K. N. (2018). Acne basics. Journal of the Dermatology Nurses’ Association, 10(1S), S2–S10. doi: 10.1097/JDN.0000000000000361. Retrieved from https://journals.lww.com/jdnaonline/fulltext/2018/01001/acne_basics__pathophysiology,_assessment,_and.2.aspx
- National Center for Complementary and Integrative Health (NCCIH). (2020). Tea tree oil. Retrieved on Sept. 21, 2021 from https://www.nccih.nih.gov/health/tea-tree-oil
- Oge, L. K., Broussard, A., & Marshall, M. D. (2019). Acne vulgaris: diagnosis and treatment. American Family Physician, 100(8), 475–484. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31613567/
- U.S. Food & Drug Administration (FDA). (2016). FDA drug safety communication: FDA warns or rare but serious hypersensitivity reactions with certain over-the-counter topical acne products. Retrieved on Sept. 21, 2021 from https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-rare-serious-hypersensitivity-reactions-certain-over-counter
- Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., et al. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945–73.e33. doi: 10.1016/j.jaad.2015.12.037. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26897386/