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Acne is a frequent skin problem prevalent in up to 85% of teenagers at least once during adolescence. (1)
Of the different types of acne, whiteheads are among the most common and are characterized by the appearance of tiny white bumps on the skin. These are typically seen on the face, shoulders, back, and upper arms, especially in teenagers.
Whiteheads, similar to other forms of acne, develop due to clogging of skin pores with dead skin cells, oil, and debris. They have a characteristic white appearance because they are closed comedones, that is, the clogged pore is covered with a thin skin layer.
Causes of Whiteheads
Whiteheads are generally a result of increased sebum or oil production, which in turn leads to a higher risk of clogging of pores. A number of factors can increase oil production or contribute to debris entrapment in the skin pores, including:
- Hormonal changes, especially during puberty, pregnancy, menstruation, and menopause
- Genetics
- Use of oil-based cosmetics, skin care products, and hair products
- Excessive stress
- Anxiety
- Exposure to air pollution
- Extreme weather conditions such as high humidity
Symptoms of Whiteheads
Whiteheads appear as small bumps on the skin with a white tip. These may be seen on the face, chest, shoulders, back, neck, or arms.
Treatment for Whiteheads
Several treatment modalities are available for whitehead management. You can consult your doctor or dermatologist on the following treatments to determine which is best suited for your skin:
1. Benzoyl peroxide
Benzoyl peroxide kills acne-causing bacteria and also aids in the removal of dead skin cells. It is one of the most common treatments for inflammatory acne, as it can be used for longer periods than antibiotics. (2)
There are a variety of prescription and over-the-counter products containing benzoyl peroxide that you can try to treat whiteheads.
2. Retinoid creams
Retinoids are keratolytic, which means they help dissolve dead skin cells, therefore aiding in unclogging skin pores. You may be prescribed gels, creams, or lotions containing retinoic acids or tretinoin. (3)
3. Topical products containing alpha and beta hydroxy acids (AHAs and BHAs)
Alpha and beta hydroxy acids are generally used as mild chemical exfoliants. They help remove the dead skin cell layer to reveal new, rejuvenated skin. Moreover, they are antibacterial agents that help control acne formation.
The AHAs and BHAs commonly used for whitehead treatment are glycolic acid, lactic acid, salicylic acid, and their derivatives. Salicylic acid is the most commonly used hydroxy acid as it is highly efficient in exfoliating the skin and preventing clogging of pores.
Salicylic acid can be found at 0.5%–2% (4) strength in topical over-the-counter products such as creams, gels, toners, and moisturizers. It is suggested to use these products 2–3 times daily.
Lactic acid is another commonly used hydroxy acid. Depending on its pH, concentration, and bioavailability, it may be used at home as a mild exfoliant, moisturizer, or chemical peel agent. (5)
4. Niacinamide creams
Niacinamide is commonly used for symptomatic treatment of acne since it helps reduce the redness and swelling. This anti-inflammatory medication can be procured as a topical cream. For severe acne, your doctor may prescribe oral niacinamide supplements.
5. Comedone extraction
Performed by an expert, comedone extraction involves the removal of the contents of acne using specialized, sterilized tools. (4)
Avoid performing extraction at home since you may push the contents of the acne deeper into the skin and increase the risk of infection. (6)
6. Microdermabrasion
Microdermabrasion refers to a clinical skin exfoliation procedure that uses a specialized tool. When performed correctly by an expert, microdermabrasion can unclog the pores effectively and therefore aid in the treatment of whiteheads and other forms of acne.
7. Chemical peels
Chemical peels are skin exfoliation treatments that use high-strength alpha or beta hydroxy acids and therefore should be performed by an expert in a clinical setting.
This treatment helps remove the outer skin layer that contains dead skin cells and dirt, revealing a new, fresher, smoother skin layer. Moreover, chemical peels can help control oil production and therefore prevent the formation of whiteheads and other forms of acne.
8. Yellow peels
Yellow peel is a retinol-based treatment that is applied to the skin and left for a few hours before rinsing it off.
The peel helps remove the superficial layers of the skin, allowing fresh new rejuvenated skin to grow underneath. This treatment also stimulates new collagen formation and thus tightens the skin to remove fine lines and wrinkles.
9. Hydra facial
Hydra facial is a special skin care treatment to unclog pores and remove acne-causing agents from the skin. Additionally, this noninvasive procedure can improve acne scars and hyperpigmentation.
10. CO2 laser
A CO2 laser treatment is generally used to treat acne scars, but it is also recommended to exfoliate the skin surface to reveal rejuvenated skin. In addition, the use of ablative lasers, such as in CO2 laser, stimulates collagen synthesis, aiding in smooth skin development.
CO2 lasers can be used all over the skin surface. Areas with acne scars may be targeted to fade the scars and blend them with the surrounding skin.
11. Erbium:YAG laser
As opposed to the CO2 laser treatment, erbium:YAG laser employs a nonablative laser to treat acne scars, wrinkles, and open pores. It helps get rid of whiteheads and gives the skin a smoother appearance by stimulating collagen synthesis without damaging the skin.
This treatment delivers laser energy to the skin in tiny dots over the targeted area and requires a very short recovery time.
Diagnosing Whiteheads
Whiteheads can be easily diagnosed with a physical examination of the face, chest, neck, upper arms, and back, in general the areas with the highest number of sebaceous glands.
To determine the cause of the lesions, your doctor may ask about your medical history, skin type, and skin care routine.
Risk Factors
Here are a few things that can increase your likelihood of developing whiteheads:
- Teenagers undergo puberty-related hormonal changes, making them more prone to acne. Among this high-risk group, boys are more commonly affected than girls.
- Adult acne is more prevalent among females than males.
- Excessive intake of sugar and junk food on a regular basis is linked to a higher incidence of acne.
- Using skin products that contain harsh chemicals can strip the natural moisture from your skin and thereby trigger sebum overproduction, paving the way for acne.
- Scrubbing your skin too much or too vigorously can trigger or worsen acne. (7)
When to See a Doctor
Whiteheads are a common cosmetic problem that generally does not require any medical attention. However, you must consult your doctor if the whiteheads are frequently recurring or are associated with the development of cysts or nodules.
In addition, make sure to pay an emergency visit to the doctor if the medication you are using for whiteheads or acne causes faintness or inflammation in the face, eyes, tongue, or lips.
Final Word
Whiteheads are a common form of acne and appear as small, closed lesions on the skin surface. While they are rarely a serious medical problem, people often seek treatment for whiteheads due to cosmetic reasons.
There are a number of treatments that you can try to improve your whiteheads. These include over-the-counter, prescription, and in-office treatments. Consult your dermatologist to identify the reason behind your whiteheads so you can prevent their recurrence.
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