Whiteheads: Causes, Treatment, and Prevent

by | Aug 20, 2020

Open comedones (blackheads) and closed comedones (whiteheads) are the two most common types of comedones. Comedone is non-inflammatory acne.

Whitehead looks like it has a white head. It can feel bumpy to the touch and is not easy to notice without looking closely. The appearance of the blackhead is black, and others can see it at a glance.

The appearance of the blackheads is a black spot exposed outside the large pores. The dirt in the pores is squeezed out and appears black at the top.

Whiteheads hidden under the skin, the skin has a small white particle, and the facial skin is bumpy. Whiteheads are not red, swollen, painful, or itchy. If you don’t look carefully, you may not even notice it. You will find that there are many small white particles on the skin. When you touch your face, you will find that your face is uneven. Whiteheads often appear in the forehead and chin area.

Whitehead usually has two endings:

  1. One is rupture, it actually grows bigger, reddish, hardened, a little pain when pressed, and eventually, it becomes inflammatory acne.
  2. The second is to stay there for as long as it stays the same.

The difference between blackheads and whiteheads

The pores of the blackhead are not covered by the epidermis. The sebum plug composed of sebum and dead cells blocks the pores. The sebum plug cannot be discharged naturally, and the sebum plug can be exposed to the air.

The blackhead’s sebum plug can contact the external oxygen (Meaning that it can also contact the external dust), and it will be oxidized by the oxygen to black oxide. You can find that only the head of the extruded blackhead is black, and the other parts are still white because only the head of the blackhead is oxidized.

Whitehead is a condition in which cutin cannot fall off normally and the pores are covered by the epidermis. The mixture of sebum and dead cells is blocked up in the pores and the mixture cannot contact the external oxygen, and the inside of the hair follicle is in an anaerobic environment. Inflammatory acne may break out at any time.

Smaller whiteheads on the surface of the skin
Large whiteheads on the surface of the skin


What causes whiteheads?

1. The sebaceous glands in the hair follicle secrete too much oil

Why do sebaceous glands secrete too much oil?

  • The eldership in the family have oily skin, and you are more likely to have oily skin.
  • High temperature. The oil output in summer is always less than that in winter
  • High pressure
  • Hormonal changes. Especially the excessive secretion of male hormones can cause sebaceous glands to secrete oil. These groups are prone to hormonal changes:


Menstrual women.

Pregnant women.

People after fitness (especially after squats).

The crowd after staying up late.

People who love sweets.

2. Abnormal keratin shedding and clogged pores.

The outermost layer of the skin structure is the epidermal layer, which is composed of four layers of skin cells, the basal layer, the spinous layer, the granular layer, and the stratum corneum.

The stratum corneum is located in the outermost layer of the skin, and the stratum corneum and the sebum film (a liquid protective layer formed by the oil secreted by the sebaceous glands spread evenly on the skin) protect the skin.

The differentiation process of cells. Newborn cells are produced from the stratum basale and gradually migrate upward to the stratum corneum. The migration process takes about 14 days. Keratinocytes and intercellular lipids form the stratum corneum, which is finally shed from the skin. This process takes about 14 days.
  • The epidermal cells gradually move outward from the basal layer, and the period of reaching the stratum corneum in about 14 days;
  • Keratinocytes that have aged and died accumulate in the stratum corneum until shedding for about 14 days.
  • The cells are pushed up from the basal layer to the stratum corneum and then shed from the stratum corneum, generally 28 days.
The structure of the sebaceous glands. The sebaceous glands connect the hair follicle channels, and the sebum secreted by the sebaceous glands and the dead cells shed from the stratum corneum are excreted through the channels. However, if the cells at the funnel of the hair follicle cannot fall off normally, the pores are covered, and sebum and dead cells are blocked inside the hair follicle.

The area from the sebaceous glands to the pores is called the hair follicle funnel. The skin at the hair follicle funnel also undergoes a process of transforming from basal cells to keratinocytes and then gradually shed. However, due to some reasons, this part of the cells stick together and cannot fall off normally. The more keratinocytes accumulate in the mouth of the hair follicle, the more they will eventually clog the pores. This phenomenon is called hyperkeratosis.

The reasons that make keratinocytes unable to fall off normally include:

  • Heredity
  • Androgen
  • Changes in sebum composition
  • Propionibacterium acnes
  • Inflammatory factor

Too much oil on the skin will also stick to the cells that should have fallen off, making it impossible to leave the skin surface smoothly, further clogging the pores.

Whiteheads are the mildest grade of acne. Papules, pustules, nodules, and cysts all develop from whiteheads.

Propionibacterium acnes is one of the bacteria residents on the skin. Once the pores on the skin surface are covered, the oil produced by the sebaceous glands cannot be drained out and is blocked in the hair follicles. P.acne, which belongs to anaerobic bacteria, is not only in an anaerobic environment, but also has a lot of oil as food. P.acne can reproduce in large quantities. The human immune system detects a large amount of P.acne and sends soldiers to eliminate P.acne. From this, non-inflammatory whiteheads develop into inflammatory red bumps.

Where do whiteheads usually appear?

Whitehead is the most initial symptom of acne. It has the widest distribution and the largest number of appearances. It usually develops in the following places:

  • All facial areas (Including forehead, nose, cheeks, chin)
  • Near ear
  • Neck
  • Shoulder
  • Back

Whiteheads usually appear in teenagers. At this stage, the hormonal changes are dramatic, the skin is prone to oil, and the epidermal hyperkeratosis.

However, many people do not have whiteheads when they are young. The older they are, the more likely they are. Because with the increase of age, the metabolism of the skin gradually decreases, and the exfoliation of keratin slows down, which blocks the pores.

How to get rid of whiteheads?

The most effective treatment for removing whiteheads is retinoid and alpha hydroxy acid.

Both the International Acne Treatment Guidelines and the American Acne Treatment Guidelines use topical retinoid as a single first-line treatment for closed comedones.


Retinoids can effectively reverse the photoaging of the skin. Retinoids can promote the differentiation of basal cells, promote the metabolism of the stratum corneum, prevent the sticky cells of the stratum corneum, and dissolve the stratum corneum. The effect of Retinoid is not to unclog when pores are clogged, but to treat from the source to prevent clogging of pores and the formation of whiteheads. Retinoids can also prevent the formation of micro-comedones, thereby preventing whiteheads and inflammatory lesions. At present, there are no known drugs that are superior to topical retinoids in maintaining the efficacy and safety of acne treatment.

It is recommended to use adapalene (Differin) because adapalene is the least irritating. Although it takes a long time to produce an effect, it has a better effect on the treatment of mild to moderate acne. If you have oily skin, try to avoid cream-like retinoid ointments (Tretinoin, tazarotene), because their blocking agents (Such as petrolatum) are easy to clog your pores, and these two drugs are prescription drugs, and Differin is over the counter. But if you are a very serious whitehead, then it is recommended that you seek a doctor to prescribe tretinoin or tazarotene.

Topical retinoid should use a moisturizing cream, and there must be the irritant reaction, your skin will appear dry, peeling, tingling, itching, and so on. If the stimulus-response is strong, please reduce the dose and frequency of use.

How to use retinoid?

If you have only a few whiteheads on your face, apply a small amount of retinoid to the whitehead area.

If you have whiteheads everywhere on your face, you can take retinoid of the size of mung beans every night and mix them with your cream or lotion, once every 3 days. Retinoid has strong photosensitivity and can only be used at night. When your skin adapts to retinoid, gradually increase the amount and frequency of use until you find the amount that suits you.

Green beans

Alpha hydroxy acid

Alpha hydroxy acid (AHA) is a general term for organic acids extracted from various fruits. So alpha hydrochloric acids are also called alpha hydroxy acid.

AHA is water-soluble acid.

AHA can dissociate cell connections and accelerate cell shedding

1. Dissociate cell connections

Alpha hydroxy acid can destroy the desmosomes linking the keratinocytes, and the keratinocytes that have lost the desmosomes become loose and easily fall off.

Keratinocytes are connected to each other through desmosomes to form a compact structure. If desmosomes are destroyed, keratinocytes become loose.

 2. Accelerate cell shedding

Alpha hydroxy acid can also accelerate the natural metabolic rate of dermal and epidermal cells and promote the rapid shedding of cells in the stratum corneum.

The desmosomes connecting the keratinocytes are broken and the keratinocytes become loose, making the keratinocytes easy to fall off.

In summary, the effect of alpha hydroxy acid is to unclog blocked pores.

Oilyskinbeauty Comparison of the skin surface before and after

If your closed comedones are very serious, the doctor will generally prescribe a medical cosmetic for chemical peeling.

If it is not serious, you can apply skin care products containing alpha hydroxy acid. However, when using acid products such as alpha hydroxy acid and salicylic acid at first, there may be symptoms of acne outbreaks, because the dissolved keratinocytes will fall into the pores, temporarily exacerbate clogging of pores, until the dead cells of the skin all disappear will ease the outbreak of acne.

How to prevent whiteheads?

The following suggestions can effectively reduce acne outbreaks:

  • Don’t stay up late, reduce stress
  • Eat less food with high GI, eat fewer sweets, drink less milk, eat less chocolate
  • Eat more fruits and vegetables
  • Do a good job of removing makeup and cleansing, try to use a mild amino acid facial cleanser to avoid excessive cleaning
  • Use moisturizing, repairing, and anti-inflammatory skin care products
  • Using non-comedogenic cosmetics
  • Don’t rub your face
  • Don’t squeeze whiteheads
  • Use skin care products containing retinol at night, retinol will be converted into a low concentration of retinoic acid in the skin to exert its effect.

You should consult your doctor

Whiteheads and acne can irritate you.

If the acne on your face is mostly whiteheads or papules, you can use retinoid or alpha hydroxy acid products.

If there is too much inflammation on the face, try to avoid using exfoliating products

But if the whiteheads develop into pustules, nodules, and cysts, please see a doctor. Do not use retinoids or alpha hydroxy acids for red, swollen acne, as they may increase the severity of acne. The doctor may prescribe benzoyl peroxide. Or prescribe local and oral antibiotic drugs, anti-androgen drugs (Not for men), or even isotretinoin.