How to treat whiteheads (acne)?

In a Nutshell

• Whiteheads are clogged skin pores/ follicles that contain dead cells, debris, and bacteria.
• Whiteheads are closed and are hence non-extractable
• Management involves self-care, use of topical retinoids, and antibiotics. In severe cases, oral antibiotics or hormonal treatment may be needed

What are Whiteheads?

When a skin pore is clogged up with dead cells, bacteria, debris, and oil secretions and becomes closed it is referred to as a whitehead. Visually whiteheads resemble tiny, fresh-colored bumps.

Whiteheads are a type of acne lesion that mostly occur on the face, neck, chin, back, shoulders, chest, or other parts of the body. Whiteheads or acne are extremely common, and it is estimated that 80% population between 12 to 30 years of age report some form of whiteheads or acne related lesions.

The exact cause of acne is not known, it is believed that acne is a result of several factors, such as:

- Hormonal changes

- Pattern of perspiration

- History of allergy to certain foods, fabrics, or skin care products

Most cases of whiteheads respond very well to periodic face washing with a mild soap/ facewash and basic skin care regimen.

Simple Treatment Regimen

Treatment regimen revolves around the age of person and severity of condition.

1. Mild cases of whiteheads respond very well to over the counter topical medications like benzoyl peroxide that can be applied once or twice a day (or as suggested by your doctor).
2. You can also use medicated soaps, gels, ointments, creams, or face pads that contain antiseptics like salicylic acid, resorcinol, or sulfur as an ingredient. The only side effect with some of these agents is, dryness or irritation of skin and sensitivity to sunlight.
3. More severe cases that are refractory to over the counter treatment options include prescription antibiotics or hormonal treatments (if cause is hormonal imbalance).
4. If acne is severe, your dermatologist may advise even stronger treatment options like Accutane (or isotretinoin) that is effective against all forms of acne including whiteheads.

Self-Help Tips to manage Whiteheads

Following self-help tips can improve the cosmetic appearance of your skin and reduce the severity of whiteheads:

- Avoid touching your face unnecessarily

- Wash your face at least twice with a gentle soap and water

- Do not pick on your acne, whiteheads, or blackheads as it may cause infection/ inflammation of pores resulting in scarring and worsening of acne

- Avoid unnecessary cosmetics on your face. Cleanse/ wash your face thoroughly to remove all the traces of cosmetics

- If you have sensitive skin, use only water-based, non-comedogenic cosmetics and skin care products

- Limit your exposure to sun

Nuances/ Safety

Dermatologists can perform whitehead extraction by specialized equipment. If you are concerned about your whiteheads or other cosmetic issues of skin, speak to a dermatologist for proper remedy.

If you are pregnant or are looking to get pregnant, Accutane may not be a great choice due to its adverse effects and potential complications (such as congenital anomalies in the newborn).

Strength of Evidence: B
The recommendations made in this article are based on best practices as suggested by the National Health Services and American Dermatology Association.

Our Ruling:

Whiteheads are very common and may lead to acne, scarring and other cosmetic issues in poorly managed cases. For mild cases, self-help alone is sufficient but if you are experiencing whiteheads with acne and scarring, speak to a dermatologist to explore pharmacological / cosmetic options.

Our Sources:

1. https://www.medicalnewstoday.com/articles/315104
2. https://www.nhs.uk/conditions/acne/treatment/
3. https://www.aad.org/public/diseases/acne/diy/types-breakouts