Blackheads and Whiteheads in Acne

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Acne, commonly referred to as pimples, is the most common skin disease treated by physicians. It is a chronic condition that affects about 85 percent of adolescents and young adults. What is the difference between whiteheads and blackheads, why is this distinction important, and what treatments are available?

Treatment Options for Blackheads and Whiteheads
Verywell / Brianna Gilmartin

Types of Acne

Not all acne is the same. Simplistically, acne can be divided into red bumps and blackheads or whiteheads. This division is important because each type is treated differently. Blackheads and whiteheads, known medically as comedones, can be more numerous on the face and shoulders than red bumps filled with pus.

Good, consistent skin hygiene can help improve this condition. Therefore, knowing more about what causes comedones and how to treat them is a step towards clearer skin.

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Blackheads, also known as open comedones, are follicles that have a wider than normal opening. They are filled with plugs of sebum, keratin, and sloughed-off cells and have undergone a chemical reaction resulting in melanin oxidation. This gives the material in the follicle the typical black color. Blackheads are often found on the nose, but can also be found on other areas of the face and body.


Whiteheads, also known as closed comedones, are follicles that are filled with the same material as blackheads but have only a microscopic opening to the skin surface. Since the air cannot reach the follicle, the material is not oxidized and remains white.


Click Play to Learn More About Closed Comedones

Skin Care

The key to skincare for acne is consistency; an overnight cure has not been found. But using good skincare methods aids in the daily, steady improvement of follicle health. Since acne is not caused by eating certain foods, restricting the diet is not helpful. Since it is also not caused by "dirty" skin, excessively scrubbing does not help and can even make the skin more irritated and actually worsen acne.

Oil-based makeup should not be used since it can contribute to the buildup of oil in the follicles. Water-based makeup labeled as non-comedogenic can be used safely.


Treatment of whiteheads and blackheads takes time. Most treatments take several weeks to months before a noticeable change is seen.

  • Benzoyl Peroxide: Benzoyl peroxide has an antibacterial effect and may also decrease the chemical reaction that changes the lining of the hair follicle. This may help reduce the plugging that causes comedones. Benzoyl peroxide may be used for a mild case of comedones or to help prevent the formation of others.
  • Retinoids: Topical retinoids are commonly prescribed medications for blackheads and whiteheads. Types of retinoids include tretinoin (Retin-A, Avita, Renova), adapalene (Differin), or tazarotene (Tazorac). Retinoids are derivatives of vitamin A and work by increasing cell turnover and reducing the "stickiness" of the sloughed cells. They help expel the plugged material returning the pore to normal. Retinoids can be irritating, so specific instructions need to be followed.
  • Antibiotics: Prescription topical antibiotics or oral antibiotics might be used if some of the blackheads and whiteheads are infected, but antibiotics do not help with comedones that are not infected.
  • Isotretinoin (Accutane): Isotretinoin (Accutane) is used for severe cystic acne and has many side effects. It is very effective for comedones when used properly, but is not usually prescribed for mild acne of either type. For those who have been coping with cystic acne, however, Accutane can make a great difference, and improvement usually persists for a long time after treatment is finished. Accutane can cause severe birth defects as well as other side effects, and monthly blood tests are required while using this medication.
  • Extraction: Extraction may be used by a healthcare provider, aesthetician or facialist on open comedones. Some people are interested in extracting their blackheads and whiteheads to release the contents within these growths. Many stores sell comedone-extractors for this purpose. Comedone extractors are most often metal, and one end has a small loop. For blackheads, the opening of the extractor is placed around the blackhead, and pressure is then applied downwards and laterally. Whiteheads often need to be nicked beforehand. If you decide to extract your blackheads and whiteheads yourself, make sure to do so properly. Instruments should be sanitized, and extraction should be done gently and carefully. If you have any doubts about performing the extraction, find an experienced facialist or aesthetician to do so for you. Extraction should not be done on an inflamed pimple as it can lead to scarring.

A Word From Verywell

Whiteheads and blackheads are types of acne that affect many people. There are good treatment options available, so there is no need to suffer from this condition in silence. A primary care provider can initiate treatment for acne and follow mild to moderate cases. If your acne is severe or is not responding to treatment you should see a dermatologist for further options.

Frequently Asked Questions

  • What causes whiteheads and blackheads?

    Whiteheads and blackheads are caused by a buildup of sebum and dead skin cells getting stuck in skin pores. The best way to prevent this from occurring is by gently washing your face every day using warm water and a mild soap. This helps remove any excess oil and skin cells that have accumulated.

  • Is blackhead and whitehead treatment the same?

    In many cases, blackhead and whitehead treatment is generally the same. Topical antibiotics like benzoyl peroxide have long been used to help treat and prevent new comedones from forming. Other medications like retinoids and corticosteroids are used by dermatologists to help with blackhead and whitehead treatment, but there are many available options. If you're not sure which acne treatment is best, a dermatologist can help you figure out which one is right for you.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Dermatology Association (AAD). Skin Conditions By The Numbers.

  2. Stanford Children’s Health. Treating Teen Acne.

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  5. Fox L, Csongradi C, Aucamp M, Du plessis J, Gerber M. Treatment Modalities for Acne. Molecules. 2016;21(8). doi:10.3390/molecules21081063

  6. US Food & Drug Administration. Accutane.

  7. American Academy of Dermatology Association. Pimple Popping: Why Only A Dermatologist Should Do It.

  8. Nemours TeensHealth. Acne.

  9. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Acne: Diagnosis, Treatment, and Steps to Take.

Additional Reading
  • Hauk, L. Acne Vulgaris: Treatment Guidelines from the ADD. American Family Physician. 2017;95(11):740-741. PMID:28671431

  • Weller, Richard P. J. B., Hamish J.A. Hunter, and Margaret W. Mann. Clinical Dermatology. Chichester (West Sussex): John Wiley & Sons Inc., 2015. Print.

By Heather L. Brannon, MD
Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years.