Whitehead Causes And Treatment

  • Ellie kerrod BSc Neuroscience - The University of Manchester, England

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Overview

Whiteheads are a type of acne that appears on different areas of skin. Acne occurs when the pores become blocked by sebum oil and dead skin cells.1 Acne is most commonly noticed on the face, especially the T zone. However, acne can also appear on your back, shoulders, and chest.1  t There are many different types of acne, including:

  • Whiteheads 
  • Blackheads 
  • Papules 
  • Pustules
  • Nodules
  • Severe nodular acne1 

These types of acne can have a variety of causes. Usually, anything that causes a buildup of excess oil, and dead skin cells can result in acne breakouts.1 Whiteheads can affect anyone; however, some people are more at risk. Teenagers, those who take hormonal medication and those who have a family history of skin conditions are more prone to breakouts.3 There are also other triggers that may result in a breakout. These include: 

  • Stress
  • Diet
  • Clothing items
  • Smoking 
  • Picking at the breakouts.1

Furthermore, using the wrong skin care products or products with irritating ingredients may also contribute to causing a breakout.3

Whiteheads are a mild type of acne that look like small yellow or white spots,1 usually found on the face, back, shoulders, and chest.3 They are easily identified as they have a white or yellowish head on top of a closed pore.3 This is notably different from blackheads in that the pore is open and appears dark.3 Mild acne-like whiteheads can usually be treated using retinol and antimicrobial skincare products.7 More severe cases of acne can be treated with stronger treatment options as well as oral medications. However, these need to be prescribed by a professional doctor or dermatologist.7 Reducing stress and changing your diet may also help improve your acne.9 If you are concerned you have more than mild acne, you can consult with a doctor or dermatologist who will be able to advise you further.2

Prevalence?

Whiteheads are very common. Research shows that 85% of people aged 12-24 years old have acne.5 This percentage decreases with age. Between the ages 25 to 34 years, 8% are affected, and between 35 to 44 years, 3% are affected.5 Further research suggests that the number of people with acne peaks in girls aged 14-17 years and 16-19 years in boys.6

Causes and risk factors

Acne is an inflammatory disorder affecting the skin, in which excess sebum oil and dead skin cells accumulate in your pores, resulting in bacteria growth, which ultimately causes a breakout.1

Although anyone can get whiteheads, some people are more prone to them, and there are also other risk factors that increase the likelihood of you having a breakout.1

Who is more at risk of having acne?

  • Teenagers going through puberty1
  • People who take hormonal medications1
  • Those with a family history of skin conditions.4
  • Genetics2

The underlying reason as to why these groups are more at risk comes down to hormones. The main hormone involved is androgen. Androgen is responsible for causing oil production in your skin.3 Androgen is a male sex hormone. However, it is still present in girls and women in a lower amount.3 So, let's look at how this all links together.

  • Teenagers are more likely to have whiteheads because during puberty, more androgen is producing more oil production and build up, causing bacteria growth and resulting in ance3 
  • Hormonal medication 
  • Genetics and family medical history

What might trigger a breakout?

Although these factors don’t necessarily cause a breakout, they may contribute to the mechanism that does. Some of these factors are:1

  • Stress
  • Food choices and diet
  • Tight or irritating clothing or equipment
  • Picking breakouts
  • Over-exfoliating the skin
  • Certain skin care products3  
  • Smoking3

Identifying whiteheads

Whiteheads are a form of mild acne. Mild acne, more commonly known as pimples or breakouts, is different from severe acne. Mild acne usually disappears quickly in comparison to acne. It is also less likely to leave scarring than severe acne.3 Moderate to severe acne presents differently on the skin compared to pimples. Moderate acne is characterised by small bumps (papules) filled with yellow pus (pustules).3 Severe acne has these and nodules.3

Mild acne starts to occur during puberty and can continue into adulthood. It can affect assigned females at birth (AFAB) and assigned males at birth (AMAB). Acne is more present during puberty due to the excess oil due to the changes in your hormones.3

Where can acne appear?

Acne appears on areas of skin that have a lot of oil, so areas near oil glands are very common. These include:3

  • Face 
  • Chest
  • Back
  • Shoulders

However, this does not mean acne won't appear on other areas of skin; it is just less common.3

Treatment options

There are lots of treatment options available for mild acne; usually, skincare products are recommended. Below is a list of first and second-line treatments for whiteheads.7

These ingredients and products, in different combinations, can help smooth out the skin and get rid of breakouts.7 Furthermore, intense treatments are also available for moderate-to-severe acne; however, these often require a prescription.7

Treatments like retinoids and antimicrobials are available as creams, lotions, washes, solutions, and gels.7 The effectiveness of these treatments can be seen over time rather than working instantly. Normally, it can take anywhere from six to eight weeks for significant results to be noticed.7 Following this, the treatment may need to be maintained for years after the initial results.7

Retinoids

Retinoids are a great treatment when looking to get rid of whiteheads. Research suggests that you should start with small amounts, as retinol can cause skin irritation and scaling initially. This is sometimes referred to as skin purging.7 Although you may notice results after six weeks, it is often suggested that the best results will be seen after 12 weeks of consistent use.7

Retinoids are available in different concentrations. Some higher concentrations are only available from a doctor for more severe acne; however, over-the-counter retinoids can help treat mild acne.8 It is important to follow the guidelines for each product.

Antimicrobials

Antimicrobials can be used topically or orally (in severe cases). For example, benzoyl peroxide is used. Like retinoids, the concentration varies, and in this case, they can range from 2.5%-10%.7 It is best to start with a lower concentration and build up to a higher one.7

In some cases, a combination of these therapies can be used and may even be more effective.7 

Prevention

The best way to try and prevent whiteheads is to reduce or eliminate some of the factors that may cause the breakouts. These include: 

  • Stop picking at any spots or blemishes
  • Avoid heavy exfoliating products
  • Reduce stress through relaxation techniques and meditation
  • Change your diet3

Your diet

  • Low-glycemic diet - High-glycemic foods are associated with promoting insulin resistance. This resistance leads to increased sebum oil production, which clogs up your pores, resulting in breakouts.9 Therefore, adopting a diet of low-glycemic foods has been suggested to improve acne.9
    • Foods to incorporate include lots of fruits and vegetables, lean proteins, and healthy fats.9
  • Obesity - If your diet has led to obesity, this may be contributing to your acne. Adapting healthier diet habits and exercising can help reduce the negative effects.9
  • Omega-3 fatty acids - Incorporating omega-3 fatty acids into your diet may be beneficial as they are associated with sebaceous cells and, therefore, may impact your acne.9
    • Some omega-3-rich foods include fish, nuts, seeds, and plant oils.10

When to see a professional

Whitehead breakouts aren’t typically considered a medical condition as they are not harmful. However, there are a few instances when it may be best to seek professional help from a doctor or dermatologist.2 

  1. Scarring - If you notice any scarring after your breakouts, you may want to consider speaking to a professional. Scarring is normally a result of a more severe type of acne. More severe acne is often treated with stronger treatments that need to be prescribed by a specialist.2
  2. Low confidence - Although acne is not a medical emergency, it can be damaging to your self-esteem and lower your confidence. If you are struggling with the emotional effects of acne, it may be worth seeking further advice.2 Studies report that people often experience anxiety, depression, low confidence, and insecurity as well. This has the risk of worsening into feelings of suicide and severe mental health issues. If this sounds like something you are struggling with, it is best to speak to a professional as soon as possible.2

Summary

Whiteheads are a mild form of acne that appears on the face, back, shoulders, and chest. They are caused by an excess of sebum oil that clogs the pores, resulting in a breakout. Whiteheads can be caused by a genetic predisposition, taking hormonal medication, and hormones associated with age. However, other factors, such as your diet and stress, may contribute to the development of acne as well. Some treatments for whiteheads are retinoids and antimicrobials. These are available in a topical formula for mild acne but can be taken orally for severe acne. Alternatively, finding methods to reduce your stress may help, as well as making changes to your diet. To adapt your diet, try eating low-glycemic foods and omega-3-rich foods and developing a more balanced and healthy diet overall. This means eating lots of fruit and vegetables, protein and healthy fats. Although whiteheads are not a medical emergency, they may affect your confidence and cause scarring if your condition is severe. If this is the case, you can consult with a doctor or dermatologist who will be able to recommend more intense treatment options and offer some counselling. 

References

  1. Branch NSC and O. National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2016 [cited 2023 Sep 21]. Acne. Available from: https://www.niams.nih.gov/health-topics/acne
  2. Ayer J, Burrows N. Acne: more than skin deep. Postgrad Med J [Internet]. 2006 Aug [cited 2023 Sep 21];82(970):500–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585707/
  3. Acne: overview. In: InformedHealth.org [Internet] [Internet]. Institute for Quality and Efficiency in Health Care (IQWiG); 2019 [cited 2023 Sep 21]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279211
  4. Zahra Ghodsi S, Orawa H, Zouboulis CC. Prevalence, severity, and severity risk factors of acne in high school pupils: a community-based study. Journal of Investigative Dermatology [Internet]. 2009 Sep 1 [cited 2023 Sep 22];129(9):2136–41. Available from: https://www.sciencedirect.com/science/article/pii/S0022202X15344808
  5. NICE [Internet]. [cited 2023 Sep 22]. CKS is only available in the UK. Available from: https://www.nice.org.uk/cks-uk-only
  6. Rocha MA, Bagatin E. Adult-onset acne: prevalence, impact, and management challenges. Clin Cosmet Investig Dermatol [Internet]. 2018 Feb 1 [cited 2023 Sep 22];11:59–69. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798558/
  7. Kraft J, Freiman A. Management of acne. CMAJ [Internet]. 2011 Apr 19 [cited 2023 Sep 22];183(7):E430–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080563/
  8. Leyden J, Stein-Gold L, Weiss J. Why topical retinoids are mainstay of therapy for acne. Dermatol Ther (Heidelb) [Internet]. 2017 Jun 5 [cited 2023 Sep 22];7(3):293–304. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574737/
  9. Pappas A. The relationship of diet and acne. Dermatoendocrinol [Internet]. 2009 [cited 2023 Sep 22];1(5):262–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836431/
  10. Office of dietary supplements - omega-3 fatty acids [Internet]. [cited 2023 Sep 22]. Available from: https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Ellie Kerrod

BSc Neuroscience - The University of Manchester, England

I’m a Neuroscience BSc student studying at The University of Manchester, UK and have experience in medical writing. I am passionate about ensuing that everyone can assess accurate medical information and I am committed to bridging the gap between complex medical concepts and the public.

my.klarity.health presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
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