Whiteheads Vs Blackheads: What’s The Difference?

Introduction

In the pursuit of healthy, radiant skin, an understanding of common skin issues is important. Acne is a common skin condition affecting approximately 9.4% of the global population.¹ This stands to be one of the most common concerns that people will experience at some point in their lifetime. Not all acne is the same; it can manifest in various forms and types. Blackheads and whiteheads, medically known as comedones, are common forms of acne. Though they are strikingly similar, they are distinct skin conditions in their own right. Consistent, good skin hygiene practices can help improve these conditions. Therefore, unravelling their unique characteristics, causes, and treatments can equip you with a clear, comprehensive understanding of them. Whether you're seeking to treat existing blemishes or prevent future outbreaks, this exploration will serve as a valuable guide on whiteheads and blackheads for your skincare knowledge. 

What are whiteheads?

Whiteheads are scientifically known as closed comedones. They are formed when the pores become clogged with excess dead skin cells, oil (sebum), and sometimes bacteria. As a result, the hair follicles or sebaceous glands (oil glands) close up, forming the characteristic small, raised white bumps. Unlike other types of acne, such as papules (raised red bumps) or pustules (pus-filled acne lesions), whiteheads are typically present without any sign of inflammation.² Whiteheads can occur anywhere on the body but are most commonly found in the areas of the body that present with an abundance of sebaceous glands, such as the face, back and chest.³

What are blackheads?

Blackheads are also known as open comedones. Blackheads are formed when the blocked follicles are open to the air, causing the contents in the follicles to oxidise. While whiteheads are identified by their closed pores and white appearance, blackheads are named for their dark or black colouration. The dark pigment is the result of the oxidation of excess dead skin cells, oil (sebum), and bacteria, which are all produced by keratinocytes when exposed to air. Similar to whiteheads, blackheads typically do not present with signs of inflammation.² Like whiteheads, blackheads tend to emerge in areas with large amounts of sebaceous glands, such as the face, neck and back. 

Causes

Acne, including whiteheads and blackheads, is a multifaceted skin condition resulting in various contributing factors. The main factors are the following:^{4 5 6}

• Excess oil (sebum) production
• Pores clogged by oil and dead skin cells
• Bacteria: Cutibacterium acnes (C. acnes) is a type of bacteria that naturally resides on the skin. When these bacteria grow excessively within clogged pores, they can contribute to inflammation and the formation of inflammatory acne lesions.
• Hormones: Hormonal fluctuations during puberty, mensuration, pregnancy and menopause can stimulate the production of sebum in the sebaceous glands. 
• Genetics: You are more likely to develop acne if one of your family members has acne.
• Medications: Certain medications, such as lithium and corticosteroids, can increase the chances of developing acne. 
• Age: It is commonly observed in adolescents and young adults.
• Diet: Several studies have suggested that increased milk consumption and high glycemic load diets are connected to the increased risk of acne in adolescents 
• Stress: The release of stress hormones, such as cortisol, can contribute to acne
• Excessive scrubbing of the skin with soaps and detergents
• Pressure from sports helmets, tight clothes, or backpacks
• Environmental irritants, such as pollution and high humidity

Treatment

The treatment and management of whiteheads and blackheads depend on the severity. A healthcare professional may advise on different treatments to help reduce the excess sebum and remove dead skin cells clogging the pores. To see noticeable improvements, you will need to remain consistent on treatment for two to three months. Some of these treatments include:³

1. Retinoids: Retinoids are vitamin A derivatives and work by increasing skin cell regeneration (proliferation) and helping control sebum (oil) production. This helps unclog the pores and remove components such as dead skin cells. Types of retinoids include tretinoin and adapalene. Common side effects of retinoids are irritation, dryness and sensitivity to sunlight. Therefore, it is recommended to be applied at night and to wear sunscreen protection throughout the day. 
2. Salicylic acid: Salicylic acid is a beta hydroxy acid (BHA). It works by penetrating into the skin and dissolving the debris that clogs the pores, acting as an exfoliant. Doing this helps break the bonds between the dead skin cells. Salicylic acid has antibacterial and anti-inflammatory properties and works deep in the follicles to control sebum production. 
3. Benzoyl peroxide: Benzoyl peroxide is an exfoliating agent that increases skin cell regeneration and removes pore debris. It has antibacterial properties and helps reduce chemical reactions that may be occurring in the hair follicles.
4. Azelaic acid: Azelaic acid can be found naturally in wheat, barley and on the skin produced by certain fungi. It helps normalise the shedding of the skin and reduce keratinisation, which is a process where the skin cells join together and block pores. Additionally, it helps promote skin cell regeneration and has both antibacterial and anti-inflammatory properties. A standout characteristic of azelaic acid is its skin-brightening effect, which benefits those with discolouration and hyperpigmentation resulting from acne. 
5. Antibiotics: Topical antibiotics and oral antibiotics are prescribed by healthcare professionals. They can be used to treat moderate to severe acne. Antibiotics work by effectively inhibiting the growth of C. acnes. They also have antibacterial properties.

Topical antibiotics include clindamycin and erythromycin. Oral antibiotics include lymecycline and doxycycline.

6. Isotretinoin: Isotretinoin is a vitamin A derivative that can help combat severe cases of acne. This is used when other treatments, such as oral antibiotics, are proven ineffective for the treatment of acne. Although the exact mechanism remains unknown, Isotretinoin is recognised for its ability to decrease sebaceous gland secretion and keratinisation. A typical treatment course lasts between 4-6 months. Isotretinoin is teratogenic (can cause severe birth defects) and, therefore, not recommended during pregnancy. Other side effects include visual changes, dry skin and skin thinning.

What should I not do?

It is crucial to ensure you avoid certain habits and practices that can lead to the formation of whiteheads and blackheads. Here are tips that you can follow to help reduce and eliminate blackheads and whiteheads:

1. Avoid squeezing whiteheads and blackheads; this will help prevent bacteria from going deeper into the skin, resulting in an infection. This also prevents scarring.
2. Cleansing regularly helps remove dirt, oil and dead skin cells that clog the pores.
3. Avoid touching your face and regularly wash your hands to prevent the spread of acne-causing bacteria like C. acnes.
4. Clean makeup brushes to prevent the build-up of makeup and bacteria. Also, washing off makeup before bed.
5. Using sunscreen with at least SPF 30 helps protect your skin from potential UV damage, which can worsen acne.
6. Maintaining a healthy and balanced diet promotes healthy skin.
7. If you have long hair, try to keep it clean and away from your face, as the oils from hair can contribute to pore blockage. 
8. When choosing skincare and makeup products, look for those that are labelled as “non-comedogenic”. These are products that contain ingredients which will not clog the pores. 

Conclusion

Whiteheads and blackheads are types of acne that affect many people. Both are caused by a buildup of dead skin cells, oil and sometimes bacteria in the pores. Although they share similarities, they each have distinct characteristics: whiteheads are closed comedones, while blackheads are open comedones. Consistent skin care practices are essential for maintaining clear and healthy skin. There is a wide range of proven treatments such as retinoids, salicylic acid and antibiotics that are deemed beneficial with helping reduce and eliminate blackheads and whiteheads.

Remember, skincare is a personal journey. Therefore, what works for you may not work for others, so it is advised that you speak to a healthcare professional if severe acne persists. If you encounter persistent and severe issues, seek guidance from a healthcare professional. By adhering to these principles and tailoring an individualised skincare routine, you can nurture and showcase your skin’s natural radiance, achieving healthy and clear skin.