1 Whiteheads Summary

Whitehead, or closed comedones, is a type of acne formed by the accumulation of dead skin cells, oil, and bacteria in the pores or hair follicles on the skin. The bacteria may be present in the skin or airborne and gets trapped along with sebum just below the skin surface.

The pores are closed off and hence the name, closed comedones. They look like tiny white spots, and in some cases, the spots are too small to be seen with naked eye. If the pores open up, whiteheads may turn into blackheads. In some cases, the whiteheads may rupture causing an inflammatory reaction in the region.

Whiteheads may be present in neck, shoulders, face, and chest. It is most commonly seen in the ‘T-zone’ – nose, chin, and forehead. This part of the face is oily and most prone to the development of whiteheads.

It occurs in both men and women and can occur at any age. People who never had any acne in their teenage may still develop it in adulthood. It most of the cases, whiteheads or acne has its onset during puberty.

It usually goes away in the 20s. But in some people, acne may become a problem in their thirties. They appear to develop overnight, but actually takes months to form inside the skin by the accumulation of debris.

As mentioned in the development of acne, whiteheads are caused by the clogging of skin pores by sebum, bacteria and dead skin cells. Blocking of pores may be caused by several reasons. One of the most common causes of clogged pore is hormonal change.

Secretion of sebum by the glands increases during certain stages of life. The excess oil produced during this period clogs the pores of the skin. The different stages in which this happens include puberty, menstruation, pregnancy, and menopause.

Certain medications like birth control pills are known to cause acne. Studies show that development of acne may be hereditary, with certain genes associated with the formation of acne. The risk of developing whiteheads increases if there is a family member with whiteheads.

Whiteheads are easy to treat and resolve with over-the-counter and prescription medications and products. Products containing benzoyl peroxide reduce the production of oil in the skin, thus reducing the chances of whiteheads.

Salicylic acid helps in breaking the closed comedones. Whiteheads usually respond to treatment within six to eight weeks. Stubborn whiteheads, just like any other acne, are treated with topical and oral prescription medications.

Retinoids help to remove dead skin cells and to unclog the pore. Skin bacteria may be treated with antibiotics, and this helps in reducing inflammation and redness of the region. Other acne treatment methods include spironolactone, isotretinoin, and steroid injections. Phototherapy, chemical peels, and whitehead extraction are also suggested to reduce whiteheads.

Whiteheads can be prevented by using non-comedogenic cosmetic products. Oil-free lotions and moisturizers also help to reduce the amount of oil on the skin. Make-up should be removed before sleeping. Constant picking of whitehead may lead to irritation of the skin, leading to scars on the skin. Severe scarring can be removed only by surgery.

2 Causes

Closed comedones or whiteheads are caused by clogging of skin pores. Sebum produced by sebaceous glands provides nourishment to hair and skin and prevent them from drying.

Under normal health conditions, sebum does not cause any skin issues that are of concern. Excess production of sebum results in the buildup under the skin. This accumulation gets exacerbated when the pores are blocked by dead skin cells or debris.

When the pore is blocked by cells and debris, the flow of sebum through the pore is blocked, resulting in the buildup. The buildup causes a small bump on the skin, called as a comedo.

Whiteheads are often formed during puberty in the majority of people. The hormonal changes in the body, in both boys and girls, cause excess production of sebum by the sebaceous glands. Excess sebum in the skin makes it oily.

Enlargement of sebaceous glands is caused by androgen-type hormones produced by the body at the time of puberty. Androgens are produced more in males when compared to females, whiteheads are more common and severe in males.

Closed comedone may occur in adulthood as well, though it is more common among teenagers. In adults, sudden changes in hormonal levels are the most common cause of the condition.

This may result from certain medications that affect hormonal levels like steroids. Medications used in the treatment of bipolar disorder and depression may also result in hormonal imbalance, leading to whitehead formation.

The onset of acne is seen during pregnancy in women. This is also related to the hormonal changes occurring during pregnancy. These changes are more obvious during the first trimester when hormonal imbalance are triggered.

In most cases, the hormonal changes taper by the end of three months into the pregnancy. Hormone changes during menstruation may also trigger whitehead formation in women. The whitehead outbreak during this time is mild when compared to other cases.

Genetics is also known to play an important role in the development of whitehead in many people. Having a family member with whitehead and acne increases the risk of closed comedone.

The size and activity of sebaceous glands are influenced by hereditary factors. Large, active glands produce more sebum, increasing the chance of whitehead formation. In some cases, the bacteria that are part of the skin may produce substances that irritate the skin.

This triggers an inflammatory reaction in the region. Apart from hormonal changes and genetics, make-up may also cause whiteheads in some. This is particularly true of oil-based cosmetic products.

Heavy creams, lotions, and other products may clog the pores resulting in whiteheads. If hair products are the cause of whiteheads, the bumps may be seen around the hair line.

Some other causes include: 

  • Dietary factors like high glycemic index food like sugar or fats
  • Contact with isopropyl myristate, propylene glycol, dyes and other chemicals present in cosmetics
  • Rough washing of skin
  • Squeezing of pimples
  • Over-hydration of skin
  • Laser treatments
  • Chemical peels
  • Increased activity of male sex hormone

3 Diagnosis and Treatment

Diagnosis of whiteheads is based on symptoms and physical examination. It is more commonly seen on shoulders and face. The follicles will be filled with white-colored debris, which is an accumulation of bacteria, dead cells, and sebum.

They can be seen singly or in groups in an area. They look like bumps across the skin, but is generally reddish in color or inflamed as in a pimple.

Whiteheads are relatively mild when compared to other forms of acne and resolve easily with treatment. Over-the-counter ointments and washes are generally suggested for treating the small bumps.

Oil production in the skin can be reduced using products that contain benzoyl peroxide. Whiteheads can be broken down using salicylic acid-containing creams and lotions. Any product takes approximately six to eight weeks to bring down the whiteheads.

Other treatment options depend on the severity and individual needs. In many cases, acne may flare-up at the start of the treatment. Mild to moderate form of acne is treated with topical medications. These medications can be used in combination with better results.

Benzoyl peroxide products are suggested in the treatment of whitehead as they have an antibacterial effect. Antibiotics are recommended to reduce the bacterial population in skin. Oral antibiotics also help change the composition of sebum and to reduce inflammation.

Metronidazole, clindamycin, and erythromycin are the common antibiotics suggested in the treatment of whiteheads. In most cases, it is used in combination with benzoyl peroxide. It is effective in the treatment of moderate to severe form of whiteheads that do not resolve with topical agents.

Retinoids and antikeratolytic agent are used to unclog the pores on the skin. These are useful in the treatment of both white- and blackheads. Some of these products may irritate the skin to a certain extent. This effect is seen only in case of topical agents and not oral vitamin products.

Spironolactone and cyproterone acetate are hormone pills that are used to reduce the size of sebaceous glands, thus decreasing the amount of sebum produced.

Isotretinoin is a vitamin A derivative that is usually used in the treatment of severe form of cystic acne.

Surgical methods are suggested in certain cases. This includes extraction of whiteheads, freezing of comodones, and injection of steroids into the lesions. In most of the cases, whiteheads can be prevented.

This can be done by:

  • Keeping the skin clean by washing with gentle soap or cleanser and warm water. This helps to remove excess oil from the skin.
  • Using water-based make-up to prevent buildup of sebum
  • Keeping hair away from face and washing hair frequently
  • Having a healthy lifestyle with well-balanced diet that helps in preventing acne and its outbreak
  • Avoiding certain foods like artificial sweeteners, sugars, and processed products.
  • Keeping oneself well hydrated. Having 6-8 glasses of water to hydrate skin helps to remove toxins.
  • Quitting smoking and avoiding passive smoking

Home remedies are also used in alleviating whiteheads. Hot compress is used to open up the pores of the skin. The follicle can be then cleared using a sterile needle.

A paste of oatmeal and yogurt is applied onto the pore and left for some time. The pack is rinsed and the procedure repeated for best results. A face mask made of water, lemon juice, and sugar also help to unclog the pores in whitehead.

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