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Whiteheads Vs. Blackheads


Comedones, or clogged hair follicles/pores, affect 40-50 million people in the U.S. every year [1]. Most of us will experience them at some point in our life but, do we know what causes them, why they may be a certain color, or how to treat them? Below, we discuss various causes of whiteheads and blackheads, why they look the way they do, and what they’re telling us about the current state of our skin. Finally, we’ll talk about tried-and-true products that help manage or reduce the frequency of these blemishes and the consequences of picking at them. 


Comedones are the lowest level of acne severity.They are often slightly visible but not inflamed (red appearance and sore to the touch).When a pore or hair follicle becomes plugged by abuildup ofsebum and cellulardebris like keratin, a comedone is formed. Open comedones appear asblackheads because this “plug” becomesoxidized as it is exposed to the free radicals in the air. Closed comedones appear aswhiteheads since a thin layer ofskin still covers the pore and protects it from oxidation [2].


We’ve been toldthere are a wide range of causes for acne fromdiet totopical products, to theenvironment, topersonal hygiene habits. For the most part, this is all true. Our own hormonal androgen levels combined with external factors like comedogenic skin care or poor hydration/diet can set off a breakout.Additionally, a few more common but less well-knowncauses of acne can include taking the followingsupplements or prescriptions

  • Hormonalbirth control 
  • Neuropsychotherapeutic drugs (i.e. tricyclic antidepressants, SSRIs, lithium)
  • SomeB vitamins
  • Immunomodulatory drugs (i.e.cyclosporine)
  • Targeted therapies for cancer or inflammatory conditions


Sometimes it can be difficult to identify and therefore treat the causes of comedones.Hydrating, tryingelimination diets,double cleansing, andreducing oil-based makeup andskin care products will set you on the right path. Staying hydrated directly affects the hydration levels of the skin barrier and similarly, identifying and eliminating certain foods (commonly dairy and items with refined sugar) can reduce inflammation.The addition oftwo of the most common topical treatments for acne, (1) benzoyl peroxide (anti-bacterial and keratolytic)and (2) salicylic acid (a beta-hydroxy acid that breaks up sebum)will also reduce the likelihood of comedone formation [3]. 

The use ofretinoids, or plant-based alternatives, andchemical exfoliants like alpha-hydroxy acids (AHAs) is also highly effective separately or in combination [4]. Retinoids boost collagen production and loosen the interactions between keratinocytes at the epidermis, improving cell turnover.Together with AHAs which also loosen cell-to-cell interactions, these can help dead skin cells slough off during cleansing andreduce the amount ofclogged pores. Altogether, acne has both internal and external causes but comedone formation can be managed and reduced with safe and effective products and lifestyle monitoring. 


[1] Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J (2002) Acne Vulgaris: A Disease of Western Civilization.Archives of Dermatology 138, 1584–1590.

[2] Sutaria AH, Masood S, Schlessinger J (2022) Acne Vulgaris. InStatPearls StatPearls Publishing, Treasure Island (FL).

[3] Tan AU, Schlosser BJ, Paller AS (2017) A review of diagnosis and treatment of acne in adult female patients.Int J Womens Dermatol 4, 56–71.

[4] Draelos Z, Lewis J, McHugh L, Pellegrino A, Popescu L (2016) Novel retinoid ester in combination with salicylic acid for the treatment of acne.J Cosmet Dermatol 15, 36–42.