Too often when it comes to skin care, we can’t catch a break—just a breakout. Acne looks different on everyone, but the ever-present whiteheads and blackheads remain the same. Is it bad karma, bad skin care or just a few bad habits? Where do they come from, and what can we do to treat them? We sat down with Lauren Hartman, MS, PA-C, a skin care expert from the Warmuth Institute of Dermatology, to talk about the differences and similarities between whiteheads and blackheads and the treatment of each one.
Hartman tells us that acne is a self-limited disease that involves the sebaceous follicles and is considered to be one of the most common skin conditions in the United States. It can be found on the face, chest, back, upper arms and shoulders. More commonly, it appears in the form of either whiteheads or blackheads. So what does that mean? “Acne lesions are characterized as inflammatory or noninflammatory,” says Hartman. “The non-inflammatory lesions are called comedones, which can be open or closed.”
Categorized as the “closed comedones”—whiteheads are generally pale in color, slightly elevated and can be more difficult to detect. The pore becomes clogged beneath the skin, so it is important to avoid squeezing or popping a whitehead as it will break the protective layer of skin, increasing the risk of scarring.
Categorized as the “open comedones”—blackheads are slightly raised or flat with a dark follicle filled with lipids and keratin. Because blackheads are open and exposed to the air, the color changes to a dark gray or “black.” Blackheads are extremely common and can be even harder to extract without proper exfoliation two to three times a week.
According to Hartman, the primary cause of acne itself is unknown, but she shared that there are several factors believed to influence it.
Because the pore of a whitehead is clogged and “closed,” it may be more likely due to internal (or not at all our fault) causes such as genetics, hormones, menstruation and emotional stress on the body.
Because the pore of a blackhead is clogged and “open,” it may be more likely to occur due to an external cause such as increased oil on the skin from sunscreens, moisturizers, cosmetic products, etc., or contact from your hands, smartphones, pillows, towels or any type of transferrable bacteria.
Though there are differences between the two, Hartman says that all of these things can affect the state of our pores and whether or not they become clogged. The process that creates both whiteheads and blackheads involves sebum production, inflammation, follicular hyperkeratinization and the multiplication of the organism “propionibacterium acnes” (a bacteria that can essentially grow within the pore). Your diet might also be to blame for acne breakouts, with high-glycemic ingredients like white grains and sugars responsible for most of the damage, Hartman adds. “A healthy, balanced diet is one of the more important aspects of managing it.”
“Early treatment of acne is the best way to prevent scarring and further development,” says Hartman.
“Over-the-counter face washes containing salicylic acid or benzoyl peroxide tend to work well for whiteheads as they are the predecessor to an infected pore,” she adds. “Dermatologists can prescribe topical medications such as those containing benzoyl peroxide, topical antibiotics, topical retinoids and, in more severe cases, oral antibiotics.”
Salicylic acid and benzoyl peroxide can also fight blackheads, but treatment for blackheads should be focused more on maintaining the oil and products that come in direct contact with the skin. Having a consistent acne regimen without the introduction of several different products can prevent an overage of oil—for example: a cleanser, toner and moisturizer.
Hartman also states that scarring is unique to each patient, so treatment of acne scarring is individualized and can consist of chemical peels, microdermabrasion and laser resurfacing.