Published 31 October 2026 · Reviewed by Dr Sin Yong
Whiteheads and blackheads are both comedones: hair follicles plugged with keratin and sebum. A whitehead, or closed comedone, has a closed surface and shows as a small skin-coloured bump. A blackhead, or open comedone, has an open pore, so the top of the plug darkens in air. Both are early, non-inflamed acne and respond to the same follicle-normalising treatment.
Short answerThe difference between whiteheads and blackheads is the opening: closed over the plug in a whitehead, open in a blackhead. The colour of a blackhead comes from oxidised keratin and melanin, not dirt. Both are treated by stopping new plugs forming, mainly with a topical retinoid, and by clearing existing plugs with salicylic acid, careful extraction or a Hydrafacial.
Whiteheads vs blackheads: the same plug, a different opening
Whiteheads and blackheads begin in exactly the same way, and what separates them is whether the follicle opening stays closed or opens up. In both, the cells lining the hair follicle stick together instead of shedding, mix with sebum and form a plug, the microcomedone, which is invisible at first and then grows.
Illustrative image — not a patient.
If the surface stays sealed over the plug, the result is a closed comedone: a whitehead. If the opening stretches and the plug is exposed, it is an open comedone: a blackhead. A 2004 review of comedone formation in Clinics in Dermatology described the microcomedone as the precursor of every acne lesion, and noted that the number and size of microcomedones track the severity of acne. That is why comedones are treated, not just tolerated: they are the stage before inflamed spots.
Feature
Whitehead (closed comedone)
Blackhead (open comedone)
Opening
Closed; no visible pore
Open; a dilated pore
Colour
Skin-coloured or whitish
Dark brown to black at the tip
Feel
Small, firm, slightly raised; easier to feel than see
A blackhead is dark because its exposed tip contains keratin, lipids and melanin that oxidise and darken in air; it is chemistry, not dirt. A whitehead's plug is sealed beneath the skin, so it is never exposed and stays pale.
This matters in practice. Scrubbing harder does not remove the colour, because the colour is part of the plug, and aggressive washing only irritates the skin around it. The same logic explains why a blackhead cleared by extraction leaves a slightly open pore: the opening was stretched by the plug, and it takes time and skincare that normalises the follicle for that pore to look less obvious.
A common source of confusion is the word whitehead itself. Many people use it for a pustule, the yellow-white head on an inflamed red spot. That is a different lesion: a comedone that has become inflamed, with pus at the surface. A true whitehead has no surrounding redness and is not tender.
“A blackhead is not dirt and a whitehead is not a pimple. Both are the same blocked follicle, and treating the blockage matters more than emptying the pore.”
Dr Sin YongOn whiteheads and blackheads
Sebaceous filaments vs blackheads
Most of the dark dots people call blackheads on the nose are sebaceous filaments: soft, normal columns of sebum and skin cells that line oily pores and refill after they are squeezed. A true blackhead is a firm plug that sits in fewer pores, looks darker and does not refill once cleared.
Clue
Sebaceous filament
Blackhead
Pattern
Even, in almost every pore of the nose
Scattered, a few here and there
Colour
Grey, tan or pale yellow
Dark brown to black
What comes out
A soft, pale thread
A firm plug with a dark tip
After clearing
Refills as a matter of course
Stays clear unless a new plug forms
Is it acne?
No; it is normal
Yes; the earliest stage
The difference changes the plan. Filaments are kept small with oil control and salicylic acid, and squeezing them does more harm than good. Blackheads are cleared and then prevented with a retinoid.
Whiteheads or milia? Other white bumps that are not comedones
Several common bumps look like whiteheads but are not comedones, and they do not respond to acne treatment. Telling them apart first saves months of using the wrong products.
Lookalike
Clues
What it needs
Read more
Milia
Hard, pearly white dots, often around the eyes; cannot be squeezed out
A doctor can usually tell these apart by looking closely and asking how the bumps behave: whether they itch, whether they can be expressed and whether they come and go.
What causes whiteheads and blackheads?
Whiteheads and blackheads are caused by a follicle lining that sheds abnormally, combined with sebum output that is high enough to bind the shed cells into a plug. Androgens drive the sebum, which is why comedones appear at puberty, cluster in the oily centre of the face and, in some adults, flare with the menstrual cycle.
Hormones: rising androgens in the teenage years, and hormonal shifts in adult women.
Occlusive products: heavy creams, oils, some sunscreens and hair products that sit on the skin.
Friction and heat: masks, helmet straps and resting the chin on a hand, especially in humid weather.
Picking and scrubbing: irritation of the follicle wall, which can turn a comedone into an inflamed spot.
Dirt is not a cause. Diet is debated; the evidence on sugar and dairy, and what it does and does not show, is set out on acne types and severity.
How to treat whiteheads and blackheads
Whiteheads and blackheads are treated in two steps: stop new plugs forming, then clear the ones already there. A topical retinoid does the first job; salicylic acid, careful extraction or a Hydrafacial does the second.
Topical retinoids act on the blockage itself. A 2017 review in Dermatology and Therapy explained why expert guidelines place retinoids at the core of topical acne treatment: they are comedolytic, they resolve the microcomedone and they help keep skin clear once it has settled. The American Academy of Dermatology's 2024 guideline, a systematic review graded by the GRADE method, made strong recommendations for topical retinoids and benzoyl peroxide, and conditional recommendations for salicylic acid and azelaic acid.
Option
What it does
Suits
Not for
Page
Topical retinoid
Normalises follicle shedding so plugs stop forming
Blackheads have an open door, so the plug can be loosened from above. Whiteheads are sealed, so a retinoid has to work from within the follicle, and extraction needs the surface opened carefully with a sterile instrument. Squeezing a closed comedone at home is the most common way to turn it into an inflamed spot and, in Asian skin, a dark mark that outlasts it; see post-inflammatory hyperpigmentation.
When to see a doctor about blackheads and whiteheads
See a doctor when comedones persist despite a fair trial of over-the-counter care, when they keep turning into red or painful spots, or when they are leaving marks or scars. A prescription retinoid is often the step that makes the difference, and it is introduced slowly to limit irritation.
Many closed comedones across the forehead or chin that do not change with salicylic acid.
Comedones alongside inflamed spots, nodules or early scarring.
Acne that starts in adulthood with irregular periods, excess hair growth or scalp thinning.
Bumps that itch, are all the same size, or will not squeeze out, which may not be comedones at all.
At the clinic on Orchard Road, Singapore, Dr Sin Yong grades the acne, confirms what each bump is and plans treatment for the stage in front of him, from skincare alone to prescription treatment. The full approach to acne is on acne treatment.
Your next step
1. MessageWhatsApp +65 8023 7170 with what is bothering you. A reply comes from the clinic, not a bot.
2. AssessmentDr Sin Yong examines you himself on Orchard Road, with ultrasound where earlier filler is involved.
3. A plan in writingWhat he would do, what he would not, the fee factors, and the option of no treatment.
Every treatment is performed by Dr Sin Yong personally. Singapore Medical Council registered · invited to share his clinical expertise internationally for CLASSYS, DEKA, Fotona, Hironic and Ilooda.
Bring the products you use, including sunscreen and hair products, so occlusive ones can be identified. How consultations work.
If the bumps turn out to be milia, what decides the fee is set out under milia removal Singapore.
Frequently Asked Questions
Neither is worse in itself, but whiteheads are more likely to become inflamed because the plug is sealed beneath the skin, while a blackhead's open pore relieves pressure. Both are the earliest stage of acne. Many whiteheads, or comedones that keep turning into red spots, are worth treating early with a topical retinoid, because inflamed spots are what leave marks and scars.
Squeezing whiteheads or blackheads at home is not advised. A blackhead can be lifted out cleanly by a doctor with a sterile extractor, but fingers press unevenly and can rupture the follicle wall. A whitehead is sealed, so squeezing pushes its contents deeper and often turns it into an inflamed spot. In Asian skin that commonly leaves a dark mark that lasts longer than the spot.
A true whitehead is not a pimple. A whitehead is a closed comedone: a small, skin-coloured bump with no redness and no tenderness. A pimple is an inflamed spot, either a red papule or a pustule with a yellow-white head. Many people call that head a whitehead, which causes the confusion. Comedones can become pimples when the follicle wall inflames.
Yes, a whitehead can become a blackhead if the follicle opening stretches and exposes the plug, which then darkens in air. More often, whiteheads either stay closed, clear slowly with treatment, or become inflamed. Because both types start as the same microcomedone, the same follicle-normalising treatment, mainly a topical retinoid, works on both.
Pore strips lift the top of blackheads and sebaceous filaments, so the strip shows small plugs, but they do not remove the whole plug, do nothing for whiteheads and do not stop new plugs forming. They can irritate the skin with repeated use. A salicylic acid product and a topical retinoid act on the cause and give a more lasting change.
Toothpaste is not a treatment for whiteheads. Some ingredients dry the skin, but others, such as fragrance, menthol and abrasives, irritate it and can leave red or dark patches, especially on the face. A whitehead is a sealed plug, and drying the surface does not open it. A topical retinoid, salicylic acid or careful clinic extraction are the appropriate options.
No. Whiteheads are closed comedones, plugs of keratin and sebum in a hair follicle, and are part of acne. Milia are tiny keratin cysts just under the surface, pearly white and very hard, often around the eyes, and they cannot be squeezed out. Milia do not respond to acne treatment; they are opened and the keratin is lifted out by a doctor.
Whiteheads on the forehead and chin are common because these are oily areas with many sebaceous glands. Forehead whiteheads are often linked to hair products and fringes, and chin whiteheads to hormones, masks and resting the chin on a hand. Uniform, itchy bumps on the forehead may instead be fungal acne. Patterns on the chin and jaw are covered on chin acne.
References
Comedone formation: etiology, clinical presentation, and treatment. Clinics in Dermatology 22(5):367-374, 2004. source
Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatology and Therapy 7(3):293-304, 2017. source
Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology 90(5):1006.e1-1006.e30, 2024. source
About this page: written and medically reviewed by Dr Sin Yong, MBBS (NUS), MRCS (Edinburgh) · Last reviewed 31 October 2026 · Illustrative images only, not patients · Editorial policy
