treating whiteheads cysts and blackheads

How to Treat Whiteheads, Blackheads, Pustules, Milia, Closed Comedones and Cysts


Updated 2/1/18. Skin Fact: All types of acne and blemishes are not equal. You must learn the differences between whiteheads, blackheads, pustules, papules, milia, closed comedones and cysts, and treat them accordingly to make them go away fast with the least amount of scarring.

Whiteheads

Whiteheads are small blemishes caused by Propioni­bacterium acnes (P. acnes) bacteria without much redness or pain when touched, unlike a papule, pustule or cyst. When they begin, the infection comes to the surface fairly quickly and forms a white colored head. When squeezed, the pus pops out easily (usually on the first try) and not much scarring or redness is left behind. Of all the types of blemishes where the infection works its way to the surface of the skin, these are the easiest to deal with because the life cycle is fast.

In the photo above, you might think a whitehead looks a lot like a pustule. There are similarities in that they both have visible pus on the surface, but whiteheads have less infection around them so the raised part of the face is usually just the whitehead. Versus with a pustule, you can see that not only is the whitehead protruding from the skin to make a bump but also all of the area around it, too. Simply put, a whitehead is a small bump that can be easily popped and removed (often times without any blood coming along with it) and a pustule is a larger, raised bump that will be painful and when squeezed can ooze with blood.

What you can do to get rid of whiteheads

Whiteheads can sometimes appear in a small cluster such as 3-4 in one area and often on the oilier areas of the face like the chin, cheeks or sides of the nose. They could possibly be caused by a skincare product with a high concentration of oils or emollients that may cause a blocking in some of the pores. In my experience, I have noticed that whiteheads can be more likely to occur if you apply a rich, emollient moisturizer or facial oil after the use of a facial scrub or acid exfoliating mask or peel. Exfoliants work to remove surface dead cells that block the pore opening, so when removed, ingredients can be pushed deeper into the pore. (Whiteheads don’t show up immediately but will take a day or so for them to appear.) You always want to use a moisturizer for your skin type. If you’re feeling tight or dry and need additional moisture, you’re best off applying a skin serum underneath to give a boost of hydration so you don’t have to risk using a moisturizer that might result in the appearance of whiteheads. Take our Skin Type Quiz to get the perfect moisturizer recommended. Read the differences between dry and dehydrated skin.

Additionally, whiteheads could possibly appear if you’re new to using exfoliating products. This can be called a “purging” process as trapped oils are being released due to the removal of surface dead skin cell buildup. Generally, this is short lived.

Closed Comedones

Closed comedones are little clogged, non-inflammatory bumps under the skin that aren’t red or sore and generally don’t go away on their own. They appear as white-ish, clear or flesh colored bumps under the skin and are referred to as “clogged pores.” Most people get them on the chin, sides of the mouth, cheekbones or hairline, but they certainly can be on all areas of the face. They are also very common in deeper skin tones. (Note: Just because you have a bump doesn’t mean it’s a clogged pore. You could have skin growths like these.)

In the photo above, you can see how they are small raised bumps that just sit there and don’t do much of anything.

What you can do to get rid of closed comedones

Since these have no infection (meaning, they are not sore and are there consistently), you’ll want to avoid using overly drying acne products as these will cause a barrier of dryness on the surface and keep oil trapped underneath which causes a clogging in the pore. The best course of action is to use gentle products for your skin type and increase your exfoliation. When you exfoliate the skin with gentle acid serums or facial scrubs, you’re removing the blockage in the pore which can help them purge naturally. Read my complete guide to exfoliation. You’ll also want to consider getting a deep pore cleansing professional facial which is very beneficial for removing the impurities from the pores—especially if the whiteheads just don’t seem to be going away. (You could also try cleaning them yourself using this DIY method.) Once you get the pores cleaned out, exfoliating products work deep within the skin to keep them clean.

With the popularity of liquid foundations, primers and cream blushes, I find that many people are getting closed comedones due to ingredients found in makeup that could be clogging the pores—especially when worn in a hot environment. In the photo above, this is actually a picture of singer, Katy Perry’s face. I am certain that hers is due to a lot of the makeup she wears. What I wouldn’t give to be able to easily clean those out for her! There’s no reason why anyone should have closed comedones. They are so easy to remove, especially in a professional facial with someone who is experienced at extractions. Products alone just can’t remove these efficiently.

You’ll also want to limit the use of facial oils. While cleansing oils and facial oils are popular to use these days, this might only add to your clogged pore condition. Read more about facial oils.

Blackheads

Blackheads are large pores that contain oil that has oxidized with the air causing it to turn black. Almost anyone with enlarged pores has them.

How to treat blackheads

Although there is no way to permanently get rid of blackheads forever (I wish!), my best advice is to get regular monthly deep pore cleansing facials followed by home use of a well-formulated salicylic acid product like BHA Clarifying Serum to keep the pores clean long after the facial. Long-term use of prescription retinoids can also help a lot but it has to be used regularly and for years before you can really see a difference. When it comes to choosing a moisturizer, avoid the ingredients isopropyl myristate and isopropyl palmitate in your skin care products as these may contribute to the formation of blackheads and clogged pores. For more information, read my 3-step plan for reducing blackheads.

Pustules

Pustules are red, inflamed blemishes that contain pus (inflammatory blood cells) caused by Propioni­bacterium acnes (P. acnes) bacteria. These are what you know as your traditional inflammatory “zits” that can easily cause a post-breakout red or dark scar due to the surface of the skin being broken as the white pus exits the pore.

In the photo above, you might think a pustule looks a lot like a whitehead. There are similarities in that they both have visible pus on the surface, but pustules are much larger and have more redness associated with them. When squeezed and the white infection is removed, you’ll generally get a lot of blood along with it. (A whitehead is a small bump that can be easily popped and removed without much bleeding.)

How to treat pustules

You MUST NOT touch these until you can see a visible whitehead. It’s best to leave them alone. Read these tips for how to get rid of a blemish fast so you can learn exactly which kinds of acne spot treatments are the best to use to make it heal quickly with the least amount of scarring.

Papules

A papule is a red, painful blemish that has not quite pushed its way to the surface. It’s the stage past a closed comedone but before a pustule where bacteria the caused by Propioni­bacterium acnes (P. acnes) bacteria has caused inflammation. A papule will then usually turn into a pustule but sometimes they can just stay in the skin for a while and not do much of anything for a while.

In the photo above, you might think a papule looks a lot like a cyst. There are similarities in that they both are large, painful bumps under the skin but as you can see ever so slightly, the white infection (inflammatory blood cells) is under the skin. After a few days, this should come up to the skin’s surface which is when it’s in the pustule phase of the blemish cycle.

Read these tips for how to get rid of a blemish fast so you can learn exactly which kinds of acne spot treatments are the best to use to make it heal quickly with the least amount of scarring.

How to eliminate papules

The main symptom of a papule is inflammation and irritation so the goal is not to dry it out with acne products but rather to calm down the inflammation by using topical cortisone cream (found at a pharmacy), ice compresses or ideally, my favorite Anti Cyst Treatment. These will all reduce the visible inflammation until the whitehead reaches the surface and can be gently extracted. (Or sometimes they will go back down while your body reabsorbs the infection.) It is so important not to pick at a papule as there is nothing to get rid of at this stage.

Cysts

Cysts are hard, painful bumps that develop deep within the skin and can linger for weeks. They are the most frustrating type of inflammatory blemish because they last the longest and can cause long-term scarring. (Especially when cysts turn into nodules, which occur at an even deeper level in the skin.)

In the photo above, you might think a cyst looks a lot like a papule. There are similarities in that they both are large, painful bumps under the skin but with a cyst, they will stay as a bump and never surface with any white pus.

Getting rid of cysts

Do not pick! Despite being sore, you’ll never get that infection out and if you attempt to, you’ll most certainly have a scar that will linger for months. The rule is: If a whitehead does not forms (which they never do if it’s a true cyst) then hands off. With a cyst, despite feeling something sore and painful underneath and wanting to make it come out, you have to understand that your body will eventually reabsorb the infection. You have only two options. Consider using a topical product like Anti Cyst Treatment (a true miracle of a product) or schedule an appointment to get a cortisone injection by a dermatologist.

Read these tips for how to get rid of a blemish fast so you can learn exactly which kinds of acne spot treatments are the best to use to make it heal quickly with the least amount of scarring.

Milia

Milia are hard, white, raised bumps that feel like a little ball under the skin; most commonly found around the eyes and the apples of the cheeks, but can appear elsewhere. These are considered to be non-inflammatory lesions.

How to treat milia

All the acne spot treatments in the world will never get rid of these. They may be caused by heavy pore-clogging oils found in moisturizer (mainly Mineral Oil or Petrolatum), but for many people, they are genetic or caused by smoking. The only way to remove these is to get them manually extracted by an esthetician or dermatologist. They are stubborn to remove so if you try to do it yourself, you’ll probably end up with some temporary scarring so it’s best to put your skin in the hands of a trusted professional. Once you get them removed, regular exfoliation is essential to keep them from coming back—or at least as quickly. This exfoliating serum works extremely well to keep the skin exfoliated so milia have a harder time forming underneath the skin. If you get them around the eyes, then you’ll definitely want to use an exfoliating acid serum exclusively formulated for the eye area like Overnight Eye Serum.

It’s also important to use gentle, low-foaming cleansing gels to deep clean without drying out the skin. See my recommendations for non-drying, sulfate-free cleansers. Take our Skin Type Quiz or schedule a virtual consultation to get customized advice and product recommendations in person, over the phone or online via Skype or FaceTime.

Acne Scars

Most blemishes will leave a purple or red mark once the blemish has crusted over. Depending on the severity of the blemish and if you picked at it, will determine how long the scar will last, but often times they can be there for up to two months.

Healing acne scars

When the blemish is healed and the scab is gone, you’ll now be left with a red or dark mark that can linger for weeks or even months. (A lot of this depends on how much you messed with it. Less picking = less scarring. Read how to break your skin picking habit.)

To get it to fade faster, you’ll want to do two things. 

  1. Protect it from the sun or daylight. Sunscreen is really important during this stage. Read why here.
  2. Gently exfoliate to remove the damaged and pigmented cells. Over time, new, healthy non-scarred cells will come in their place. Recommended product: Post-Breakout Fading Gel is what I give to all of my clients to get a blemish scar to go away quickly.

It’s so important that you educate yourself on the type of bumps and blemishes you get because they all have a different course of action for how to best heal them. I hope this post provides you some new insight in your quest for clearer skin!

Looking for the most comprehensive solution for spot treating breakouts? Shop this Zit Care Kit, complete with everything you need to visibly heal blemishes at every stage.

Want to understand more about why blemishes appear? Read this fascinating post about the science behind breakouts.