Blackheads vs Whiteheads: Open vs Closed Comedones Explained

Blackheads and whiteheads are the same thing at heart: a hair follicle plugged with oil and dead skin cells. The difference is whether the pore is open or closed. A blackhead is an open comedo whose plug has turned dark at the surface; a whitehead is a closed comedo sealed under a thin layer of skin. Both respond best to the same slow, boring fix: a topical retinoid, often paired with benzoyl peroxide, used consistently for weeks. Squeezing and scrubbing tend to make things worse.

What is the difference between blackheads and whiteheads?

Both are comedones, the non-inflamed type of acne lesion. The American Academy of Dermatology (AAD) explains that they form when pores become clogged with excess oil, bacteria and dead skin cells: if the pore closes, you get a whitehead; if it stays open, you get a blackhead. MedlinePlus puts it even more simply: if the top of the plug is white it’s a whitehead, and if it’s dark it’s a blackhead.

On the skin, they look quite different. The NIH’s StatPearls review of acne describes open comedones as bumps with a central, dilated pore containing grey, brown or black material, and closed comedones as smooth, dome-shaped bumps that sit beneath the skin surface. According to DermNet, comedonal acne most often affects the forehead and chin.

If you want the bigger picture of how comedones fit alongside papules, pustules and cysts, see my guide to the types of acne.

Why are blackheads black if they’re not dirt?

This is the single most useful fact about blackheads, because it changes how you treat them. DermNet states plainly that open comedones are black because of surface pigment (melanin), not dirt. The contents of the open pore are exposed to air at the surface, and the tip darkens.

That means no amount of scrubbing will “clean” a blackhead out, and the AAD specifically advises that you resist scrubbing, because it will only worsen your acne. Harsh cleansing irritates the skin without touching the plug that sits inside the follicle.

Are those dots on my nose blackheads or sebaceous filaments?

Often, they’re not blackheads at all. Sebaceous filaments are a normal part of skin. Cleveland Clinic describes them as thin, thread-like structures that line your oil glands and help move sebum to the skin surface. Unlike a blackhead, a sebaceous filament isn’t a blockage: oil still flows through it.

A few practical ways to tell them apart, based on that Cleveland Clinic guidance:

• Colour: sebaceous filaments tend to look like small, flat, light-coloured dots (grey, light brown or yellowish). Blackheads are darker specks, often in a slightly raised bump.
• What comes out if squeezed: a filament releases a pale, waxy, thread-like strand; a blackhead releases a dark, waxy plug.
• Where: filaments are most noticeable on the nose, forehead, chin and cheeks, which overlaps with where comedones show up, so colour and what comes out are better clues than location.

The honest bottom line: you can’t get rid of sebaceous filaments permanently, only make them less visible, and Cleveland Clinic notes that squeezed pores fill up again within about 30 days. Squeezing them is all risk and no lasting reward.

What causes blackheads and whiteheads?

All acne begins with a plug too small to see. StatPearls describes the microcomedo as the primary lesion and the precursor of every other type of acne spot. Four processes drive acne: increased sebum production, abnormal shedding of skin cells inside the follicle (hyperkeratinisation), the skin bacterium Cutibacterium acnes, and inflammation.

MedlinePlus lists some everyday factors that can aggravate breakouts, including greasy cosmetics or creams and tight headbands or hats. The same page recommends water-based or noncomedogenic cosmetics and skin creams. Picking matters too: DermNet notes that follicle rupture from squeezing spots is one of the factors linked to comedone formation.

What does the evidence say actually clears comedones?

Topical retinoids: the backbone

Because comedones are a plugging problem, the most logical treatment is one that normalises how the follicle sheds cells. The AAD says that to unclog pores, dermatologists recommend a retinoid, and notes that adapalene is available without a prescription (Differin is the best-known brand of OTC adapalene 0.1%). StatPearls adds that for predominantly comedonal acne, topical retinoids can be used on their own. The 2024 AAD guideline of care makes a strong recommendation for topical retinoids for acne overall.

Patience is non-negotiable. The OTC adapalene 0.1% Drug Facts label says it may take up to 3 months of once-daily use to see results, and warns that acne may appear to worsen during the early weeks. There’s more on getting started in adapalene (Differin).

Benzoyl peroxide

The AAD pairs the retinoid with a benzoyl peroxide wash to reduce bacteria, and the 2024 guideline strongly recommends benzoyl peroxide. Under the US OTC acne rules, benzoyl peroxide is sold at 2.5% to 10%, and those rules require a warning that it can bleach hair and fabric.

Salicylic acid and azelaic acid

Salicylic acid is the ingredient most marketed for blackheads, and DermNet lists it among the comedolytic agents. OTC products may contain 0.5% to 2%. But the evidence is thinner than the marketing suggests. The 2024 AAD guideline gives salicylic acid only a conditional recommendation, and a 2020 Cochrane review found just one small study (46 participants) comparing it with tretinoin, showing little or no difference in overall improvement, with the evidence rated low quality. That doesn’t mean it’s useless; it means we don’t have strong trials.

Azelaic acid also gets a conditional recommendation in the AAD guideline. The same Cochrane review found moderate-quality evidence that it is probably about as effective as tretinoin and probably less effective than benzoyl peroxide. For a deeper dive, see salicylic acid for acne.

Should you squeeze blackheads or whiteheads?

The short answer is no. The AAD warns that popping spots yourself can push material deeper into the skin, cause more-noticeable acne, pain, scarring, and infection from bacteria on your hands. Whiteheads are especially tempting because they look “ready”, but there is no opening to the surface, so squeezing means forcing the plug through skin.

Dermatologists can do comedo extraction with sterile instruments. The AAD describes it as a safe way to get rid of blackheads and whiteheads, but notes it’s usually offered only when other treatment fails, is rarely a first choice because of time and cost, and that comedones can come back without ongoing treatment. More in should you pop pimples?

How to build a simple routine for blackheads and whiteheads

1. Cleanse gently once or twice a day. MedlinePlus recommends a mild, nondrying cleanser and removing all makeup.
2. Add a retinoid at night. The adapalene label directs once-daily use on clean, dry skin. StatPearls describes building up how often you apply a retinoid gradually, which helps limit irritation.
3. Consider benzoyl peroxide as a wash or leave-on, following the AAD’s retinoid-plus-benzoyl-peroxide approach.
4. Use sunscreen daily. The adapalene label says to limit sun exposure and use sunscreen when going outdoors.
5. Keep going for 6 to 8 weeks minimum. The AAD advises giving treatment six to eight weeks to work, and the adapalene label allows up to 3 months.

Two safety notes. First, the FDA has warned about rare but serious allergic reactions to OTC acne products containing benzoyl peroxide or salicylic acid; it suggests applying a small amount to one or two small areas for 3 days before full use, and seeking emergency care for throat tightness, trouble breathing, faintness, or swelling of the face, lips or tongue. Second, if you are pregnant or breastfeeding, the adapalene label says to ask a doctor before use.

Frequently asked questions