Acne comes in many forms, and whiteheads are one of them. You may notice them as small, round, white bumps on the skin’s surface.

Sometimes, whiteheads can be extremely stubborn to remove, even persisting after facial extractions. Also known as closed comedones, whiteheads occur when a pore in the skin is blocked with oil, keratin, and/or bacteria.

This was the plight faced by a DoctorxDentist reader. He wanted to know why his whiteheads were recurring even after thorough facial extractions.

He wondered if he should continue the extractions to remove the whiteheads or if he should try other medication. Doctors from the DoctorxDentist community responded with these pieces of advice.

Whiteheads, also known as closed comedones, are common and natural occurrences

Whiteheads will most probably always occur. There may be ways to reduce the emergence of comedones. Some may have side effects and some may be safer, more gradual approaches.

There are two types of comedones

According to Dr K K Chew, there are open or black comedones and closed or white comedones. White comedones are sometimes enclosed beneath the skin and formed due to the excessive accumulation of sebum, dead skin cells, and debris.

Acne is often a chronic recurring problem that can begin again even after months or years of acne-free skin.

What causes acne relapse?

When acne reemerges, you might be looking at various factors from stress and hormonal changes to dietary issues and other habits. The main culprit is the accumulation of excess sebum and oil which clogs follicular ducts and pores.

This can even cause you to get an infection which leads to the typical inflamed and red look of acne.

Proper skin care is key to minimal whiteheads

The solution lies in maintaining relatively oil or comedone free skin through a proper skincare regimen. This will help to both reduce the sebum being produced and exfoliate as well as prevent the clogging up of waste that forms comedones.

There are two common solutions to oily skin

To maintain proper skincare, these are typically used:

• Salicylic acid-based toners (which promote exfoliation, prevent debris accumulation that might congest pores, and reduce sebum secretion)

• Adapalene/retinoids (which increase the rate of cell turnover and promote collagen stimulation to help tighten pores)

Physical extraction can promote long-term skin health

For a more thorough and consistent outcome, consider physical extraction (done professionally if possible) every once in a while.

You could also use clay or peel-off masks which help remove the bulk of gunk that could build up even with proper skincare.

Oral isotretinoin is great for severe acne but there’s a risk

Oral isotretinoin treatment (Accutane is a well-known example) can be an effective option for people with stubborn acne that resists other treatments. However, the benefits come with possible risks (liver impairment and teratogenicity) in some people.

Though rare, it’s best that you consult your doctor before use.

Other treatment options are available

There are many treatment options including the use of benzoyl peroxide, salicylic acid, azelaic acid, adapalene, and Retin-A. Oral medication includes antibiotics such as doxycycline, minocycline and isotretinoin.

Agnes RF treatment is another option at your doctor’s clinic

Dr Chew explained the Agnes RF treatment for recurring acne, which uses a fine microneedle that’s inserted through the follicle opening and directed at the sebaceous gland.

It then destroys the gland and reduces sebum secretion to treat the problem.

Even then, comedonal build-up can still occur in some people

Even after all the above is applied, comedonal buildup can start again right after you stop your skincare regimen. Optimising your skincare routine and being consistent should produce satisfactory results in the long run.

Acne is experienced by many people in Singapore and although it is a condition that many can live with, it is good to know that persistent and recurring whiteheads can be treated.

Do remember that with or without medical treatment, consistent skincare and proper consultation from medical experts should be a focus.

References:

1. Informed Health Online [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Acne: Overview. 2013 Jan 16.

2. Wise, Emily M and Emmy M Graber. “Clinical pearl: comedone extraction for persistent macrocomedones while on isotretinoin therapy” Journal of Clinical and Aesthetic Dermatology vol. 4,11 (2011): 20-1.
3. Henry H. Roenigk Jr. Liver toxicity of retinoid therapy. Journal of the American Academy of Dermatology. Volume 19, Issue 1, Part 2, July 1988, Pages 199-208. Accessed April 2019.