White Points

What are White Points

Technically known as closed comedones, white spots represent a type of non-inflammatory acne that, while ideally affecting any area of ​​the skin, tends to manifest itself in the face, neck, back and forearm.


The comedones closed with the millet grains must not be confused: although apparently similar, the two types of white points differ in the triggering causes and the necessary treatment. In this article we will focus exclusively on closed comedones.


Closed comedones are small infarctions rich in keratin, sebum and bacteria that accumulate inside the hair follicles, forming small (and unaesthetic) white, swollen and soft balls. The characteristic nickname with which this imperfection is identified derives precisely from their particular "white dome" appearance.


In addition to representing a clear aesthetic damage for the individuals who manifest them, in general, the white points do not cause particular disturbances. However, in some cases, they could give rise to itching or pain.


Evolution and degeneration of White Points

In a sense, the white points are progenitors of acne: it is not rare that, over time, the secretion contained within the sebaceous follicle pours into the interior, triggering an inflammatory reaction characterized precisely by papules and pustules ( pus-stuffed boils).

Before turning into the so-called pimple or boil, the white point must however pass into the intermediate stage of black point: when the white point opens, the oxidation of the lipids and the migration of cells rich in melanin and sebum favor the formation of a typical dark head (hence the term black point or open blackhead).


After the white dot has turned into a black spot, it is not necessarily the case that the pimple forms: once opened, the open comedones (blackheads) can in fact regress, remain so or degenerate into inflammatory acne, papules and pustules .


The origin of the closed comedones is closely related to a hyperactivity of the sebaceous glands, the tiny anatomical structures used for the production of sebum. Any possible increase in the size of the sebaceous glands, as well as an overproduction of sebaceous secretions, can heavily influence the onset of white spots.

Closed comedones are also related to hormonal alterations: it is no coincidence that white spots are often observed during puberty and among young adults, as well as in women affected by polycystic ovary syndrome. In fact, during the phase preceding puberty, the androgenic hormones - produced by the adrenal glands (testosterone, dihydrotestosterone, dehydroepiandrosterone, androstenedione etc.) and by the testes in the male - undergo a physiological elevation: consequently, the activity of the sebaceous glands is stimulated to the point of favoring the appearance of open, closed comedones and acne.

In addition to the causes just listed, it seems that the appearance of white points is also linked to other factors:

  • Presence of infected scratches on the skin or other forms of skin irritation.
  • Exaggerated accumulation of sebum on the skin.
  • Poor face cleansing.
  • Use of aggressive detergents or cosmetics.
  • Presence of scars.
  • Stress.
  • Hereditary factors.
  • Other forms of hormonal alteration (eg menstruation, pregnancy).
  • Constant exposure to UV rays from the sun or artificial lamps (especially in the absence of adequate sun protection).
  • Incorrect feeding.

Treatments and Remedies

Let's start by saying that the white spots should not be crushed: the treatment of blackheads, whether they are open or closed, cannot be done without a specialized dermatological control.

By crushing the white point with your fingers or, worse still with your nails, you risk infecting the area, favoring the appearance of scars and spreading dirt and bacteria in nearby areas. For this reason, it is recommended to resist the temptation to squeeze the white spots, relying exclusively on the care of an expert.

Behavioral measures

When not instigated, the white points tend to regress spontaneously through the correction of some imperfect behaviors: it is in fact sufficient to optimize the method of cleaning the face and always choose quality cosmetics, suited to one's skin type, to favor the spontaneous regression of blackheads closed.

It is also recommended to use astringent lotions for the treatment of oily skin with moderation and common sense. By drying up the skin too much, these substances stimulate the sebaceous glands which, reacting to the insult, increase sebum production and predispose to the formation of white spots.

Pharmacological and aesthetic treatment

In the past, for the treatment of white spots, it was customary to prescribe patients a treatment based on retinoids; considering the risks and side effects derived from these drugs (eg teratogenic effect), doctors today recommend sessions of chemical peels based on alpha- and beta-hydroxy acids (in particular, tartaric acid, glycolic acid and salicylic acid). By smoothing the skin and removing dead surface cells, these exfoliating treatments stimulate both cell renewal and the synthesis of collagen and elastin in the dermis.

On the market, moreover, there are several drugs available without a medical prescription to be used topically based on active ingredients with antibacterial, comedolytic and exfoliating action. As a rule, these drugs are mainly used for the treatment of acne manifestations, but they can be very useful even in the case of white spots unrelated to acne. The classic example of an active ingredient of this type is given by benzoyl peroxide (Benzac®).

The topical application of antibiotic drugs, on the other hand, is reserved for severe cases of acne, characterized by the simultaneous presence of open comedones, closed comedones, papules and inflamed pustules.

Interventions of dermo-aesthetic medicine

When local drug treatments are not sufficient to eradicate the disorder, white spots can be removed by minimally invasive procedures. The sessions of micro-dermabrasion with salicylic acid, laser therapy or surgical enucleation (a practice which involves the expulsion of the infarction of the white point using a special surgical instrument) are generally sufficient to completely eliminate the comedones closed by the skin, avoiding any eventual reappearance.

Useful tips

Despite what one might commonly think, a skin with white spots needs care and treatment just like dry or sensitive skin. To do this and to prevent, or at least limit, the appearance of white points, it may be useful to take some precautions:

  • For facial cleansing, use non-oily and, above all, delicate products. In fact, the use of aggressive detergents - similarly to the excessive use of astringent products for oily skin - would stimulate the sebaceous glands, thus accentuating the problem of white spots.
  • Avoid excessive washing.
  • Reduce direct exposure to UV rays and use adequate sunscreens.
  • Use quality make-up products.
  • Ensure a good degree of skin hydration through the use of products suited to your skin type.
  • Adopt a balanced diet without excesses.