November 12, 2020

Acne is a common skin condition that affects over 17 million Americans and occurs among kids and adults.  While many people take acne as just a single type of skin breakout, it’s essential to know that there are numerous acne types and not all spread across the surface of the skin.

It’s possible to get more than one type of acne at once. Some cases of acne can be more severe than others and could warrant professional involvement. Recognizing the type of acne that you have is essential to successful treatment.

This piece elaborates the different types of acne and how to treat them. But first, let’s look at how acne forms and factors that cause acne.

Acne Formation and Causes

Clogged pores cause acne. This clogging is attributed to:

  • Excess oil (sebum) production
  •  Inflammation
  •  Ingrown hairs
  •  Dead skin cells
  •  Bacteria

Mostly, acne pops up on the face, chest, shoulders, and upper back - as these are the parts of the body that have the most sebaceous (oil) glands.

The hair follicles are closely attached to the sebaceous oil glands and may bulge out when clogged, resulting in whiteheads.

When the bulging form is open and darker, it is called a blackhead. Blackhead acne appears like some “dirt” is stuck in the skin pores. Typically, it’s not dirt but bacteria and oil clogging the pores. And when exposed to air, it turns brown.

Pimples are usually inflamed red spots with a white center, and they appear when bacteria infect the blocked follicles. This inflammation and the blockage happen deep inside the follicles and form a cyst-like lump beneath the skin’s surface.  

Several things trigger or worsen acne. They include:

  • Hormonal Changes- Hormones are the main culprit that triggers acne. During puberty, boys and girls produce androgen hormones that cause the oil glands to swell and make additional sebum.

    Fluctuations of hormones in women who are menstruating, pregnant and in menopause also result in acne breakouts.

  • Diet- Research shows that you can trigger or worsen acne if you consume certain foods, including bagels, bread and chips. However, consuming chocolate and greasy foods has little to no impact on acne (as most people believe).

  • Stress- While stress does not cause acne breakout, it can worsen it if you already have it.
  • Certain Medications- Certain medications can worsen acne such as those drugs that contain lithium, corticosteroids, and testosterone.

Different Types of Acne

The signs of acne vary depending on the severity of the condition. Acne can either be inflammatory (cause swelling) or non-inflammatory (does not cause swelling).

Non-Inflammatory Types of Acne

Some non-inflammatory types of acne include whiteheads and blackheads. These respond to over-the-counter treatments and are the mildest.

To treat non-inflammatory types of acne, the dermatologists recommend retinoid and adapalene, which you can buy even without a prescription.

Also, washing them with benzoyl can eliminate the excess cutibacterium acnes (former P.acnes) bacteria on the skin. Within six to eight weeks, the acne will clear out. If it doesn’t, you need to visit a dermatologist for a more potent treatment.


1. Whiteheads(Closed Comedones/pores)

Acne occurs due to your skin pores’ clogging due to too much skin cell production, oil, or bacteria. Whitehead type of acne occurs if the clogging goes all the way through the skin and closes the pores. That means both the pore’s length and the pore’s head are completely clogged (closed clogged-pore).

When the pore is completely closed, on top of the skin appears a white bump. Squeezing or trying to pop out whiteheads is not advisable and can cause scarring.

How to Treat Whiteheads

  • Over-the-counter (OTC) whitehead treatments

You can treat whiteheads with topical treatments such as salicylic acid, sulfur or benzoyl peroxide. You can apply the medicines to the spots directly or use it as a full facial treatment. These topical treatments remove excess oil and dead skin cells.

While sulfur is the mildest on the skin, benzoyl peroxide is the most effective option. Salicylic acid is the best option as it can prevent non-inflammatory acne from forming on your skin again in the future.

  • Topical retinoids

Derived from Vitamin A, topical retinoids are the most effective treatment option for non-inflammatory acne. According to the American Academy of Dermatology, retinoids are the core topical therapy for acne. Some examples include tretinoin (Retin –A), retinol, and adapalene (Differin).

2. Blackheads (Open Comedones)

Unlike Whiteheads, where both the head and the pore’s length remain closed, blackheads, also known as open plugged pores, remain open at the pore’s tip/head while the rest of the pore is blocked.

You can squeeze blackheads, although this is not recommended as it also results in scarring.

How to Treat Blackheads

Blackheads can be treated with the same treatments as whiteheads. Avoid pore strips that pull out the blackheads. The pore strips are abrasive and can damage the upper layer of skin, which may worsen the acne. And they are only a temporary fix.

Inflammatory Types of Acne

Inflammatory types of acne are swollen and are mostly a result of clogging and infection. They are challenging to treat, and some could even be painful. Some of the inflammatory types include papules, pustules, nodules, and cysts.

Papules and pustules are more moderate, while nodules and cysts are the most severe and do not respond to OTC treatments alone. Widespread acne requires a prescription from a dermatologist.

3. Papules (Pimples with no pus)

Papules appear as small, tender, red bumps. They form when the excess skin cells or oil clog the pores and mix with bacteria called Cutibacterium acnes or C. acnes (previously called Propionibacterium acnes).

The clogged pore spills spill out, which lets the bacteria escape into the surrounding skin tissues. This bacterium forms a lesion that is inflamed. Papules don’t contain pus.

How to Treat Papules

  • The OTC treatment benzoyl peroxide

Benzoyl peroxide can treat papules and other kinds of inflammatory acne since it has an antibacterial action. Your dermatologist may also recommend topical retinoids for inflammatory acne, certain antibiotics to get rid of the C.acnes bacteria, and certain birth control pills (for women) can help decrease androgen levels.

4. Pustules (Pimples with pus at the tip)

Pustules are bulging small bumps with a white center and red, inflamed skin around them. They form when bacteria infect the clogged pores, but they can also occur due to hormonal changes.

Pustules appear as clusters and are usually found on the chest, back and face.  They have some similarities with papules except that pustules contain pus (a yellowish fluid) at the tip.

Avoid popping out or squeezing pustules as this can make the bacteria to spread and infect the surrounding skin causing a breakout.

How to Treat Pustules

You can treat pustules with the same prescription and OTC treatment options used to treat papules. When treating pustules, antibiotics are recommended as they help eliminate the bacteria-filled pus. Also, you can visit a doctor who will safely drain the pustules.

5. Nodules

Nodules are large, solid, flesh-colored, painful, and deep red bumps beneath the skin level surface. They form when the C.acne bacteria infects the skin deep within the pore.

How to Treat Nodules

OTC treatments are not effective on nodular acne as they occur under the skin’s surface.

A doctor can offer prescription antibiotics, benzoyl peroxide, salicylic acid, retinoid, or birth control pills (for ladies) to help eliminate nodular acne.

If the treatment doesn’t work, your dermatologist can help drain the nodules using chemical peels, laser, or by hand.

6. Cysts- Paintful, pus-filled lumps

Cysts appear as large, inflamed, red, painful, and pus-filled bumps. It is the most severe acne case and results from an infection that occurs deep within the skin.

Though cysts are softer than nodules, they are filled with pus and habitually burst and infect the surrounding skin.

How to Treat Cystic Acne

Cystic is the most challenging type of acne to treat. You require multiple  types of medications, such as topical retinoid, spironolactone, antibiotics, isotretinoin, which is an oral retinoid sold under brand names such as Myorisan, Claravis, Zenatane, and more) and birth control pills (for women) that help decrease the levels of androgen.

Your dermatologist will let you know the best combination of medications, as some of these can have a negative effect mainly on men. Some stubborn cysts may be eliminated using steroid injections to remove the inflammation.


Parting Shot

If you notice bumps or swelling on your skin, it’s crucial to confirm whether they are acne. Some type’s skin conditions such as folliculitis, milia, keratosis pilaris, sebaceous filaments, rosacea, and sebaceous hyperplasia can have similar symptoms of acne. Visiting a dermatologist is crucial so that you can get full and accurate diagnoses. After correct diagnoses, you will also be offered the right treatment.


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