Medical News Today: What type of acne do I have?

Acne can form several types of skin blemish, each with a distinct appearance and symptoms.

Most minor acne blemishes respond to at-home care and over-the-counter medications. However, people with severe or long-term acne should speak with a doctor or dermatologist.

Acne affects around 80 percent of adolescents and young adults. About 40–50 million Americans have acne at any given time.

The following are common types of blemish associated with acne:

Each type of acne lesion requires a different treatment. Receiving prompt, correct treatment can reduce the risk of long-term skin complications, such as dark spots and scarring.

Acne blemishes fall into two categories, depending on whether or not they cause inflammation of the surrounding skin.


Noninflammatory acne types

Whiteheads and blackheads are types of noninflammatory acne lesion. They are the least severe forms of acne.

Noninflammatory blemishes usually do not cause swelling and are not very painful.

Whiteheads

The medical term for whiteheads is closed comedones. These are small, whitish or flesh-colored spots or bumps. They usually have a white, circular center surrounded by a red halo.

A hair will sometimes emerge from the center of a whitehead, or it may appear to be trapped within the blemish.

The skin around a whitehead may appear to be tight or wrinkled, especially when the whitehead is large or especially raised.

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Whiteheads typically do not cause scarring.

Blackheads

Blackheads are also called open comedones. They are small, black or dark-colored spots that may appear as slightly raised bumps.

The skin around a blackhead usually appears normal, while the center of the blackhead is darker than the surrounding area.

The coloration is not a result of trapped dirt. Blackheads are simply whiteheads that have opened and widened. When the contents of a whitehead are exposed to air, they darken.

Treatment options

Many over-the-counter rinses, moisturizers, gels, toners, and creams can treat noninflammatory acne blemishes. They often contain a mix of active ingredients.

The following ingredients in over-the-counter treatments can help to break down whiteheads and blackheads:

  • benzoyl peroxide
  • salicylic acid
  • sulfur
  • resorcinol

Also, several home remedies and lifestyle changes can help to reduce most minor-to-mild forms of noninflammatory acne. It may help to try:

  • washing the face with lukewarm water and soap twice daily
  • washing the whole body every 2 days
  • reducing stress
  • eating a healthful, balanced diet
  • staying hydrated
  • avoiding over-washing or irritating the skin
  • limiting exposure to the sun
  • always wearing sunscreen when outdoors

People should never pop acne blemishes. Doing so can lead to complications, such as:

  • nodules
  • cysts
  • scarring
  • dark spots
  • pitting

Inflammatory acne types

Inflammatory acne blemishes include:

  • papules
  • pustules
  • nodules
  • cysts

Inflammatory acne is more severe than noninflammatory acne, and this type is more likely to cause complications, such as scarring or pitting.

Blemishes or lesions that are inflamed, or red, swollen, and warm to the touch can result from inflammatory acne.

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Minor-to-mild forms

Papules

Papules are bumps under the skin’s surface. They are solid, tender, pink, and raised, and the skin around a papule is usually slightly swollen and red.

Unlike whiteheads, papules have no visible center. Unlike blackheads, the pores of a papule do not appear to be widened.

Papules develop when whiteheads or blackheads cause so much irritation that they damage some of the surrounding skin. The damage leads to inflammation.

Pustules (pimples)

Pustules are larger, tender bumps with a defined circular center. The center is filled with whitish or yellowish pus, and the bump has a pink or red base. Immune cells and bacterial cells collect to form this pus.

Pustules typically look like much larger and more inflamed whiteheads.

Treatment options

Several home remedies and over-the-counter medications can treat minor-to-mild papules and pustules. The following tips can help:

  • washing the affected area with cool water and soap using clean hands or a clean, gentle facecloth twice a day
  • applying a warm compress or cloth to the affected area for 10–15 minutes to encourage trapped debris to rise to the surface
  • using products with benzoyl peroxide to combat bacteria
  • using products with salicylic acid to remove dead skin cells and other debris

Moderate-to-severe forms

Nodules

Nodules are hard, painful, inflamed lumps located deep within the skin. They look like larger, deeper papules and have no visible center or head.

This type of acne lesion develops when clogged pores damage tissues and cells deep beneath the skin’s surface.

Nodules are a severe form of acne blemish, and they can cause skin complications such as dark spots or scarring.

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Cysts

Cysts are very large, soft, painful, red or white lumps situated deep in the skin. They are filled with pus.

Cysts form deeper within the skin than nodules, and they are the most severe type of acne blemish. Cysts can also cause skin complications, such as scarring.

Treatment options

People cannot treat moderate-to-severe inflammatory blemishes at home. These lesions require care from a doctor or dermatologist.

The doctor can use many products and procedures to treat nodules and cysts. These include:

  • antibiotics, such as tetracycline, doxycycline, and amoxicillin
  • topical corticosteroids
  • oral contraceptives for hormonal-related acne
  • systematic retinoids, such as isotretinoin
  • steroid injections
  • chemical peels
  • photodynamic therapy to combat bacteria
  • drainage and extraction to remove large cysts


What causes acne?

young woman with forehead acne
When a pore becomes clogged, acne can develop.

Normally, dead cells collect in the skin’s pores, then slowly rise to the surface of the openings and eventually fall away from the skin.

A natural body oil called sebum helps to prevent skin cells from drying out. The glands that produce this oil are attached to the pores.

When excess sebum builds up, it can cause dead cells to stick together, forming a mixture that becomes trapped in the pores.

Acne occurs when a pore becomes clogged with dead skin cells, natural body oils, and a type of bacteria.

These bacteria live on the skin and are called Propionibacterium acnes. If they enter and infect clogged pores, this causes acne blemishes to form.

When to see a doctor

In cases of minor-to-moderate acne, a person will generally have to use home and over-the-counter remedies consistently for 4–8 weeks before they see results.

More severe inflammatory types of acne tend to take much longer to clear up.

Speak to a doctor or dermatologist if whiteheads, blackheads, papules, or pustules:

  • are severe
  • do not respond to over-the-counter medications
  • are very painful
  • are very large
  • bleed a lot
  • release a lot of pus
  • cover a significant portion of the face or body
  • cause emotional distress
  • develop very close to sensitive areas, such as the eyes or lips

Most active ingredients in over-the-counter products are available in prescription-strength treatments.

Dermatologists can also remove lesions that are very large or persistent. They can also remove those that do not respond to other forms of treatment.

Always see a doctor or dermatologist about nodules and cysts, because these require medical care.

Untreated nodules and cysts and those that have been picked or popped can cause scarring.

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