You may hear the term ‘breakout’ used to describe all forms of acne, but this is not always an accurate description. Not all types of acne spread across the skin.
Clogged pores cause acne. These may be attributed to:
- excess production of oil (sebum)
- dead skin cells
- ingrown hairs
Acne is usually associated with hormonal fluctuations experienced during your teenage years, but adults can experience acne, too. About 17 million Americans have acne, making it one of the most common skin conditions among both children and adults.
Identifying which type of acne you’re experiencing is the key to successful treatment. Acne may be noninflammatory or inflammatory. Subtypes of acne within these two categories include:
It’s possible to have multiple types of acne at once — some cases may even be severe enough to warrant a visit to the dermatologist.
Noninflammatory acne includes blackheads and whiteheads. These normally don’t cause swelling. They also respond relatively well to over-the-counter (OTC) treatments.
Salicylic acid is often marketed for acne in general, but it usually works best on noninflammatory acne. It naturally exfoliates the skin, removing dead skin cells that can lead to blackheads and whiteheads. Look for it in cleansers, toners, and moisturizers.
Blackheads (open comedones)
Blackheads occur when a pore is clogged by a combination of sebum and dead skin cells. The top of the pore stays open, despite the rest of it being clogged. This results in the characteristic black color seen on the surface.
Whiteheads (closed comedones)
Whiteheads can also form when a pore gets clogged by sebum and dead skin cells. But unlike with blackheads, the top of the pore closes up. It looks like a small bump protruding from the skin.
Whiteheads are more difficult to treat because the pores are already closed. Products containing salicylic acid can be helpful. Topical retinoids give the best results for comedonal acne. Currently, adapalene (Differin) is available over the counter as a retinoid. If it does not work for you, stronger topical retinoids are available by prescription from your dermatologist.
Pimples that are red and swollen are referred to as inflammatory acne.
Although sebum and dead skin cells contribute to inflammatory acne, bacteria can also play a role in clogging up pores. Bacteria can cause an infection deep beneath the skin’s surface. This may result in painful acne spots that are hard to get rid of.
Products containing benzoyl peroxide may help reduce swelling and get rid of bacteria within the skin. These can also remove excess sebum. Your doctor may prescribe either an oral or topical antibiotic along with the benzoyl-peroxide to treat your inflammatory acne. Topical retinoids are also an important part of combatting inflammatory papules and pustules.
Papules occur when the walls surrounding your pores break down from severe inflammation. This results in hard, clogged pores that are tender to the touch. The skin around these pores is usually pink.
Pustules can also form when the walls around your pores break down. Unlike papules, pustules are filled with pus. These bumps come out from the skin and are usually red in color. They often have yellow or whiteheads on top.
Nodules occur when clogged, swollen pores endure further irritation and grow larger. Unlike pustules and papules, nodules are deeper underneath the skin.
Because nodules are so deep within the skin, you can’t typically treat them at home. Prescription medication is necessary to help clear these up.
Your doctor or dermatologist will likely prescribe the oral medication isotretinoin (Sotret). This is made from a form of vitamin A and is taken daily for four to six months. It can treat and prevent nodules by decreasing the oil gland size within the pores.
Cysts can develop when pores are clogged by a combination of bacteria, sebum, and dead skin cells. The clogs occur deep within the skin and are further below the surface than nodules.
These large red or white bumps are often painful to the touch. Cysts are the largest form of acne, and their formation usually results from a severe infection. This type of acne is also the most likely to scar.
The prescription medication isotretinoin (Sotret) is commonly used to treat cysts. In severe cases, your dermatologist may surgically remove a cyst.
How severe is each type of acne?
Blackheads and whiteheads are the mildest forms of acne. These can sometimes be cleared up with OTC topical medications, such as salicylic acid-based toners or benzoyl-peroxide spot treatments. If they don’t respond to OTC medications, comedones are easily treated with topical retinoids.
There is even one type of retinoid, known as adapalene, which is now available over the counter. It’s very effective in clearing blackheads and whiteheads.
Pustules and papules are more moderate forms of acne. These may or may not clear up with OTC meds. Widespread moderate acne may require an oral or topical prescription from a dermatologist.
Nodules and cysts are the most severe form of acne. You have to see a dermatologist clear up severe acne. Picking or popping nodules and cysts can lead to scars.
What you can do now
It’s important to be patient with your acne treatment. While some treatments may work immediately, you may not see widespread improvement for several months You should also use caution in using too many acne products at once — this can cause dry skin. In response, your pores can create more sebum, then leading to more acne issues.
You should also confirm whether any bumps or swelling are actually the results of acne. There are several skin conditions that cause symptoms similar to those with acne, though they are something entirely different. These include:
- keratosis pilaris
- sebaceous filaments
- sebaceous hyperplasia
Seeing a dermatologist is the only way you can receive a full and accurate diagnosis. In some cases, expert treatment may be the only way to fully clear and control your acne.