The truth is, acne is a broad umbrella term that can consist of different types of skin concerns and breakouts. To understand the different types of acne, it’s necessary to understand why we get acne in the first place. Melissa Kanchanapoomi Levin, MD, a board-certified dermatologist and founder of Entière Dermatology, says acne happens when there is a disorder of the hair follicle (aka the pore) and the sebaceous gland (aka the oil gland) that’s attached to the pore. She explains that acne-prone skin types have more sebum (oil), which causes dead skin cells to get clogged in the pore. “That mixture of dead skin cells and sebum becomes trapped inside the pore, creating an oxygen-free environment where a naturally occurring bacteria, called P. Acnes, which resides in the hair follicle, multiples very quickly, resulting in inflammation,” says Dr. Levin. This inflammation can create the breakouts we think about when we hear the word acne. Deanne Mraz Robinson, MD, a board-certified dermatologist, says inflammatory acne are papules, pustules, cysts, and nodules on the skin. There is also non-inflammatory acne, which is known as whiteheads and blackheads. To find out which type of acne you have and how to treat it, keep reading.
Whiteheads and Blackheads:
“Whiteheads and blackheads are both forms of clogged pores and are non-inflammatory types of acne, meaning they don’t cause swelling,” says Dr. Robinson. The difference between the two is whether the pore is open or closed. “A whitehead has a thin layer of skin covering the pore, trapping the plug beneath the pore’s surface,” explains Dr. Levin. “Since the oil in the pore isn’t exposed to oxygen, it remains white or yellowish, the natural color of sebum and dead white blood cells or pus.” Blackheads are clogged pores that are open at the surface, which means the sebum and dead skin cells in the pore are exposed to the air, explains Dr. Robinson. The oxidation that happens when exposed gives it the signature black color. To get rid of whiteheads and blackheads, try incorporating salicylic acid into your skincare routine. “It works to exfoliate the skin, removing dead skin cells and keeping pores open and clear,” says Dr. Robinson. The Neogen Pore Zero Peeling Mousse ($30; neogenlab.us) is the latest vegan iteration of the brand’s TikTok viral Pore Tight Peeling Mousse and helps remove blackheads, whiteheads, dead skin, dirt, and impurities for a smooth-looking complexion. It’s important to note that because blackheads are open, they usually respond quickly to chemical exfoliants, like salicylic acid. Sometimes, whiteheads require a bit more time and patience, says Dr. Robinson. If you aren’t noticing any significant changes to your whiteheads after about a couple of weeks, she recommends using retinol, which is also helpful at removing dead skin cells. If you don’t know where to start, a fan-favorite you can try is the Shani Darden Skin Care Retinol Reform ($88; sephora.com), which reviewers at Sephora say is worth every penny.
Papules:
Papules typically appear as red or pink bumps caused by inflammation. “When the pore becomes clogged with sebum, dead skin cells and bacteria push deeper into the skin, causing redness and swelling,” says Dr. Robinson. “At the skin’s surface, you will see small, red bumps that are often hard and painful to the touch.” In addition to salicylic acid, benzoyl peroxide can also help reduce swelling and kill bacteria within the skin. “Benzoyl peroxide works in multiple ways to fight acne,” says Dr. Levin. “It can deliver oxygen into the pores, which are where P. acnes, the bacteria that naturally reside in the pores, lives.” She explains that this bacteria loves oily conditions without oxygen, so when benzoyl peroxide delivers that oxygen, it stops the bacteria from growing and multiplying. The American Academy of Dermatology (AAD) recommends using a benzoyl peroxide-infused face wash twice daily. The CeraVe Acne Foaming Cream Cleanser ($12, amazon.com) is an affordable and effective option that doesn’t dry out the skin.
Pustules:
“These acne lesions are a lot like papule, however, they contain pus, and so you’ll notice a yellow-colored center around the lesion’s head,” says Dr. Robinson. These are the pimples that you may want to pick at to get out the pus, but Dr. Levin says that’s the last thing you should do. “Resist the urge to pick because it will make it worse and cause post-inflammatory hyperpigmentation that makes the mark last for months,” she says. The treatment for pustules is the same as papules, but with more frequency. Try using a chemical exfoliant and retinol once to twice a week into your routine. Be sure to rotate between the two so as not to aggravate the skin even more. “While not all retinoids are the same, Differin Gel ($13; amazon.com) was designed with tolerability in mind, so it is a great starter retinoid for sensitive adult skin,” says Dr. Levin. If you aren’t seeing results from topical skincare products, you can also schedule an appointment with your dermatologist to get an in-office red and blue LED light therapy treatment. “This has an anti-inflammatory and anti-microbial benefit, which reduces the bacterial element of this type of acne,” says Dr. Robinson.
Nodules and Cysts:
According to the AAD, these inflammatory acne blemishes penetrate deep into the skin and often cause permanent scarring. If the treatments for papules and pustules are not effective, then a dermatologist may prescribe oral medications to deal with this type of acne. “For the right candidates, I will prescribe oral isotretinoin—aka Accutane,” says Dr. Robinson. “While the drug is controversial, it has great benefit for this type of acne, which can otherwise plague patients for many years and leave behind scars.” Dr. Levin says some quick fixes to this type of acne can be corticosteroid injections, which decrease inflammation to reduce the size and pain, and extractions, to remove deep-rooted cysts or inflamed pimples. In addition to these treatments, both dermatologists say lifestyle changes can help improve inflammatory acne, too. “The data and research currently state that a diet that has a high glycemic index (elevate blood sugar levels) can increase the risk of acne along with dairy products due to hormones given to cows,” says Dr. Levin. Managing stress is also important. “When we are stressed, our cortisol levels spike and cause an inflammatory response, which fuels inflammatory types of acne,” says Dr. Robinson. While lifestyle changes may not be a cure-all for some, it’s worth trying to see if there is any benefit or improvement with acne. If you’re not seeing any improvements to your acne or aren’t sure which type of acne you’re dealing with, Dr. Levin says it’s always best to consult with a medical professional. “Seeing a board-certified dermatologist will assist in the proper diagnosis of the type of acne as well as potentially other inflammatory disorders, such as rosacea or perioral dermatitis that may look like acne but is a completely different diagnosis and requires different treatment.”
