Acne is one of the top three most common skin disorders in the US, with approximately 85% of people aged between 12 and 24 years¹ experiencing acne at some point.
Acne bumps, also called hard pimples, are caused by buildup of dead skin cells, sebum (a naturally secreted oil that lubricates your skin and hair), and bacteria in the pores of hair follicles on your skin.
Acne bumps can be painful, as well as not being particularly aesthetically pleasing. If you experience acne bumps or hard acne, it is important to consult a healthcare professional for the right treatment as they can result in scarring if not managed properly. Read on to find out what causes hard pimples and how you can treat them effectively.
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Acne bumps form when the pores on your skin or hair follicles become blocked. Pores and follicles can become blocked by a combination of dead skin cells and sebum, a naturally secreted oil that lubricates your skin and hair to keep them healthy. Sebum production can increase in response to hormonal changes, especially during puberty¹.
When pores are blocked, they may become infected with a bacteria called Propionibacterium acnes, which leads to inflammation. Increased sebum levels also create an environment that promotes the growth of Propionibacterium acnes.
Acne bumps can take a range of forms:
See the table below in this article for more information about the different types of acne.
Although acne most commonly appears in adolescents, it can strike at any age. When acne appears after age 25, it is called adult acne.
While adult acne may present in somewhat different ways to adolescent acne, as adult acne tends to be located in the lower third of the face and along the jawline, they share many of the same causes.
Common causes of acne bumps and hard pimples include:
During puberty, the release of hormones causes excess sebum production, resulting in more blocked pores and an increased likelihood of infection with the bacteria Propionibacterium acnes.
Certtain medications may cause acne bumps, such as corticosteroids and anabolic steroids. Testosterone and certain hormonal contraceptive medications can cause acne flare-ups.
If you have a family history¹ of acne, you are more likely to develop acne. The severity of your acne bumps and hard pimples is also influenced by your genes.
Numerous studies¹ have shown that stress exacerbates acne bumps, which may be related to the release of local neuropeptides during stressful times.
Cosmetics, such as make-up and face creams, that block pores or that have a high oil content can contribute to the formation of acne bumps and hard pimples.
6. Hormonal fluctuations
Changes in hormone levels after puberty also contribute to acne. For women, these hormonal fluctuations can occur before your period or during menopause, for instance.
7. Polycystic ovarian syndrome (PCOS)
Acne is a common symptom in women who have PCOS, which is likely due to the increased androgen levels associated with the condition. Many women with PCOS experience facial acne, while up to 50% of women with PCOS also have acne bumps and hard pimples on their chest, neck, and upper back.
The type of acne bumps you have, their severity, and their causes determine the kind of treatment required. The following table can help you to identify if your acne bumps are mild, moderate, or severe²:
Mild acne bumps
If you have a mild case of acne on your face or body, topical treatments that you apply to your skin are usually enough to treat it. A topical treatment acts by drying out your pimples, unblocking your pores, or fighting infection.
Topical treatments include:
Benzoyl peroxide cream — Kills bacteria, reduces inflammation, and unclogs pores.
Salicylic acid cream — Removes dead skin cells to prevent further pore blockages.
Tretinoin cream — Prevents pores from becoming blocked.
Adapalene gel — Prevents pores from becoming blocked.
Antibiotic cream or lotion — Eliminates acne-causing bacteria.
Moderate acne bumps
Moderate acne is usually effectively treated with a combination of topical and oral treatment.
Topical treatments may include:
Benzoyl peroxide cream — Eliminates bacteria and unclogs pores.
Tretinoin cream — Prevents pores from becoming blocked.
Antibiotic cream or lotion — Kills acne-causing bacteria.
Oral treatments used in conjunction with topical treatments may include:
Antibiotics — These may need to be taken for up to 12 weeks to be effective.
Combined oral contraceptive pill — For women, some forms of this treatment can be effective.
Severe acne bumps
If you are experiencing severe acne bumps or hard pimples, oral isotretinoin is commonly prescribed for effective treatment. This type of medication works by targeting all causes of acne simultaneously by reducing excess oil production, acne-causing bacteria, and inflammation, and unclogging pores. However, oral isotretinoin is associated with potentially severe side effects so it should always be prescribed and monitored by a healthcare professional. The most severe side effect is that it can cause birth defects, so women taking oral isotretinoin are advised to use two forms of effective contraception to prevent pregnancy.
Spironolactone, a drug that inhibits aldosterone production, can also be used for the treatment of moderate to severe hard pimples in women.
Your doctor can treat cystic acne bumps by injecting corticosteroids into the cysts.
Whatever type of acne bumps or hard pimples you have, make sure to avoid cosmetics and face products with a high oil content as they can lead to blocked pores and aggravate your acne. Instead, opt for water-based solutions. It’s a good idea to stick to products described as non-comedogenic, non-acnegenic, or oil-free. You should also avoid antibacterial or abrasive soaps, alcohol pads, and heavy exfoliation which may damage your skin and cause your acne bumps to become infected.
If your acne bumps don’t resolve with topical treatment, you should see your doctor for a diagnosis and proper treatment. Although acne is common, it is important to make sure your acne is not caused by an underlying medical condition.
Chloracne is a rare skin condition characterized by blackheads, cysts, and nodules. It has been linked directly to dioxin exposure. Dioxin is a major component of Agent Orange. Although chloracne lesions can appear similar to normal acne bumps, the pathology is different and there is a direct link to dioxin or halogenated polycyclic hydrocarbon exposure.
Rosacea is another condition that is characterized by reddening of the skin over the central part of the face and the formation of pimples and pustules. Rosacea bumps can look like hard pimples, but the treatment plan can be different.
Sometimes, certain types of skin cancer, such as basal cell carcinoma, can give the appearance of an acne nodule or cyst.
Acne bumps or hard pimples form when pores or hair follicles in the skin become blocked with sebum and dead skin cells. These blocked pores may then become infected by the bacteria Propionibacterium acnes. Acne comes in multiple forms and ranges in severity. Treatment depends on the type of acne you have, how severe it is, and its causes.
Your doctor or healthcare professional may prescribe topical treatment only, or a combination of topical and oral medication. If you have deep cysts or nodules, your doctor may need to inject them with corticosteroids or drain the cysts. You can also take simple measures, such as using an appropriate cleanser and avoiding cosmetics that block your pores, which may help to prevent the formation of acne bumps.
If your acne does not respond to treatment, make sure to consult your doctor to assess whether there are any other potential causes.