Acne is not a one-size-fits-all condition. There are several types, and what kind of acne you have will determine the treatment you should try.
This brief acne guide will tell you what type of acne you have and what you can do to treat it.
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Acne is a common skin condition worldwide. It occurs when hair follicles get clogged, producing pimples on your face, chest, and other parts of your body. They come in different shapes and sizes, depending on how they’re caused and where they form in your skin.
You may have different types of acne at the same time or on separate occasions. Here are the types you may have at some point in your life.¹
Named for their characteristic white top, whiteheads are closed pimples that occur when a pore becomes blocked by dead skin cells, sebum, and bacteria. Whiteheads are typically not inflamed or sore to the touch.
Like whiteheads, blackheads are also formed by dead skin cells, sebum, and bacteria blocking a pore. They are also not likely to be inflamed or infected.
Blackheads have a black top because the pimple is open, and the tip of the blockage inside the pimple has oxidized upon contact with oxygen and turned black.
Pustules occur when a blocked pore has become infected. This type of pimple will contain pus and likely be red, inflamed, and sore to the touch.
Pustules tend to have a white tip like whiteheads but are distinguishable by the red ring that surrounds them.
Papules are small raised bumps that are often red and inflamed. This type of acne can look like a rash and develop into a pustule.
Fungal acne occurs when there is an excessive amount of yeast in hair follicles. Fungal acne tends to be uniform in shape and size and appears in clusters of typically small, itchy, pus-filled pustules. Fungal acne will not respond to typical acne treatment.
Nodules are small and solid pimples that form deep in your skin. This type of pimple doesn’t have a head and cannot be popped. They are thought to occur thanks to a buildup of dead skin cells and acne bacteria. As they get bigger, nodules can start to become red.
Cysts are pus-filled pimples that form deep underneath the skin. They develop when dead skin cells, sebum, and bacteria get trapped deep within your pores.
Cysts tend to be more common in teens and people undergoing hormonal changes. They tend to be red and painful to the touch and can develop a white top as they extend out.
The best way to figure out what type of acne you have is to look at the structure of your pimples and compare them to the list above. It’s important to remember that you can experience different types of pimples at the same time, so you should evaluate new blemishes as they occur.
If you’re struggling to figure out exactly what type of acne you’re experiencing, consult a dermatologist for proper treatment.
Benzoyl peroxide is an over-the-counter topical acne treatment that you can purchase at any pharmacy.² It is a great spot treatment for pimples caused by the acne bacteria C. acnes due to its ability to target and kill the pimple-causing bacteria.
Research shows that benzoyl peroxide can significantly reduce the amount of C. acnes on the skin, helping to reduce the development of pimples. It is toxic to the acne bacteria, which is important as it means C. acnes is unlikely to become resistant to benzoyl peroxide, as it can be to antibiotics.
Benzoyl peroxide is effective for whiteheads, blackheads, and pustules.
Antibiotics are a common treatment option for patients looking to get their acne under control. Tetracycline antibiotics are commonly used for acne specifically; they target C. acnes, the bacteria that cause pimple formation.
While oral antibiotics have been used for decades as an acne treatment, there is some concern that they could lead to antibiotic resistance.³ Before starting treatment, discuss this issue with your doctor.
Other side effects to consider before starting antibiotics for bacterial acne include increased susceptibility to sunburn, nausea, vomiting, and diarrhea. Tetracycline antibiotics, in particular, should be avoided when pregnant due to their ability to impair bone growth.
Antibiotics are effective for all bacterial acne, including cysts, pustules, and whiteheads.
Salicylic acid is an effective exfoliant acne treatment for most types of pimples. It is a beta-hydroxy acid that dissolves dead skin cells, making it a key anti-acne ingredient as dead skin cells often block pores and lead to the development of acne.
Research has shown that regular use of salicylic acid can significantly reduce pimple development.⁴ While it is safe to use, it can make your skin more sensitive, so it’s advisable to ease it into your routine by using it only once or twice a week.
Salicylic acid can also make your skin more sensitive to light, so take care to always wear sunscreen while using it.
Salicylic acid is effective for whiteheads, blackheads, pustules, nodules, and cysts.
Oral contraceptive medicine
Oral contraceptive medicines are a great acne treatment option for women. These contain both estrogen and progestin hormones that have been found to help treat acne, thanks to their ability to reduce androgen, the male sex hormones that increase sebum production and pimple development.
There is ample evidence for the effectiveness of oral contraceptives as an acne treatment.⁵ One study found that estrogen-progestin birth control effectively reduced both inflammatory and non-inflammatory acne blemishes.
Oral contraceptives are effective for cysts, nodules, pustules, papules, whiteheads, and blackheads (for women only).
Niacinamide is a common skincare ingredient that is a derivative of vitamin B-3. When applied to the skin, niacinamide has been found to:
Regulate oil production, helping reduce the amount of sebum that clog your pores and cause pimples
Hydrate the skin by improving your lipid barrier, the part of your skin that helps it retain moisture and function at its best (i.e., not developing pimples)
Reduce inflammation and the size of pimples⁶
Niacinamide is effective for whiteheads, blackheads, cysts, and nodules.
Blue light therapy
Blue light therapy uses UVB blue wavelength range light to treat acne.⁷ Blue light is readily absorbed by particular antioxidants and helps destroy acne-causing bacteria. Studies have shown that it can be effective in reducing inflammation and the number of pimples.⁸
Blue light therapy is effective for pustules, cysts, nodules, whiteheads, and blackheads.
Tretinoin belongs to the retinol family and is a form of vitamin A. Tretinoin can be taken orally or applied to the skin as a topical treatment to improve acne.⁹ It works by increasing cell turnover rate; pores will have less opportunity to become blocked, and skin cells will be healthier.
Tretinoin can be a strong medication and should be avoided by pregnant women and people with a history of depression. You may find that this treatment option appears to make your acne worse in the first few weeks.
This is known as the purge; it happens while your skin adjusts to the increased cell turnover rate. The purge should pass after a few weeks.
Tretinoin is effective for cysts, nodules, pustules, papules, whiteheads, and blackheads.
Spironolactone is a prescription-only medication that targets the hormones contributing to acne development. It blocks androgen production, which is a group of male sex hormones that have been linked to acne development.¹⁰ This is typically only prescribed to women for acne treatment.
Studies on spironolactone as an acne treatment show that women who received it for acne treatment saw a dramatic improvement in their skin condition.
Spironolactone is effective for cysts, nodules, pustules, papules, whiteheads, and blackheads (for women only).
A good rule of thumb is to see your doctor if your acne is impacting your life. Other signs you should look out for that might warrant a trip to the doctor or dermatologist is if your acne is persistent, severe, or resistant to all treatment options you have tried.
Acne can be a complicated condition to treat, but once you determine the type of acne that you have, you’ll be better positioned to treat your acne with targeted treatment.
Acne | Cleveland Clinic
Blue light acne treatment | DermNet NZ