Millions of people experience acne but most don’t know much more than that. Did you know there are different types of acne? And different reasons for its presentation.

So what are the different types of acne? Three main variations characterize the acne you might be experiencing.

Comedonal Acne

Comedonal acne refers to the development of comedones — small flesh-colored blemishes on the skin, known as papules or acne blemishes. These bumps occur as a result of oil and dead skin buildup stuck in hair follicle openings and pores.

While most people associate acne with breakouts, comedonal acne often results in very little inflammation. The condition ranges from mild to severe, with mild symptoms resulting in only a few occasional blemishes and severe symptoms covering larger areas, sometimes the face, back ("backne"), chest ("chestne"), and shoulders. 

When identifying comedonal acne, two types of comedones can be present: closed (whiteheads) or open (blackheads).

Whiteheads

Whiteheads, or closed comedones, are the result of clogging through the entire pore. The entire length of the pore is closed and essentially capped off by a thin layer of skin, resulting in a white bump on the surface. While tempting, do not pop or squeeze closed comedones; doing so can result in scarring.

Blackheads

Blackheads, or open comedones, appear black on the skin's surface because the gunk clogging the pore oxidizes when exposed to air. Unlike whiteheads, open comedones do not have a layer of skin preventing air from contacting the plug.

It is possible to squeeze blackheads out and remove them, but it’s not recommended. As with whiteheads, using force can result in scarring or damage to the skin’s surface, so it’s best to consult a professional.

Treatment Options

Comedonal acne is often the result of excessive sebum production from the sebaceous glands, and because of this, over-the-counter treatment options may only result in temporary relief. There are times when a stronger medication or treatment is necessary to resolve acne for good. Treatment options, whether prescription or over-the-counter, come in two varieties: topicals and oral medications.

Topical treatments are applied directly to the face. These creams and washes help to unclog pores and control excessive sebum production. Typical ingredients in topical therapies include:

• Benzoyl peroxide
• Salicylic acid
• Azelaic acid
• Sulfur
• Glycolic acid
• Retinoids

If you need something stronger than store-bought treatments, consider talking to a dermatologist about a prescription. The medications can come in topical or oral forms. The most commonly prescribed medications for comedonal acne include:

• Isotretinoin
• Spironolactone
• Antibiotics
• Oral contraceptives

If over-the-counter options or prescription medications do not work, a dermatologist might recommend procedures, especially if the comedonal acne is severe. The periodic interventions might include the physical removal of comedones using needles and small blades, microdermabrasion, or cryotherapy.

Inflammatory Acne

When considering the different types of acne, you’ll come across a couple of terms: inflammatory and noninflammatory acne. Comedonal acne is noninflammatory and does not typically have bacterial concerns. Inflammatory acne, on the other hand, goes beyond the typical clogged pores of other acne varieties.

Inflamed acne is more resilient and can lead to redness and swelling. While the pores are also clogged, these clogs tend to sit well below the skin's surface, allowing bacteria to settle. When identifying inflammatory acne, dermatologists look for pustules and papules.

Pustules

Typically found in clusters on the back, chest, or face, pustules are formations surrounding an infected pore. The blemishes are small, red bumps with a white center. The surrounding skin is usually inflamed. While hormonal changes can also cause pustules, they tend to stem from infections. Therefore, while tempting, do not pop them, as popping can allow the infection to spread. It’s best to let a dermatologist drain the pustules.

Papules

Often caused by the bacteria Cutibacterium acnes, papules are small red bumps on the skin’s surface. Sometimes excess skin and oils block a pore, forcing the contents of the pore, including the bacteria, to pour out onto the surrounding skin, creating an inflamed lesion instead of a pus-filled growth.

Treatment Options

While inflammatory acne can evolve into severe acne conditions, it is possible to deal with the condition with over-the-counter treatments if caught early enough. In fact, many dermatologists prefer to start patients with these readily available options before looking into more substantial medications.

When looking for over-the-counter acne treatment, it’s necessary to pay attention to the ingredient label. To treat inflammatory acne, you should look for a treatment containing the following main ingredients:

• Salicylic acid
• Benzoyl peroxide
• Sulfur

Depending on the extent of your acne and its severity, a dermatologist might suggest the immediate use of prescription medication. These treatments come in various forms but most often are topical creams or oral medications. There are five treatments typically used to treat inflammatory acne:

1. Oral isotretinoin
2. Topical retinoids
3. Topical antibiotics
4. Hormonal treatments
5. Oral antibiotics

Nodulocystic Acne

Myths plague nodulocystic acne. This form of acne presents with cysts and nodules on the face, neck, shoulders, chest, or back. Many people believe this severe form of inflammatory acne results from poor hygiene, poor diet, or some type of contagious interaction. 

None of these are accurate. 

Research actually points to a genetic cause in the development of severe acne, meaning if a child’s parents experienced bad acne, the child is likely to experience it as well. Studies also suggest nodulocystic acne is more likely to affect boys and men than girls or women.

Unfortunately for those suffering from nodulocystic acne, it’s a painful condition. Nodulocystic breakouts result in deeper and larger pimples, and as a progression of inflammatory acne, the blemishes contain a bacterial element. If you’re experiencing or suspect nodulocystic acne, seek treatment from a licensed dermatologist. 

Cysts

While similar to pustules, cysts are much bigger. Because of the size and potential infection, cysts tend to be more painful than other pimples and can even become itchy. As with all forms of acne, it’s best to leave the cysts to the professionals and refrain from popping them on your own and risking scarring.

Nodules

Nodules develop under the surface of the skin, never forming a head. Because they do not form a head, nodules can become incredibly painful. While some people try DIY methods for relief, it’s best to seek help from a dermatologist. Using professional tools like cortisone shots, a trained doctor can provide effective relief.

Treatment Options

Nodulocystic acne can lead to scarring because of the size and depth of the breakouts. Unfortunately, over-the-counter treatments are not effective options for this type of acne. 

A dermatologist can help, prescribing topical treatments such as retinoids or antibacterial creams when necessary. It’s not uncommon for a dermatologist to also prescribe oral medications, depending on skin sensitivity.

If necessary, cortisone shots or corticosteroid injections might be used to relieve pain from severe blemishes quickly. It’s crucial to understand that cortisone shots are only used in emergencies to relieve pain. These shots do not and cannot treat the underlying condition, only individual blemishes.

Understanding what are the different types of acne is only the first step to finding the right treatment options for your acne. Nava MD has made dermatology visits easier, cheaper, and faster than ever… because it’s all done online. With Nava MD, your visit begins with a medical intake form that gives our dermatologists the background information they need. You provide a photo of your condition, and your situation is evaluated by one of our board-certified dermatologists. If appropriate, they can prescribed a custom prescription treatment that’s delivered to your door, with ongoing followup and the ability to contact your dermatologist through our Member Portal. 

It’s simple and effective. Get started with telemedicine from Nava MD by clicking here.