A blemish is an area of imperfection on the skin, appearing as a mark or discoloration, and can be a flat, raised, or depressed spot. Blemishes on the face can make one self-conscious and can affect an individual’s confidence.
There are different types of skin blemishes and each one can have different causes behind it. In most cases they’re harmless. However, sometimes they might indicate some serious underlying skin condition.
Table of Contents
Types
A blemish is a broad term used to describe any skin spot or imperfection that appears different from the rest of the skin. Blemishes are of several types and can be grouped based on their color, such as:
- Red blemishes are usually seen due to acne, rashes, rosacea, allergies, and sometimes skin cancers.
- White blemishes can occur due to pustules or pus-filled bumps, milia, vitiligo, tinea versicolor, and so on.
- Brown or dark blemishes can occur due to melasma, acne marks, age spots, moles, skin cancers like melanoma, etc.
- Black blemishes can occur due to moles, blackheads, acanthosis nigricans, melanoma, etc.
Below, you will find details about 10 common skin blemishes on the face, along with their pictures.
1. Acne
Acne blemishes are among the most common types of blemishes seen on the face. Acne can be divided into two types: inflammatory and non-inflammatory.
Non-inflammatory acne does not lead to redness or swelling and includes:
- Blackheads (Open comedones): These occur when pores are clogged by sebum and dead skin cells. The top of these clogged pores is open, causing the material inside to oxidize, which gives the appearance of a black spot.
- Whiteheads (Closed comedones): These are formed when pores are clogged by skin oils and dead skin cells. The top of the pore is closed, making it appear like a white bump on the skin.
Inflammatory acne is characterized by redness and swelling due to inflammation and includes:
- Papules: These are red bumps caused by inflammation surrounding blocked pores.
- Pustules: These are pus-filled bumps with an area of redness around them.
- Nodules: These are large red bumps present deep in the skin that are often tender to touch.
- Cysts: These are large, painful, pus-filled bumps that extend deep into the skin.
2. Skin rashes
There are several different skin rashes that can lead to visible marks on the face. Each of them may have a different cause and can present differently.
The common skin rashes are :
- Seborrheic dermatitis: This results in red areas with greasy yellow scales. It commonly involves areas between eyebrows and nasolabial folds.
- Psoriasis: This can lead to red plaques covered with silvery scales.
- Atopic dermatitis: This results in dry, red, and scaly patches.
- Rosacea: This is characterized by flushing, papules, pustules, and broken capillaries.
- Perioral dermatitis: This causes a rash around the mouth.
- Bacterial or fungal infections: The presentation will depend on what’s causing the infection.
- Cold sores (Fever blisters): These result in blisters, usually seen on the lips.
- Contact dermatitis: The skin can become itchy, dry, ooze, or crack.
- Malassezia folliculitis: It appears as small red bumps in clusters that itch.
- Heat rash: It is a fine red rash.
- Lupus: It can cause a rash on the face in a butterfly pattern involving cheeks and nose.
3. Milia
Milia are 1–2 mm small pearly white bumps that contain keratin (a protein found in the skin). These are more common in neonates (small babies) but can occur in adults as well.
Common causes are injury or trauma, some topical medications like steroids, some procedures like resurfacing, skin rashes, and the use of thick occlusive ointments.
4. Birthmarks
Birthmarks are blemishes that are present since birth or appear shortly after birth:
They can be:
- Pigmented lesions due to excess pigment like congenital moles.
- Vascular lesions due to abnormal blood vessels. These include:
- Salmon patches
- Hemangioma
- Port-wine stain
5. Broken capillaries
Broken capillaries are dilated blood vessels under the skin and can very commonly lead to blemished cheeks. These can appear as red blemishes in lighter skin tones and as brown or dark blemishes in darker skin tones.
It can occur due to an underlying skin condition rosacea, physical trauma, or sun damage.
6. Hyperpigmentation
Hyperpigmentation refers to excess melanin pigment resulting in dark spots or brown patches. It can happen due to a number of causes.
- Post-inflammatory hyperpigmentation: This type of hyperpigmentation develops due to inflammation or injury which heals leaving behind excess pigment. It often occurs after acne, skin rashes, and physical trauma.
- Melasma: This is a type of hyperpigmentation in which you see symmetrical dark patches on the cheeks, nose, and other parts of the face. Hormones and sun exposure are implicated in the development of these.
- Age or sun spots: These are dark spots that develop due to prolonged sun exposure. These are often seen in people over 50 years of age.
7. Hypopigmentation and depigmentation
Hypopigmentation refers to the decrease in melanin pigment and depigmentation refers to the complete loss of melanin pigment. These can result in white patches or spots.
- Certain fungal infections like tinea versicolor can result in hypopigmented patches.
- Some procedures or topical medications like hydroquinone can also result in areas of hypopigmentation.
- Vitiligo is a skin condition in which there is a loss of melanin pigment.
8. Scars
Scars can develop after an injury, infection, burn, or wound. Though scars are part of the natural healing process of the skin, they can result in raised or depressed areas.
Acne can result in different types of scars. Atrophic scars develop due to decreased collagen production and hypertrophic scars develop due to excess collagen production.
9. Cysts
Cysts are sacs filled with material or substance, and these are usually present under the skin. They may or may not have an opening on the surface. There are different types of cysts; some of which can be seen on the face are:
- Epidermoid cysts are small bumps due to the proliferation of squamous epithelial cells. They usually contain keratin debris.
- Dermoid cysts have squamous epithelial cells along with other skin structures such as hair and sweat glands.
10. Skin Cancer
Rarely, skin cancers can appear as blemishes. Sometimes one can have precancerous lesions like actinic keratosis which can appear as rough scaly patches.
Skin cancers can grow quickly or show changes in color. It includes:
- Squamous cell carcinoma
- Basal cell carcinoma
- Malignant melanoma
Causes
There are several causes behind blemishes.
1. Sun exposure
Exposure to sun rays can lead to various skin blemishes and can also worsen some skin conditions.
- Sun exposure can lead to age spots, some precancerous or cancerous lesions, and broken capillaries.
- It can worsen skin conditions like dark spots, melasma, and certain skin rashes like psoriasis, rosacea, and lupus.
2. Hormones
Hormones can directly affect our skin in many ways.
Melasma is triggered by hormonal changes during pregnancy, with oral hormones or tumors that secrete hormones. In some cases, when this trigger is removed melasma improves. Like some people develop melasma during pregnancy but it goes away after the baby is born.
Hormones (androgens) can directly affect the sebum secretion of our skin. Excess oil is linked to acne blemishes.
3. Blocked pores
Clogging of pores with dead skin cells is one of the causes of acne. When these dead skin cells mix with oil, it can lead to blackheads or whiteheads.
4. Infections
Infection by bacteria, fungi, or viruses can lead to several different kinds of blemishes. These include
- Cold sores due to herpes virus (type 1).
- Chickenpox due to varicella-zoster virus.
- Seborrheic dermatitis due to excess Malassezia (fungi).
- Malassezia folliculitis or fungal acne due to fungi Malassezia.
- Bacterial infections like impetigo.
5. Immune dysfunction
Sometimes our immune cells attack our own skin cells resulting in autoimmune skin conditions like psoriasis, vitiligo, and lupus.
6. Contact with an allergen or irritant
When our skin comes in contact with an allergen or irritant, it can lead to contact dermatitis.
- Common allergens are:
- Mold
- Metals like nickel
- Dust
- Poison ivy
- Common irritants are:
- Detergents
- Fragrance
- Dyes
- Hair products
7. Picking on skin
Picking or rubbing skin aggressively can lead to areas of hyperpigmentation. It also increases the chances of scar formation and telangiectasia (broken capillaries).
8. Stress
Stress can lead to a flare of certain skin rashes like psoriasis, seborrheic dermatitis, atopic dermatitis, and rosacea.
9. Genetic factors
Certain skin blemishes have a role of genetics behind them. Atopic dermatitis, psoriasis, and a few skin cancers are some of them.
10. Harsh skincare products
Harsh skin care products and strong actives when used incorrectly can lead to skin barrier damage and post-inflammatory hyperpigmentation.
11. Heat
Heat can lead to heat rash due to the blockage of sweat glands. Heat can also lead to photosensitive reactions and can worsen some skin conditions like melasma and rosacea.
12. Diet
High glycemic foods may lead to acne breakouts. If you are allergic to a food, it can result in a skin rash or hives.
13. Medications
Some medications can result in acne-like breakouts and photosensitive reactions. Topical steroids are associated with perioral dermatitis.
How to get rid of them
The treatment of blemishes will depend on the underlying cause. Below are the ways that can help in removing blemishes or in improving their appearance.
1. Sun protection
Protecting skin from sun rays is very important to prevent and treat blemishes. Using sunscreen alone can result in faster fading of dark spots.
- Use a broad-spectrum sunscreen that protects from both UVA and UVB rays.
- Avoid sun exposure during peak hours – 11 a.m. to 3 p.m.
- Avoid direct sun rays when possible.
- Use sun-protective clothing.
Iron oxides and antioxidants can protect our skin from high-energy visible light which can cause hyperpigmentation and erythema or redness.
2. Moisturizer
Skin barrier dysfunction can be the underlying cause behind several skin conditions and a moisturizer can help heal our skin barrier. It can also help us tolerate other prescription medications.
3. Acne treatment
Treatment of pimple blemishes will depend on the type of acne and its severity.
- Mild acne can be treated with over-the-counter topicals like retinol, adapalene, benzoyl peroxide, and salicylic acid.
- Benzoyl peroxide can be particularly useful for inflammatory acne.
- For moderate to severe acne, one will need prescription-strength retinoids like tretinoin or trifarotene Sometimes, the oral form of Vitamin A, isotretinoin, is prescribed for severe acne.
- Oral contraceptives can be prescribed for hormonal acne.
Related: How to remove blackheads
4. Hyperpigmentation treatment
There are several ingredients that can be useful for hyperpigmentation and the good news is many of them are available over the counter. These include:
- Retinoids
- Arbutin
- Azelaic acid
- Tranexamic acid
- Niacinamide
- Vitamin C and its derivatives
- Kojic acid
- Hexylresorcinol
If your dark spots do not respond to over-the-counter treatment, a doctor can prescribe hydroquinone, used alone or in combination with a steroid and retinoid (triple therapy).
Resistant cases of hyperpigmentation can be improved with:
- Laser Treatment
- IPL Treatment
- Microdermabrasion
- Chemical peels
5. Over-the-counter dandruff shampoos
Over-the-counter dandruff shampoos can be beneficial for seborrheic dermatitis, psoriasis, tinea versicolor, or fungal acne. They have ingredients that can target the fungi Malassezia or decrease the build-up of dead skin cells. Common ingredients found in these shampoos are:
- Zinc pyrithione
- Salicylic acid
- Coal tar
- Ketoconazole
- Piroctone olamine
6. Vitiligo treatment
This skin condition cannot be cured. However, some treatments can give positive results like topical steroids and immunosuppressants.
7. Skin rashes treatment
The treatment of skin rashes will vary depending on the cause. The commonly prescribed topicals are steroids and immunosuppressants.
If an infectious agent is suspected, an appropriate antibiotic, antifungal, or antiviral may be prescribed.
8. Birthmark treatment
Most birthmarks are not serious, however, some birthmarks may increase the chances of certain cancers.
Some of these can go away by themselves. A few will need treatment like:
- Laser therapy
- Surgical treatment
9. Broken capillaries treatment
Topical treatments do not work for telangiectasia. One will need in-office procedures like lasers to get them treated. They may come back so it is important to include preventative measures like gentle skin care and sun protection.
10. Milia treatment
In some cases, milia will go away by themselves. Retinoids and salicylic acid can be beneficial in getting rid of them. They can be extracted by a doctor as well.
Note: Do not try to pop milia, as it can lead to scarring and infection.
11. Scar treatment
Scar treatment will depend on the type of scar. Retinoids like adapalene and alpha hydroxy acids can be beneficial for acne scars.
In addition, one may need in-office treatment which may include:
- Steroid injections
- Laser treatment
- Dermabrasion
- Chemical peels
- Micro-needling
- Fillers
- Excision
12. Cysts treatment
Cysts do not need treatment unless they cause discomfort or someone wants to get rid of them for cosmetic reasons. The cysts can be drained or the entire cyst along with its wall is removed with a minor surgery.
13. Skin cancer treatment
Skin cancers need appropriate treatment depending on their size and extent of spread. Treatment can include surgical excision, chemotherapy, or radiotherapy.
When to see a doctor
One should consult a doctor and get the blemishes checked immediately if there is:
- A sudden increase in size
- Change in color
- Irregular borders
- Visible pus
- Fever
- Eye irritation
- Symptoms involving other organs in addition to skin rash
Prevention
1. Gentle skincare routine
Being gentle with the skin is the first step in preventing the formation of blemishes.
- Use a pH-balanced cleanser so that it doesn’t strip your skin barrier.
- Use a moisturizer to seal in the moisture.
- Use actives like retinoids and exfoliants with care.
- Do not scrub or rub your face too aggressively.
2. Sun protection
Always protect your skin from the sun. Use broad-spectrum sunscreen, sunglasses, and sun-protective clothing.
3. Avoid triggers
If your skin gets irritated by certain ingredients or products, avoid the use of them.
4. Avoid picking on the skin
Avoid touching or picking on the skin as it can lead to the spread of infection or can lead to scarring.
5. Diet
Diet can impact our skin as well. Include foods rich in essential fatty acids like fish, nuts, and seeds, and antioxidant-rich foods like blueberries, strawberries, and green tea.
Certain foods can trigger some skin rashes like spicy food and alcohol can lead to a rosacea flare. So, avoid these foods.
6. Stress management
Stress management can help improve our skin and overall health. Use meditation, breathing exercises, and music to de-stress. Always aim to get 6-8 hours of sleep every day.
FAQs
Do blemishes go away? Many blemishes go away over time. However, some can take a long time and some will need treatment in a doctor’s office.
What is the difference between blemish and pigmentation? Blemish is a broader term for all the marks on the face. So, pigmentation is a type of blemish.
What is the difference between acne and blemish? Just like pigmentation, acne is a type of blemish. However, every blemish is not acne. There are many different kinds of blemishes.
Summary
Blemishes are marks or imperfections on the skin that can occur due to a variety of causes. Common types of blemishes usually seen on facial skin include acne, dark spots, white or hypopigmented spots, milia, rashes, cysts, birthmarks, scars, and, rarely, cancer.
In most cases, blemishes are harmless, but they can also be indicators of skin conditions such as lupus or skin cancer.
If you are uncertain about what is causing blemishes on your skin, it is important to have them examined by a doctor for proper diagnosis and treatment.
References
- Sutaria AH, Masood S, Schlessinger J. Acne Vulgaris. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Cutaneous cysts and pseudocysts. Dermnet NZ.
- Birthmarks. NHS.
- Gruber P, Zito PM. Skin Cancer. [Updated 2021 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.