The different types of acne are closed comedones, open comedones, papules, pustules, nodules, and cysts. One may have just one type or multiple types of acne lesions or pimples. Identifying the type of pimple can help us choose the right treatment.
Overview
Acne is a common name for acne vulgaris. Often, acne lesions are also called pimples. Acne is a very common cause of skin blemishes.
The main causes of acne include excess oil or sebum production, dead skin cell buildup which blocks the hair follicles, Cutibacterium acnes proliferation, and inflammation.
The interplay of these causes can lead to 6 different types of pimples or acne lesions. These 6 types can be grouped into two categories.
- Non-inflammatory acne lesions consist of open or closed comedones.
- Inflammatory acne lesions consist of papules, pustules, nodules, and cysts.
Based on the severity of acne, it can be divided into 3 types – mild, moderate, and severe.
Below you will find details about each type of acne (along with pictures).
1. Closed comedones (whiteheads)
Closed comedones, also known as whiteheads, are a type of acne that occurs due to the blockage of hair follicles by dead skin cells and/or excess oil.
The term “closed” refers to the fact that the top of the pore is covered with a layer of skin. This gives the closed comedones a white or flesh-colored appearance. This differentiates them from “open” comedones or blackheads, which are open on the surface and turn dark due to oxidation.
If closed comedones become inflamed, they can turn into inflamed acne lesions – papule or pustule.
It’s best not to squeeze or pick at these comedones, as it can lead to skin damage, scarring, or infection.
Treatment of closed comedones
Closed comedones are generally considered mild types of acne and can be treated with over-the-counter acne medications that can exfoliate the skin or regulate skin cell turnover.
The ingredients to look for are:
- Salicylic Acid: This beta hydroxy acid (BHA) is oil-soluble, which means it can penetrate the pores more effectively than water-soluble acids like glycolic acid. This makes it particularly effective at exfoliating the inner lining of the pores, helping to clear out dead skin cells and other debris.
- Retinoids: These vitamin A derivatives are effective at promoting cell turnover and preventing the clogging of hair follicles. This can help to prevent the formation of closed comedones. Over-the-counter available retinoids include adapalene 1% (Differin), retinol, retinal, etc. Retinoids can irritate, so start using them slowly. Here is an article on how to introduce retinoids in the skincare routine.
- Other ingredients: Benzoyl Peroxide and sulfur have both antimicrobial and keratolytic properties, meaning they can kill acne-causing bacteria and help exfoliate the skin. These can be useful for both inflammatory and non-inflammatory acne lesions.
2. Open comedones (blackheads)
Open comedones, also known as blackheads, form when a pore gets blocked by excess sebum and dead skin cells. Unlike closed comedones, the top of the pore is open, allowing the trapped sebum and skin cells to oxidize and turn black or dark brown.
One should not squeeze blackheads as it can lead to skin irritation, scarring, and enlarged pores.
Treatment of open comedones
Open comedones can be treated the same way as closed comedones. Both types of comedones result from clogged pores, so treatments that help to clear the blocked pores (like salicylic acid) or regulate skin cell turnover (like retinoids) can be effective.
Benzoyl peroxide and sulfur can also be helpful due to their keratolytic properties.
3. Papules
Papules are an inflammatory type of acne that presents as small, red, raised bumps on the skin. The blocked pores can get inflamed or can give a favorable environment for acne causing bacteria to grow leading to these types of pimples. These do not contain pus but can be sensitive to touch.
Treatment of papules
Over-the-counter (OTC) treatments containing benzoyl peroxide, salicylic acid, retinoids, or sulfur can help to reduce inflammation and clear up papules.
If these treatments are not effective, your doctor may recommend topical antibiotics, retinoids, oral antibiotics, or oral contraceptives.
4. Pustules
Pustules are a type of inflammatory acne that is filled with pus. They may appear as round lesions that are red at the base and filled with pus at the top (small red circles with a white center).
Treatment of pustules
Similar to papules, pustules can be treated with over-the-counter products containing benzoyl peroxide, salicylic acid, retinoids, or sulfur. If these treatments are not effective, your doctor may recommend topical antibiotics, retinoids, oral antibiotics, or oral contraceptives.
5. Nodules
Acne nodules are considered a severe form of acne. These occur when the clogged pores get inflamed and infected. The inflammatory reaction can damage the wall of the hair follicle leading to large red painful nodules.
Unlike pustules and papules, nodules are deeper beneath the skin. These are usually hard and tender to the touch.
Treatment of nodular acne
Nodular acne is usually more resistant to over-the-counter treatment options. One should see a doctor and get prescription medication to prevent permanent scarring.
Your doctor may recommend oral antibiotics, oral contraceptives, or an oral form of Vitamin A (called isotretinoin). Topical retinoids may also be prescribed to help prevent new nodules from forming.
6. Cysts
Cystic acne is a severe form of acne and is characterized by the presence of large, inflamed, pus-filled lesions deep under the skin. In comparison to nodules, these are soft to the touch. They can be painful and often lead to scarring.
Treatment of cystic acne
Like nodular acne, cystic acne does not usually respond to the over–the–counter medications. Your doctor may prescribe oral antibiotics, oral contraceptives, or isotretinoin.
In some cases, your doctor may treat them by directly injecting corticosteroids into the cysts. This can help in reducing inflammation and can prevent scarring.
Note: One should not squeeze or pop pimples, as this can lead to scarring.
Types of acne depending on the severity
The above-mentioned are the different forms of acne lesions. Acne is often classified by severity into mild, moderate, and severe categories, although there isn’t a universally accepted system for doing so.
1. Mild acne
Mild acne mainly consists of non-inflammatory lesions (whiteheads and blackheads), with a few inflammatory lesions (papules and pustules). The total lesion count is less than 30.
Treatment of mild acne
Treatment often involves topical therapies such as benzoyl peroxide, topical retinoids, salicylic acid, and in some cases topical antibiotics.
2. Moderate acne
Moderate acne refers to comedones with many inflammatory lesions – papules, pustules, and occasional nodules. The lesion count is between 30 and 125.
Treatment of moderate acne
Treatment may involve oral and topical therapies. Topicals include- benzoyl peroxide, topical retinoids, salicylic acid, and topical antibiotics.
Oral therapy includes antibiotics (like doxycycline or minocycline) to help reduce bacteria and fight inflammation, hormone therapy, or oral isotretinoin in resistant cases.
3. Severe acne
Severe acne often includes numerous deep, painful inflammatory lesions (nodules and cysts), along with many whiteheads, blackheads, papules, and pustules. The total lesion count is more than 125.
Treatment of severe acne
The treatment options may include oral antibiotics, hormonal therapy, such as birth control pills, or oral isotretinoin. Topical retinoids, while still used, are often not enough to treat severe acne on their own.
In-office procedures, such as cortisone injections, may be recommended for large and inflamed cysts.
Other treatments
Other in-office procedures that may be recommended for treating different acne lesions include:
- Light therapy
- Chemical peels
- Extraction
Look-alikes
Several other types of skin conditions can lead to pimple-like rashes or acne-like bumps.
These include rosacea, perioral dermatitis, folliculitis, keratosis pilaris, milia, heat rash, sebaceous hyperplasia, chickenpox, atopic dermatitis, contact dermatitis, and so on.
It is crucial to differentiate acne from these conditions as treatment of each of these varies.
Prevention
Acne is a complex skin condition and there is no definitive way to prevent it completely. However, the following measures may help improve your skin’s health and prevent scarring from existing acne.
Skincare routine
- Use a gentle cleanser to cleanse your face at least once daily.
- Always remove makeup and sunscreen at the end of the day.
- Moisturize your skin daily as it can help in making your skin barrier strong.
- Always protect your skin from the sun and use broad-spectrum sunscreen.
- Use your acne medications regularly or as recommended by your treating doctor.
- Avoid touching and squeezing your acne breakouts.
Lifestyle Changes
- Eat a healthy diet rich in antioxidants and omega fatty acids and stay hydrated.
- Exercise regularly (it can help in reducing stress).
- Get adequate sleep.
- Meditation, yoga, deep breathing, or other relaxation techniques can help manage stress which can exacerbate your existing acne.
Read more: Cold sore vs. pimple
References
- Ramli R, Malik AS, Hani AF, Jamil A. Acne analysis, grading and computational assessment methods: an overview. Skin Res Technol. 2012 Feb;18(1):1-14. doi: 10.1111/j.1600-0846.2011.00542.x. Epub 2011 May 24. PMID: 21605170.
- Acne. Oakley A (2014) DermNet.
- Kraft J, Freiman A. Management of acne. CMAJ. 2011 Apr 19;183(7):E430-5. doi: 10.1503/cmaj.090374. Epub 2011 Feb 28. PMID: 21398228; PMCID: PMC3080563.
- Titus S, Hodge J. Diagnosis and treatment of acne. Am Fam Physician. 2012 Oct 15;86(8):734-40. PMID: 23062156.
- Acne Clinical Guideline. American Academy of Dermatology Association.
- Titus S, Hodge J. Diagnosis and treatment of acne. Am Fam Physician. 2012 Oct 15;86(8):734-40. PMID: 23062156.
Disclaimer: This article is for information purposes only and does not replace medical advice.