Ah, acne—something that’s plagued many of us during our teenage years, or may still be plaguing us currently as adults. Whether we’re blessed to deal with a nose full of blackheads or more serious, painful, pus-filled (...sorry) pimples, it’s no fun for anyone.
But maybe if we understood what was happening to our face (or neck, or back, or arms) a little bit better, said pimples would be less of a nuisance, and more of an indicator of what we need to change in certain aspects of our everyday lives—or, at least, allow us to get the proper treatment we need.
We chatted with expert dermatologists to get the lowdown on what the types of acne exist, what they mean, and how to treat them. Keep scrolling to find out what they had to say.
What causes pimples in the first place?Dr. Melissa K. Levin, a board-certified dermatologist, breaks it down for us:
Acne is a disorder of the pilosebaceous unit, which is the scientific word for the hair follicle or the pore, and the sebaceous gland, or the oil gland, attached to the pore. The pore gets clogged with dead skin cells. The body makes oil on the skin called sebum. That mixture of dead skin cells and sebum becomes trapped inside the pore, creating an oxygen-free environment where a naturally occurring bacteria which resides in the hair follicle, called P. [Propionibacterium] acnes, multiply very quickly and cause inflammation.
She points out that while a pimple may pop up overnight, acne has much deeper roots, and so it’s important to look beyond a quick fix. The treatments should de-clog pores, reduce inflammation, decrease oil production, and be antibacterial. And depending on which type of acne you're batling—whether comedones, papules, pustules, cystic and nodulocystic acne—that may change. Ahead, get to know each.
ComedonesComedones, or clogged hair follicles, are the least offensive and mildest forms of acne (but still quite annoying, nonetheless). Dr. Sejal Shah, dermatologist and RealSelf contributor, explains that comedones appear in two forms: the common whitehead and blackhead.
Whiteheads, which are closed comedones, form when excess oil, dead skin cells, and other debris and dirt block the pore. Because the opening of the pore is covered with a thin layer of skin, they appear as small white bumps.
Blackheads, which are open comedones, occur when excess oil, dead skin cells, and other debris block the pore. “Unlike a whitehead, the pore is open—which means the sebum within the blocked pore is exposed to air, which causes it to oxidize and turn black,” says Shah. Well, ew.
When it comes to treating comedones, Shah explains that the most effective treatments are the ones that increase cell turnover and exfoliate the skin. This includes retinoids, alpha- and beta-hydroxy acids. She also suggests treatments that reduce oils on the skin (such as tea tree oil, clay, and charcoal), as well as antibacterial ingredients, such as benzoyl peroxide, that would help combat the overgrowth of P. acnes.
Shah explains that when the P. acnes bacteria expand within a comedone, the walls of the pore begin to break down. This, then, allows the nasty stuff to push deeper into the skin, causing inflamed lesions such as papules, pustules, nodules, and cysts.
PapulesPapules are bumps on the skin, though different from whiteheads. “Papules are acne bumps, and are much more red and larger than comedones,” explains Dr. Gary Goldenberg of Goldenberg Dermatology. These are considered a moderate form of acne.
In terms of treatment, Goldenberg suggests treating with facial cleansers, over-the-counter topical creams, or, in more serious cases, prescription topical creams. “Sometimes antibiotics may be necessary,” he says. He adds that chemical peels and laser treatments also have a successful treatment rate for this type of acne.
PustulesWhile papules appear as red bumps, Goldenberg says that pustules are larger, deeper, and filled with pus—and also considered a moderate form of acne
Goldenberg explains the need for timely treatment. “These can lead to scarring and pigment change if not treated early,” he says. “This type of acne usually requires oral antibiotics; facial cleanser and prescription topical creams are usually used in combination with pills.” Again, he recommends chemical peels and laser treatments, as well as microneedling and platelet-rich plasma (PRP) treatment.
Cystic and Nodulocystic AcneOf course, it can also get more serious in the form of cystic/nodulocystic acne, which Dr. Melanie Palm, board-certified dermatologist and cosmetic surgeon, explains is the most severe form. It consists of large red, tender, and cystic bumps that rise under the skin, often appearing suddenly and lasting for days to weeks. “We, as dermatologists, get concerned about this form, because it often results in acne scarring, which can be very difficult to treat,” she says.
While an exact cause for such severe acne isn’t known, hormones, specifically androgens, are known to play a role. Heredity and genetics, emotional stress, and medications may also play a part, according to Levin. The only approved medication to treat acne this severe is isotretinoin (formerly known under the brand name Accutane). There are also a number of treatments available to improve the appearance of scarring, which you can read more about, below.
How to treat scarringThe unfortunate side effect of many types of acne—especially more severe—is scarring. While there are definitely ways to improve it, the treatments usually come with a high price tag.
Palm explains that while you can improve the appearance of scarring, it’s not always possible to eradicate completely. “Even as a fellowship-trained cosmetic surgeon with the best light, laser, and energy-based technologies at my fingertips, it’s nearly impossible to improve acne scarring to the point it appears like unblemished skin,” she says. So, which ones are the most successful? According to Palm, ablative lasers and radiofrequency microneedling.
Ablative lasers resurface the skin by actually removing its outer layers while building up collagen, which smoothes out acne scarring and improves the skin’s texture. Radiofrequency microneedling is a newer treatment that heats the skin in the area of the acne scar, which results in new collagen formation, therefore, too, improving the appearance of the scar and skin texture
Both require a few days to a few weeks of recovery time, so opting for one of these treatments can require a bit of commitment, with microneedling usually needing multiple treatments.
What does pimple placement indicate?While acne can appear all over the face, back, neck, and chest, certain spots can be indicative, or at least suggestive, of what the issue might be.
If you notice you're breaking out a lot along the hairline, on the forehead, and on the temples, Shah says your hair products may be the culprits, causing what she calls “pomade acne.” If blemishes tend to appear on your cheeks, she suggests cleaning your makeup brushes and phone, as dirt that collects on both can certainly be the root of your cheek-based woes.
If you’re suffering from body acne, Shah explains that your post-workout routine can be the cause. Not removing your damp or tight (or both) clothes and failing to cleanse the skin after breaking a sweat at the gym can cause a body breakout, so be sure to hop in the shower and change into looser clothes after you finish up.
When it comes to the jawline area, breakouts can sometimes be linked to hormones—and when it comes to hormonal acne, it’s something that tends to pop up in adult females, even if they didn’t have acne in their teenage years. “Suddenly, they develop deep, cystic acne, usually in the lower face, jawline, or neck. It typically appears cyclically, usually right before or during the start of a woman’s period,” explains Palm. While traditional acne therapy can be used to treat that, she suggests opting for both topical and oral medications to help combat the effect of hormones. “Oral birth control pills with combined low-dose estrogen and progesterone are often helpful,” she says.
However, it's not just our hormones or bad hygienic practices that can cause constant breakouts, it's also what we put in our bodies. “Acne, in general, may represent a hormonal issue, as well as a nutritional issue,” says Goldenberg. “These may manifest as any type of acne, but the likelihood is higher as more severe acne types.” Shah explains that high glycemic foods, dairy products, and whey protein are known culprits of nutritionally triggered acne.