A guide to the different types of acne
Dr. Aysha Butt is the Medical Director of FROM MARS, and is a GP Partner at Woodcote NHS Medical Practice.
Acne just won’t quit. It can be hard to treat, and it can stick around for years.
The good news is that effective acne treatments are available. The slightly worse news is that to choose the right one, you need to know what type of acne you have (and there are loads of different types of acne). The confusing news is that you probably have more than one kind of acne at the same time, so you could need a combination of treatments.
Don’t sweat it though, that’s what we’re here for. To help get your skin sorted.
What causes acne?
Your skin is covered in very small holes called follicles, or pores. These follicles are the holes in your skin from which hair grows, but you have them even where you don’t seem to have hair, as often you do have microscopic hairs in these places. Follicles and pores are usually most visible on your face, particularly on your nose, where they look like small dots.
You get acne when your follicles become blocked. The follicles produce a type of oil called sebum, which moisturises and protects your skin. Sebum can block follicles though, particularly in areas of your body where you produce lots of it, like your face. Blocked follicles become spots, and they can become infected and inflamed too. Other things can block your follicles besides sebum, like dead skin cells or ingrown hairs. Other things like your hormone levels and your diet can also make your body produce more sebum, making it more likely that your follicles become blocked and you get acne.
These are the different types of acne.
Non-inflammatory acne, also called comedonal acne, is the milder form of acne. Blocked pores become spots, but there’s no infection, and usually no swelling and soreness. You typically get two types of spot with non-inflammatory acne:
Blackheads (also called open comedones)
You get blackheads when a follicle becomes blocked, but it stays open at the surface, so you can see the black blockage inside; like looking down into a half-filled hole filled with black dirt.
Blackheads can often be cleared up with a good skin cleansing routine, particularly when using products that contain salicylic acid, like cleansers and face washes. Salicylic acid cleans your pores and exfoliates your skin, removing dead skin cells, and may be the only treatment you need for blackheads.
Whiteheads (also called closed comedones)
These are similar to blackheads in that they’re caused by a blocked follicle, but this time it closes over at the surface, causing a small, white bump on your skin.
Whiteheads are more difficult to treat than blackheads, as the follicles are closed. Using skincare products with salicylic acid can help, but whiteheads may react better to topical retinoids. Retinoids are a type of molecule that’s similar to vitamin A. Topical means that it’s applied directly to the skin. Topical retinoids for acne are usually creams or serums which you apply to your face once a day. Retinoids can unplug and clean follicles, and remove dead skin cells, like salicylic acid, but are generally stronger. In the UK, you need a prescription for retinoid acne treatments.
Inflammatory acne, also called acne vulgaris, is when your skin becomes swollen and inflamed as well as having spots. It’s more severe than non-inflammatory acne. Your skin gets inflamed when bacteria infect blocked follicles. The bacteria feed on the sebum and dead skin cells and spread through your skin. Inflammation happens as your body fights the infection. The deeper the infection gets into your skin the more painful the acne spots become, and the harder it is to fight them.
These are raised spots that are often pink to red, and tender to the touch. They occur when the walls around follicles break down and the bacterial infection spreads out into the surrounding skin, meaning papules are usually bigger than blackheads and whiteheads.
As with non-inflammatory acne, topical retinoids can be used to tackle papules, but you can also try using products which contain benzoyl-peroxide (usually creams and gels) which can be bought over-the-counter from pharmacies. The benzoyl-peroxide dries the skin, kills the bacteria, and can reduce inflammation too. You can also use prescription antibiotics, often as topical creams, to help fight the bacterial infection, such as treclin (clindamycin + tretinoin) gel.
These are papules which are filled with pus, which is the yellow/white fluid that builds up when your body fights an infection (pus is mostly made of dead white-blood cells). Pustules look similar to papules but have a white or yellow head on top where pus is near the surface of the skin.
Pustules can be treated in the same way as papules, with cleansing products which contain benzoyl-peroxide, with topical retinoids, and with antibiotics.
These look and feel like hard bumps under your skin, and they can be skin-coloured, but are often pink or red, and they’re usually painful to touch. They happen when the infection in a follicle spreads into other follicles and deeper into the skin, causing the spot to grow larger and more inflamed. Nodules are more serious than papules and pustules, are harder to deal with, and can leave scars on the skin.
Because the infection has moved deeper, nodules usually can’t be treated with over-the-counter skin products. You’ll need to use prescription medications which contain antibiotics to deal with the bacterial infection, like treclin gel.
Cysts are similar to nodules in that they form deeper in the skin and can be relatively large, but they tend to contain more pus, so usually have a white or yellow head. Like nodules, they’re harder to deal with and can leave scars on your skin.
Cystic acne is usually treated in the same way as nodules, with prescription medications that contain antibiotics, but in really severe cases cysts can be surgically removed.
You can order an effective prescription medication directly from us called treclin gel which combines retinoids to cleanse and improve your skin, and an antibiotic to fight the bacterial infection (clindamycin). It can be used to treat a range of acne types and is especially suited for fighting more than one kind of acne at a time.
But simply knowing what kind of acne you have is just the first step to tackling it.
Acne can be a tough condition to treat and it can take time to see improvements, sometimes months, even if you’re using the right treatments, so you may have to be patient. And whilst medication is important, it’s only one part of treating acne. You should have a cleansing routine to keep your skin clean and to remove excess sebum and dead skin cells, and you can also try making changes to your diet. Then the improvements should begin.