The Six Common Types of Acne

If you are suffering from acne, the first step to take before considering treatment is identifying the type of acne that you are dealing with. More mild forms of acne can be improved significantly with inexpensive over the counter products, whereas more serious types of acne can require doctor intervention.

The Different Types of Acne

  1. Open and Closed Comedones (Blackheads, Whiteheads or Milia)
  2. Treatment for Comedones
  3. Papules and Pustules (the common Pimple)
  4. Treatment for Papules and Pustules
  5. Nodular and Cystic Acne
  6. Cystic Acne Treatment
  7. Preventing Cystic Acne and Nodules

Since acne is a world-wide problem that affects nearly everyone in their lifetime, the identification and classification of acne (also called taxonomy) may vary from region to region. Many different terms can be used to refer to the same type of acne.

Mild Types of Acne

The most mild types of acne are known collectively as comedones (singular: comedo). These are blockages of hair follicles that consist of oil and dead skin cells. The defining feature of comedones that makes them less serious than other types of acne is that there is no redness or inflammation. They should not hurt to the touch.

Comedones do not cause inflammation since the material itself is confined entirely to the hair follicle. More serious types of acne involve infections and blockages that break through the follicular wall, causing the nearby skin cells to be affected.

There are two types of comedones:

Blackheads are easily identified by their distinct color and appearance.

Blackheads are easily identified by their distinct color and appearance.

Open Comedones or Blackheads occur when cellular debris and oil is exposed directly to air. Oxygen in the ambient air reacts with the dead skin cells and oil in a process called oxidation. Oxidation causes the material to turn black, forming the “blackhead”. These are very easy to spot.

Closed Comedones or Milia or Whiteheads occur when the cellular debris and oil in the hair follicle covers the entire entrance of the hair follicle. This prevents the material within from being exposed to air and turning black. Closed comedones often are just little, white or skin-colored bumps on the skin.

Whiteheads can be distinguished from more serious forms of acne due to the lack of redness and inflammation. Whiteheads should not be painful to the touch. Whiteheads can easily be confused with Keratosis Pilaris, another skin condition. Typically whiteheads occur on the face whereas Keratosis Pilaris occurs on other parts of the body, but that is not a rule. The bumps that cause Keratosis Pilaris can also be red instead of just skin-colored.

Whiteheads are white or skin-colored bumps that typically appear on the face. Whiteheads contain no redness and should not be painful to the touch.

Whiteheads are white or skin-colored bumps that typically appear on the face. Whiteheads contain no redness and should not be painful to the touch.

Treating Comedones

The effectiveness of treating comedones depends on the type and age of the comedo. The first step is to practice good hygiene. This involves using a mild cleanser or scrub 1-2 times a day and avoiding oil-based make-up. Look for water-based make-up as this is less likely to contribute to clogged pores. Wash off your make-up daily as well.

When washing your face, only use your hands in order to apply a cleanser and when washing your face. Using a cloth or a pad is often far too abrasive and can cause more harm than good. Scrubbing your face too hard can actually cause inflammation and irritation, escalating harmless comedones into more serious forms of acne.

While good hygiene is often enough to keep acne from returning, it may not help blackheads and whiteheads that have already formed. There are several options for removing existing acne, but those treatments depend on the type, as discussed below.

Treatment for Whiteheads

Most whiteheads, like the ones pictured at the start of this section, typically will clear up once simply with good hygiene practices. Whiteheads are often triggered by external irritants that are causing the pores to become clogged in the first place. For men, this is frequently the use of baseball hats, for women, the use of oil-based make-up (and sleeping in make-up).

Fortunately, these are all easy fixes. Men should wash their baseball hat(s) after each use. If you wear a hat every day and do not want to do laundry each day, have 1 hat for each day and then wash them all at the end of the week. Women should avoid oil-based make ups and remove their make up each night before bed.

If this is not enough for you, the only simple over-the-counter option for treating whiteheads aside from good cleansing practices is the use of a topical treatment. I prefer products that make use of  benzoyl peroxide. Out of all the topical treatments available over the counter for whiteheads, this is by far the most researched compound. In study after study, researchers have shown that benzoyl peroxide is a very powerful yet safe acne-fighting compound.

One of the best treatment products based on this compound is the Exposed Skin Care acne treatment cream. This cream is part of the Exposed Skin Care acne treatment kits. This powerful cream can be applied directly to trouble areas once per day after showering or washing the face. For best results, rub in the cream and allow it to completely absorb before applying make up or sun screen. Exposed Skin Care’s acne treatment kits are available by ordering directly through their website, which you can visit by clicking here.

Treatment for Blackheads

Blackheads, since they are open to the air, can actually be removed with a face wash or extracted physically. Salicylic acid, the active ingredient found in many face washes, is capable of removing the top layers of a blackhead by dissolving it. Each time you wash with salicylic acid, you will remove the top layers of the blackhead slowly. Without any physical extraction, a salicylic acid-based face wash can remove blackheads easily over the course of a few weeks. The face wash found in the Exposed Skin Care contains salicylic acid in perfect concentrations. Get it by clicking here.

Newly-formed, small blackheads can be removed via sticky strips known as “pore strips”. Pore strips can be purchased over the counter but are much cheaper online. They are particularly useful for removing blackheads on the noise and chin. A good strip will apply compounds to loosen up blackheads and the stickiness of the strip can then be used to just pull blackheads right out. This is the preferred approach for the small blackheads that form on the nose. The nose is too sensitive of an area for extraction of small blackheads. Squeezing or pinching the skin around the nose will cause swelling and irritation and may make things worse.

Fortunately, pore strips are very inexpensive. You do not have to use them every day and instead only need to apply them once every couple of days, which really helps the supply last longer. The Biore brand of pore strips is well-reviewed on Amazon. Click here to visit Amazon.com’s page on these strips, where you will find the best price on these strips (with free shipping to boot).

Larger, older blackheads may not so easily be removed with a strip. Instead, a blackhead extraction tool is sometimes used. These are very inexpensive and can be found at your local drug store or on Amazon. Please be warned however that you need the appropriate-sized tool – the extension you use should match up with the size of the blackhead. Additionally, understand that very large blackheads should be removed by a dermatologist or physician’s assistant that has been trained in using these tools. Performing the procedure yourself may lead to scarring or infection. It may be easier to just use salicylic acid-based face wash over the course of a month instead.

This tool can be used to apply pressure to blackheads in the most advantageous way, forcing out the blackhead while limiting damage to nearby skin.

This tool can be used to apply pressure to blackheads in the most advantageous way, forcing out the blackhead while limiting damage to nearby skin.

As a final warning, do not pinch the skin in order to remove whiteheads or blackheads. This can cause bleeding, scarring, and infection. Additionally, older, larger blackheads cannot be removed easily by pinching them, which is why the tool is the preferred approach. While pinching a comedo to expel the material within may clear up the targeted comedo, it also results in the irritation of nearby follicles and may ultimately spawn more comedones or even cause inflammation in the area, creating more serious forms of acne.

Moderate Types of Acne

While classifications vary in accordance with source, it is easiest to think of moderate types of acne as inflamed (red and painful) acne which is not serious enough to lead to cysts or permanent scarring (unless of course you pick at your pimples!). There are two types of acne which belong to this classification:

  • Papules are raised, red bumps on the skin that do not contain any pus or fluid. In other words, if you were to try to pop a papule, no white pus would come out (not that you should try this). The term papule however can also be used to refer to non-acne related bumps on the skin.
  • Pustules are papules that become infected and contain pus. Pus is the thick white fluid-like substance that consists of white blood cells, oil, and dead skin cells, and indicates infection. Pustules are what people typically consider to be pimples and are typically proceeded by papules.
A papule is shown on the left, whereas a pustule is shown on the right.

A papule is shown on the left, whereas a pustule is shown on the right.

Treatment of Papules and Pustules

Papules and pustules are most easily treated via the same methods as comedones – that is using a cleanser once a day, avoidance of hard scrubbing of the skin, using water-based make-up, and removing make-up before bed. Extraction or picking your pustules is not advised as this may only cause scarring and inflammation and is unlikely to speed up the recovery process.

Papules and pustules are not typically eliminated by cleansing alone. There are many over-the-counter treatments that you can pick up online or at the local store which are effective at reducing this type of acne, but the effectiveness of such treatments varies from person to person.

I personally prefer topicals that make use of benzoyl peroxide, as this without a doubt works best for me. One of the best brands of benzoyl peroxide-based products is the treatment cream provided by Exposed Skin Care. This is a potent cream that you can use once a day, applying it directly to your papules and pustules immediately after cleansing your face. Make sure you allow it to dry before applying any other compounds to your face like sunscreen or make up.

This spot treatment cream is an actual cream rather than a lotion, which means it is thicker, less-runny, and rubs in fast. Benzoyl peroxide-based acne products can bleach clothes (peroxides are powerful cleaning agents) before it dries, so having a fast-absorbing cream like Exposed Skin Care is so much more convenient than a lotion that takes 30+ minutes to dry. You can get the best price on Acnezine by ordering directly through their website.

different-acne-types

If you suffer from large numbers of papules and pustules, you may want to see a dermatologist. There are prescription medicines and creams available that help with this type of acne, though you will want to weigh the risks against the benefits before starting a prescription, as some acne prescriptions have harsh side effects.

Severe Types of Acne

While the classifications for severe acne can vary (large amounts of papules and pustules can be considered severe by some), the most serious forms of acne are known as nodules and cystic acne.

  • Nodules are hard, large, painful lumps which are often very red. A nodules occurs when the wall of a hair follicle is torn, allowing oil and cell debris to get into the lower layer of the skin known as the dermis. When the dermis is exposed to oil and dead cells, the resultant infection can cause a nodule.
  • Cystic Acne is similar in appearance and feel to nodules but is much more serious due to the presence of cysts. Cysts originally start out looking and feeling a lot like nodules (just a lump) but once the acne is healed over, the cyst may remain for your entire lifetime under the skin. Cysts may or may not be painful and can swell and decrease in size over a lifetime.
You will often see bad acne referred to as cystic acne, though not every big pimple is cystic acne. Cystic acne involves the formation of cysts deep under the skin. While it is very likely that this man has some cystic lesions, many of the lesions on this man's face are large pustules.

You will often see bad acne referred to as cystic acne, though not every big pimple is cystic acne. Cystic acne involves the formation of cysts deep under the skin. While it is very likely that this man has some cystic lesions, many of the lesions on this man’s face are large pustules.

More About Cysts

A cyst is a defense mechanism of the body and is essentially a “walling off” of foreign matter. For example, nodular acne may occur when the wall of the hair follicle is torn, allowing oil and dead skin cells to enter the dermis. The body may respond to this by surrounding the oil and skin debris with fat and connective tissue, forming a cyst. A cyst is actually a ball fat and connective tissue that has trapped a foreign invader in the middle (in this case, oil and dead skin from the surface of the skin).

Cysts are a problem for some because they can be unsightly, quite large, and occasionally painful. The real problem however is that cysts often remain a lifetime. Once formed, cysts are unlikely to go anywhere, and may result in a variety of bumps and lumps on the skin.

Treating Cystic Acne & Nodules Once They Have Formed

Once they have formed, cysts are permanent. Cysts can be reduced in size via draining. Draining is a procedure that should only be done by a dermatologist and involves cutting off a small amount of skin and more or less squeezing the material that composes the cyst out of the opening. The problem with draining is that the cyst will often reform within a year’s time.

The only way to permanently remove a cyst is via extraction. This is actually a surgical procedure that involves cutting open the skin where the cyst resides under, grabbing the cyst with a pair of forceps, pulling out the cyst in one big piece, and then stitching up the wound.

While that may sound like a lot of work to remove a cyst, it is unfortunately the best case scenario. Many cysts are not shaped like balls and the wall of the cyst instead can have finger-like projections into the surrounding tissue, making removal of the entire cyst improbable if not impossible. If any of the cyst wall is left behind, the cyst can reform. This means that you can have a cyst removed surgically, gain an ugly scar from the procedure, only to have the cyst come back some time later!

I have seen this performed before – you would be surprised at just how big a cyst can be under the skin. What may manifest itself as a small lump under the skin can actually be the size of ping-pong ball! Extraction can require an incision about .5-2 cm long, requiring stitches and leaving a scar.

As a result, cysts are very rarely treated because the treatment is frequently ineffective and worse than the cyst was in the first place, both from a cosmetic and comfort perspective. Instead, cysts are only removed if they are very painful.

Preventing Cystic Acne & Nodules

Since removing cysts is not a viable treatment in most situations, the best way to deal with cystic acne (acne vulgaris) is to prevent the cysts from forming in the first place. Standard treatments used for more mild forms of acne like proper cleansing, using water-based make-up, and applying benzoyl peroxide creams and salicylic acid-based face wash like provided by Exposed Skin Care can often reduce the severity of nodules and prevent them from developing cysts.

However, proper hygiene alone and the use of over the counter produces like benzoyl peroxide may not be enough to combat cystic and nodular acne. The reason for this is that cystic and nodular acne however is highly correlated to hormone levels and genetics. If you have severe acne, you should consult with a dermatologist as soon as possible, as the longer you let this type of acne go untreated, the more cysts and scars you may develop that can stay with you for a lifetime.