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What Kind of Acne Do You Have?

The first step in understanding the cause and treatment of acne is to recognize the different types.

There are two main categories of acne. Inflammatory acne includes pustules, papules, cysts and nodules, and result from the body's fight against an infection. Non-inflammatory acne, also called comedones, includes whiteheads and blackheads. The difference is that inflammatory acne is red and painful because the body has reacted to an infection with white blood cells. Non-inflammatory acne does not have any of those characteristics. Inflammatory acne is deep, painful, swollen and red, and often hurts on many levels. It can last for months and leave temporary dark marks or even permanent scars in some cases. It's extremely important to treat inflammatory acne as early as possible.

We’ve defined acne by it’s severity to help you understand how to treat it correctly. If you have mild acne, you’ll have several comedones but very few pustules and papules. Mild to moderate acne is characterized by a mix of comedones and several inflamed pustules and papules appearing at the same time. If there are some nodules along with pustules and papules, the acne is moderate. Any type of acne that has deep cysts or leaves behind permanent saucer-shaped or pitted scars is considered severe.

Whiteheads

A thin layer of skin covers the pore in a whitehead, trapping the plug beneath the skin’s surface. The oil in the pore is not exposed to oxygen and therefore remains yellow or white. This is the natural color of dead white blood cells (or pus) and sebum. This is different from a blackhead where an open comedo turns black when the pigment in the oil is exposed to oxygen and oxidizes. Whiteheads are normally on the face, but may appear on the torso as well.

Pores can become clogged by cosmetics, including makeup, moisturizers and thick sunblock. Beauty treatments like waxing can also cause clogging. Look for non-comedogenic products, as these won’t clog pores. Although it is tempting, a whitehead should never be squeezed. Squeezing pimples causes infection, spreads bacteria, and can create scars.

Whiteheads are a type of non-inflammatory acne that do not have any swelling or redness associated with them. A whitehead starts with too much oil being produced, followed by the pore becoming clogged by sticky dead skin cells. This traps oil and p. acnes bacteria inside in the pore. These are called comedones (the singular is comedo), as they are not inflamed.

Blackheads

As was described above, a pimple starts with too much oil being produced, followed by the pore becoming clogged by sticky dead skin cells. This traps oil and p. acnes bacteria inside the pore. These are called comedones (the singular is comedo) and is a non-inflammatory acne. A comedo is a pore or hair follicle that is clogged. If the pore fills with dead skin cell debris and oil, and is open, it turns black or gray, giving it the name "blackhead".

A blackhead's color is not caused by trapped dirt, so it can’t be washed away. The black is caused by a buildup of melanin pigment in the pore that oxidizes, similar to when metal turns dark and rusty when it is exposed to oxygen. Ironically, if the pigment does not oxidize, a blackhead can have a yellowish color. When puberty starts, the surge of androgen hormones causes the over-production of oil and blackheads appear as one of the first signs of this happening. Adults with oily skin are likely to develop them as well, as blackheads are caused by oil trapped inside the pore. Blackheads usually localize in the nose, forehead and chin (the "T-Zone" of the face); but may also appear on the chest, back, shoulders and arms where the density of hair follicles with their attached oil glands is great.

Using some types of makeup and topical face oils can cause blackheads. Products that don't clog your pores or create comedones are called non-comedogenic. Looking for this term on a label is one of the first steps you can take to treat acne.

Red, Swollen Pimples

Inflammatory acne or cystic acne is caused when pores become clogged and your immune system sends white blood cells to fight the infection. This causes the surrounding area to become swollen and red, or inflamed.

Inflammatory acne is caused by the wall of the hair follicle or pore rupturing. This allows oil and bacteria to leak into the surrounding skin. The closer this happens to the skin’s surface, the smaller the breakout will be. If the rupture happens deep inside the pore, a cyst (a large, firm bump) may be formed deep inside the skin. Inflammatory acne is often painful as the blood flow to the area is increased to deliver white blood cells to fight the infection.

Inflammatory acne is classified as different types depending on the redness, size, potential to scar and tenderness.

Papules

These are red or pink dome shaped bumps from the size of a pinhead to half an inch. No fluid or pus is visible. Papules are usually painless unless they are picked at or scratched. Like all pimples, papules form when an increase in oil production begins and bacteria inside the pore becomes trapped by dead skin cells. Papules are slightly inflamed, so your immune system fights the infection with white blood cells.

Pustules

Pustules form when bacteria and oil becomes trapped inside a pore deep below the skin’s surface. White blood cells are used to fight the infection. A collection of dead white blood cells is called pus. Pustules have a red base with a white or yellow pus-filled center. The redness and size of the pustule will depend on the level of inflammation.



Nodules and Cystic Acne

The most severe form of acne is cystic nodular acne. Cysts are painful, deep bumps filled with pus and can be quite big, measuring up to an inch. Cystic acne may result in permanent disfigurement and scarring and often runs in families. It is most common in young men and teenage boys. Any form of scarring acne, including cystic acne needs to be evaluated by a dermatologist immediately. A doctor will be able to determine the best course of action for this type of acne.

These large, painful and deep bumps are filled with blood initially, then with pus. They can remain under the surface for weeks or months and can ultimately harden. They may also cause deep scars. Nodules are bigger than papules or pustules and form deeper within the skin. They can be painful and feel solid to the touch. They develop when bacteria and oil deep inside a pore spreads, infecting adjacent follicles. Nodules can solidify into deep cysts and could leave deep scars on many different levels.