It would be nice if there was just one type of acne, and one type of solution for it. Wouldn’t it be so easy to deal with then? Alas, that’s nowhere near the case. There are several types of acne, and not all of them look like the typical red pimples that come to mind when you think of acne. This is because acne can be inflammatory or non-inflammatory. It’s even, very unfortunately, possible to have several different types of acne at the exact same time – like blackheads and papules, for example. Knowing what type of acne you’re dealing with can help you find the right kind of treatment.
It is estimated that approximately 17 million people in the United States suffer from some type of acne. Though acne mostly affects preteens and teens (about 8 in 10, in fact), it can affect adults up to their 40s as well. In rare cases, even adults in their 50s may experience the occasional breakout. Causes include excess oil production, hormonal changes or fluctuations, clogged pores and bacteria. Acne can also be exacerbated by stress.
Let’s explore the different types of acne so you’ll have a better understand of what you’re experiencing when you have some type of comedone (clogged pore) or breakout.
This type of acne includes blackheads and whiteheads. They are non-inflammatory because they do not become infected with bacteria or get swollen and red.
Blackheads are also called open comedones. They are essentially clogged pores, or hair follicles, filled with oil and dead skin cells that are stuck together to form a plug, but they are open to the air. They can stretch out pores if they’re especially big, making pores look larger and marring skin’s texture. Blackheads get their name from their dark color, which is a result of oxidation. Basically, when the oil in a clogged pore comes in contact with oxygen, it darkens.
Blackheads can occur anywhere on the body, but will mostly affect the face, chest, shoulders, upper arms, and back. Because you have millions of hair follicles, it stands to reason that you have about that many chances for getting blackheads. Of course, you probably won’t. The T-zone (the forehead, nose, and chin) will bear the brunt of blackheads because it is a naturally oily area.
Blackheads can also be sometimes confused for sebaceous filaments or glands. These are perfectly natural hair-like formations that are also dark in color. Their purpose is to direct oil along the pore. If you see them in a cluster, they are most likely filaments and not blackheads.
Whiteheads are also called closed comedones because there is a layer of skin that covers them and prevents oxidation. Thus, they are white (or more likely yellow-ish) and not black in color. Whiteheads are also pores filled with dead skin cells and oil that have become trapped. The oil inside pores can be rather sticky, making these dead skin cells that haven’t shed fast enough to attach to one another.
Like blackheads, whiteheads can also occur on the face, back, upper arms, shoulders, and back. Treatment will most likely involve some type of acid — like salicylic acid or glycolic acid — that will help break down the “glue” that holds the dead skin cells together. It is best not to pick at a whitehead or try to “pop” it because this can lead either to infection or scarring, or both.
Inflammatory acne refers to your typical pimple or breakout, which is red and/or swollen. Propionibacterium acnes, more commonly called P. acnes, bacteria causes all types of infections in the body, but is also responsible for acne infections. It resides naturally inside pores and feeds on sebum (oil).
Papules are solid, red bumps on the skin that are usually also colloquially called pimples or zits. Papules occur when there is a high break in the wall of the hair follicle, or pore. Sometimes papules can turn into pustules, meaning pus will become visible at the tip. Papules initially form when pores become clogged with debris like dead skin cells and oil. If the pressure becomes too great, the follicle wall breaks and all that debris spills into the surrounding skin. This causes irritation that will turn a papule red and cause swelling.
Pustules are basically papules with a tip of pus. Pus occurs when white blood cells try to fight off the infection caused by the P. acnes bacteria, and become stuck in the inflamed pore. Pustules also form when the follicle wall breaks from too much pressure, much like a papule. The main difference between papules and pustules is the visible pus. Pustules are also what is generally referred to as pimples, breakouts or zits.
Nodular acne is considered a severe type of acne because it is often larger, deeper inside the skin and can be painful. Nodules can be skin-colored or red. It won’t have a pus-filled tip like a pustule. Acne nodules typically don’t break follicle walls, but stay intact. They can be very stubborn, persisting in the skin for weeks or even months in extreme cases. Over-the-counter treatment options may not necessarily work for nodular acne, and strong treatment may be needed. Attempting to pop a nodule will be futile, as it simply too deep inside the skin to
Cystic acne is typically considered the most severe type of acne. It often requires treatment with medication like antibiotics or retinoids. Like all types of acne, cystic acne begins with a clogged pore that is filled with oil, dead skin cells and other debris. As a pore fills and fills with dead skin cells and oil, the pressure causes the follicle wall to rupture, leading to a cyst. Cystic acne can sometimes look like a boil. It can also look like a large, pus-filled bump with redness around the edges. Like nodular acne, cystic acne is also painful or tender to the touch.
Though it may not seem like it, it’s nevertheless important to differentiate between the many types of acne. This will ultimately help you figure out exactly which treatment option is best for you.