Types of Acne and How to Treat Them

Acne is a common skin condition that occurs when hair follicles become plugged with oil and dead skin cells. It causes whiteheads, blackheads, pimples, and bumps that can appear on the face, neck, chest, back, shoulders and upper arms. Acne is very prevalent, affecting about 85 percent of people between the ages of 12 and 24. However, it impacts people of all ages.

There are several types of acne that vary in severity. The main categories are noninflammatory acne, which includes whiteheads and blackheads, and inflammatory acne, which includes papules, pustules, nodules and cysts. Factors like hormones, genetics, certain medications, and stress can contribute to acne flares.

The right acne treatment depends on the type and severity. Mild acne can often be managed with over-the-counter cleansers, creams and gels. Moderate to severe acne usually requires prescription treatments like antibiotics, retinoids, anti-androgen therapies or isotretinoin. Proper skin care and lifestyle changes may also help prevent and treat acne outbreaks.

Types of Noninflammatory Acne

Noninflammatory acne is characterized by clogged pores that appear on the skin’s surface. The two main types are:

Whiteheads (Closed Comedones)

Whiteheads occur when dead skin cells, oil, and bacteria become trapped within a clogged hair follicle under the surface of the skin. This causes a small, flesh-colored bump to appear. Whiteheads are considered a mild form of acne. They are not red or swollen like pimples, but can turn into pimples if the clogged pore ruptures under the skin.

Blackheads (Open Comedones)

Blackheads look like tiny black dots on the skin’s surface. When a clogged hair follicle is open to the air, it oxidizes and turns black, resulting in the blackhead appearance. Blackheads are also filled with dead skin cells, oil, and bacteria. While harmless, they can stretch the pore over time and lead to scarring. Blackheads are easily removed by proper cleansing and exfoliation.

Both whiteheads and blackheads are common in teens and adults. They result from excess oil production, dead skin buildup, and bacterial growth. Proper cleansing, over-the-counter acne treatments, and prescription medications can help remove and prevent noninflammatory acne.

Types of Inflammatory Acne

Inflammatory acne occurs when the hair follicles and sebaceous glands become inflamed. This happens when bacteria, dead skin cells, and oil clog up the pore and cause swelling and redness. There are four main types of inflammatory acne:

Papules

Papules are small, pink or red bumps that are tender to the touch. They occur when a pore gets clogged with excess oil and dead skin cells, causing a small infection. The skin produces antibodies to fight the infection, resulting in inflammation and the formation of a papule.

Pustules

Pustules, or pimples, have a white or yellow center surrounded by a red base. The white or yellow tip is pus that forms from the body’s immune response to fight off infection. Pustules form in the same way as papules – when a pore gets clogged and infected.

Nodules

Nodules are large, hard lumps under the skin’s surface. They form deep within the skin and can be painful. Nodules develop the same way as other blemishes, but the clogged pore is much deeper and causes more extensive infection and inflammation.

Cysts

Cystic acne consists of large, red, and painful bumps filled with pus. Cysts occur when the clogged pore ruptures deep within the skin, causing the inflammation to spill into surrounding tissue. This results in a large, boil-like lesion. Cystic acne is considered the most severe form of acne.

The main difference between noninflammatory and inflammatory acne is that inflammatory acne is caused by bacterial infection and inflammation, which causes visible redness and swelling. Inflammatory acne also tends to be more painful and severe. Proper treatment is important to reduce the risk of scarring.

Moderate Acne

Moderate acne consists of multiple papules and pustules, but no nodules or cysts. It is more significant than just a few occasional pimples. Moderate acne commonly occurs on the face, back, chest, neck, shoulders and upper arms.

Definition: Moderate acne is characterized by multiple inflammatory papules and pustules covering localized areas of the face, neck, chest, back and shoulders. The pimples can be red, swollen, painful and tender.

Common Locations: Moderate acne frequently appears on the face, especially the forehead, cheeks and chin. It also often occurs on the back, chest and upper arms.

Treatment Options:

• Over-the-counter acne medications containing benzoyl peroxide, salicylic acid or sulfur
• Prescription topical antibiotics like clindamycin or erythromycin
• Retinoids like tretinoin, adapalene or tazarotene
• Oral antibiotics like doxycycline or minocycline
• Birth control pills for women
• Light chemical peels performed by a dermatologist
• Photodynamic therapy using blue light and aminolevulinic acid

Moderate acne usually requires prescription medications and professional procedures to achieve clearance. Using over-the-counter products alone is often not sufficient. Seeking treatment from a dermatologist is recommended to prevent scarring.

Severe Nodular/Cystic Acne

Severe nodular/cystic acne is the most serious form of acne vulgaris. It develops when oil and dead skin cells clog the pores and form deep, painful bumps under the skin called nodules or cysts.

Nodules and cysts can range from small to large in size. They are hard, smooth lumps that are lodged deep within the skin. Unlike whiteheads or pimples, nodules and cysts rarely come to a head on their own. They are extremely painful and can cause permanent scarring if not treated properly.

The main characteristics of severe nodular/cystic acne include:

• Firm, smooth, often large bumps under the skin
• Nodules are hard lumps, while cysts are filled with pus
• Located deep within the dermis layer of the skin
• Very painful to the touch
• Don’t come to a head on their own
• Can lead to pitted scarring if not treated

Treating severe nodular/cystic acne can be challenging. Over-the-counter products are usually not effective. Prescription medications like isotretinoin or steroid injections are often required. Draining large cysts via a sterile medical procedure may provide relief. Scarring can potentially be reduced with laser resurfacing treatments.

It’s important to see a dermatologist for proper diagnosis and treatment of severe cystic acne. Left untreated, it can cause permanent damage to the skin. A combination approach of prescription medications, drainage/injections, and light procedures may be needed to manage this severe form of acne.

Hormonal Acne

Hormonal acne is a common type of acne that develops due to fluctuations in hormones, usually androgens. The most common causes and triggers of hormonal acne include:

• Puberty: Rising levels of androgens during puberty lead to increased oil production and acne. This type of acne usually starts around the age of 12-13 and occurs along the t-zone and cheeks.

• Menstrual cycles: In women, acne along the chin, jawline, and neck is common right before periods due to dips in estrogen and spikes in testosterone. These hormonal shifts increase oil production.

• Pregnancy: Pregnancy leads to surges in hormones like progesterone that can worsen acne, especially during the first trimester. Acne may develop along the cheeks and jawline.

• Menopause: Declining estrogen levels and relative increases in androgen levels can trigger acne in middle-aged women. Acne tends to form along the lower face, jawline, and neck.

• Polycystic ovarian syndrome (PCOS): This condition causes higher male hormone levels, leading to acne around the mouth, jawline, and neck.

• Congenital adrenal hyperplasia: Excess androgen production starting in utero and continuing after birth can result in acne later in life. It often appears along the cheeks, forehead, and chin.

• Cushing’s disease: High levels of cortisol lead to elevated androgens and inflammatory acne around the lower face, neck, décolletage, and upper back.

• Medications: Certain medications like birth control pills, corticosteroids, lithium, androgenic progestins, and some supplements can trigger acne flares.

The main treatment options for hormonal acne include:

• Oral contraceptives: Birth control pills that contain estrogen and progestin work by decreasing androgen levels and reducing oil production. Low androgen index pills are best for acne.

• Anti-androgens: Spironolactone and other anti-androgens block the effects of androgens on the skin and oil glands to clear up acne.

• Retinoids: Topical retinoids help unclog pores and have anti-inflammatory effects. Oral isotretinoin is very effective for severe, resistant hormonal acne.

• Antibiotics: Oral antibiotics like doxycycline and minocycline combined with topical benzoyl peroxide can treat inflammatory hormonal acne lesions.

• Diet & lifestyle: A low glycemic diet, stress management, regular exercise, and healthy sleep habits may help lower androgen levels and improve hormonal acne.

Seeing a dermatologist can help diagnose the specific cause of hormonal acne and decide the best treatment plan. Combining oral and topical medications often yields the best results.

Back & Chest Acne

Acne on the back and chest is very common, especially among teens and young adults. The main causes include:

• Excess oil production – The sebaceous glands on the back and chest produce a lot of oil, which can clog pores. This is especially true during puberty.

• Sweating – Sweat gets trapped in pores along with dead skin cells, creating a breeding ground for acne bacteria. Tight clothing that rubs against the skin also makes matters worse.

• Products – Hair products and body lotions that contain pore-clogging ingredients can trigger breakouts on the back and chest.

• Bacteria – Propionibacterium acnes bacteria thrive in clogged pores and cause inflammation.

To treat back and chest acne, start with the basics:

• Shower after sweating to wash away dirt, oil, and bacteria. Use a gentle cleanser with salicylic acid.

• Avoid tight clothing made from non-breathable fabrics. Opt for loose, cotton clothing.

• Use oil-free moisturizers and avoid heavy body lotions. Look for non-comedogenic or oil-free products.

• Treat the affected area with benzoyl peroxide, which kills acne bacteria.

• Use a body wash with alpha hydroxy acids (AHAs) to exfoliate and unclog pores.

• Take oral antibiotics if you have severe inflammatory acne on the back or chest.

See a dermatologist for prescription topical medications like retinoids, antibiotics, or anti-androgens if over-the-counter treatments don’t improve the acne. Procedures like photodynamic therapy may also help in stubborn cases.