When you have a breakout, you probably see it as just that—a terribly unfortunate and potentially day-ruining development, but a breakout nonetheless. However, not all acne is the same, meaning you can’t treat small, red papules the same way you’d approach an inflamed pustule.
To break down the unique treatment plan required for each type of acne, we called in celebrity esthetician Renée Rouleau and board-certified dermatologist Dr. Anna Guanche from the Bella Skin Institute in Calabasas.
Keep reading for a complete guide to beating every kind of acne!
Meet the Expert
“Cysts are hard, painful blemishes that develop deep within the skin and will eventually heal (your body eventually reabsorbs the infection), but can remain a painful lump for weeks,” Rouleau says.
Guanche adds, "Cysts are types of inflammatory acne — these involve redness, tenderness, pus and bacteria."
Rouleau’s best advice? Do not pick at a cyst. “Despite being sore, it's not meant to come out through the surface and if you attempt to do so, you’ll most certainly have a scar that will linger for months.” Rouleau’s rule is that if a whitehead does not form (which won't happen with a cyst), then keep your hands off.
"Cysts are rooted deeper in the skin, requiring a dermatologist to access and recommend treatment," explains Guanche. Need a quick fix? Schedule an appointment with your dermatologist to get a cortisone injection into the cyst, which will usually knock it out in a day or less. “Also, if you're prone to cysts in the chin and jawline area, consider cutting back on your dairy intake, as for many, this can be the cause,” Rouleau says.
“Whiteheads, or closed comedones, are little clogged bumps under the skin that aren’t red or sore,” Rouleau says. “They’re just clogged pores that appear as white, clear, or flesh-colored bumps under the skin.”
But where do they come from? "Whiteheads form when dead skin cells, oil, and bacteria build up in the skin pore," explains Guanche.
First of all, don’t go straight for your typical drying treatments. “Since whiteheads have no infection (meaning they are not generally sore), using harsh acne products will only make them worse by causing dry skin cell buildup, which traps the oil in the skin longer,” Rouleau says.
Instead, her advice is to exfoliate. “Keeping off surface dead skin cell buildup will help them to purge naturally.” She also notes that a deep pore-cleansing facial can be beneficial for removing the impurities within the pores. “Once you get the pores cleaned out, exfoliating products work deep within the skin to keep them clean.”
Contrary to popular belief, it’s not dirt, debris, or grime in there, but simply oxidized oil. "Blackheads, also called acne vulgaris, are open papules on the skin that fill with excess oil and dead skin cells that oxidize when exposed to the air," explains Guanche.
The bad news is there isn’t really a cure for blackheads. “Although there is no way to permanently get rid of blackheads, my best advice is to get monthly deep pore-cleansing facials and use well-formulated salicylic acid products at home to keep your pores clean long after the facial,” Rouleau says.
She recommends using retinol products like prescription Retin-A to keep your pores clean, but you have to use them consistently to see results. Guanche adds, "It is also advantageous to use a benzoyl peroxide wash to mitigate further bacteria build up. Topical antibiotics can also be helpful."
Rouleau also says to avoid pore-clogging ingredients like isopropyl myristate and isopropyl palmitate in your skincare products because they could be contributing to the formation of blackheads.
“Pustules are red, inflamed blemishes that contain pus and are known as your traditional zits,” Rouleau says. “They are most likely to cause post-breakout red or dark scars if you don’t care for them properly.”
“You must not touch these until you can see a whitehead,” Rouleau says. “Then, you can carefully extract the infected pus and immediately dry it out with a spot treatment. Look for spot treatments with proven antiseptic, antibacterial ingredients like sulfur and zinc oxide, and a drying agent like camphor.
“Papules are red, painful blemishes that do not quite reach the surface,” Rouleau says. “It’s the stage past a whitehead where bacteria has caused inflammation, resulting in an infected blemish.”
When dealing with papules, you want to calm your skin, rather than dry it out. “The main symptom of a papule is inflammation and irritation, so the goal is not to dry it out with acne products, but rather to calm down the inflammation by using topical cortisone cream (from the drugstore) and ice compresses,” Rouleau says. “These will all reduce the inflammation until the whitehead reaches the surface and can be gently extracted.”
Look for products with soothing ingredients like green tea, white tea, kaolin clay, and sulfur. Guanche's Bella Miracle Cream, with a gentle, custom-made formula that includes sulfur, is specifically designed to inhibit the growth of the bacteria.
Decker A, Graber EM. Over-the-counter acne treatments: A review. J Clin Aesthet Dermatol. 2012;5(5):32-40.