In This Article
You might not know all the different types of acne offhand, but you know the annoying bumps on your face when you see them. Whether they're big, red, and angry, or small and practically undetectable, if your breakouts bother you, that's reason enough to address them. The only problem? Treating acne is a little easier said than done. To help us sort through the complex world of acne and how best to approach each type of acne, we turned to board-certified dermatologists Christine Choi Kim, MD, Devika Icecreamwala, MD, and David Lortscher, MD, CEO of Curology. Together, the skin experts break down everything there is to know about your breakouts.
Meet the Expert
- Christine Choi Kim, MD is a board- certified and fellowship- trained medical and cosmetic dermatologist in Los Angeles, California. She has authored numerous publications and lectured nationally on topics such as injections, laser hair removal, acne treatment in women, and cosmeceuticals.
- Devika Icecreamwala, MD is a board-certified dermatologist and owner of Icecreamwala Dermatology in Berkeley, CA. She has published several articles and collaborated on numerous books within her field.
- David Lortscher, MD is the CEO of skincare brand Curology. He also serves as a remote dermatology consultant for rural healthcare clinics in Arizona and New Mexico that lack specialty medical care.
Keep scrolling to find out how to identify the different types of acne (and what's not actually acne at all) as well as how to treat and prevent them.
What Is Acne?
Simply put: acne occurs when sebum (the oil that naturally lubricates our skin) mixes with dead skin cells and bacteria and clogs your pores. Kim says those with acne have abnormal shedding of the cells that line their hair follicles as well as hyperproduction of sebum, and these two factors lead to congestion of the pores. According to Lortscher, acne is generally broken down into two main categories, non-inflammatory and inflammatory acne, and within those subgroups, you'll find all the different types with different recognizable characteristics. But before we get into the different types of acne, let's go over two different skin conditions that are commonly confused with but aren't actually considered acne.
- Milia: According to Lortscher, milia can occur spontaneously, and they’re often mistaken for acne because they’re typically found on the face and appear as small white or yellow bumps with a smooth dome shape, but milia is essentially a hardened buildup of keratin that can’t be popped like a pimple. Lortscher describes them as very small (less than 3mm in diameter if you’re counting) and notes that they can vary from solitary to grouped lesions. Most often, milia resolve on their own or, funny enough, with topical acne medications that exfoliate the skin, but they can persist for many, many months. You can also see a dermatologist to extract them if their appearance bothers you.
- Fungal Acne: If you have small, uniform (and at times itchy) bumps that spread across a central area, like your forehead, jaw, hairline, chest, and back, you might have what’s commonly called fungal acne. This condition is tricky in the sense that there is a lot of overlap between ordinary acne (acne vulgaris) and acne made worse by fungus. “Fungal acne, or malassezia folliculitis, is caused by pityrosporum, a naturally occurring fungus that lives on our skin,” Lortscher explains. “The yeast of the fungus can grow in pores in moist environments—you might accidentally nurture the fungi by exposing your skin to sweat and friction, potentially pore-clogging ingredients, or humidity.” To help avoid fungal acne, rinse off any time you break a serious sweat and check your products for potentially pore-clogging ingredients. To treat it, Lortscher suggests using a product with zinc pyrithione, which has antimicrobial properties that help to stop the growth of acne-causing fungus and bacteria.
Now that we've covered what isn't acne, let's get into the nitty-gritty of what is.
With this type of acne, also called comedonal acne, you won't find any big, angry, red pimples. Instead, you'll see little blackheads and whiteheads, generally where your face is oilier, like the T-zone area (but also your chest and back). This type of acne is caused by the clogging of the pilosebaceous units (hair follicles) of the skin. Now, the difference between whiteheads and blackheads:
- Whiteheads: Also called closed comedones, this type appears as little white bumps because of the trapped dead skin cells and sebum. Lortscher explains that whiteheads are covered by a thin layer of skin, and the contents are not exposed to the air, so they appear white or yellowish, which is the default color of oil and dead skin cells.
- Blackheads: On the contrary, this type is best described as open comedones that expose the trapped oil and dead skin cells to the air. As Lortscher explains it, oxygen in the air reacts with the trapped substances (a process called oxidation) and makes the pimple look black (hence the name).
According to Icecreamwala, inflammatory acne is often caused by an overgrowth of a bacteria that lives on the skin called P. acnes that increases inflammation. This type of acne can appear as papules, pustules, nodules, and cysts.
- Papules: These are tender bumps with redness and swelling that have no visible fluid (in other words, no whitehead) and are usually less than 5 mm (think smaller than the size of a pencil eraser). Icecreamwala says papules are often caused by dead skin cells clogging the pores and increasing inflammation.
- Pustules: Pustules are inflamed lesions with a visible whitehead that may be tempting to squeeze (but it's a good idea not to), and Lortscher says they're usually raised 1 to 5 mm. Icecreamwala notes that pustules are often caused by the overgrowth of P. acnes.
- Nodules: When you think of a nodule, think large, firm, red bumps. Lortscher says these extend deeper than a papule and are notoriously painful.
- Cysts: Another painful form of inflammatory acne, cysts are the deep kind of acne under the skin that seems to take forever to go away. Lortscher describes cystic acne as highly inflamed and/or draining acne nodules. Icecreamwala explains that cysts can have more of a genetic or hormonal origin.
Causes and Prevention of Acne
According to Kim, the cause of all acne is multi-factorial, meaning that genetics, bacteria, hormones, stress, and diet may play a role to varying degrees. For that reason, a holistic approach to treating acne takes all of these factors into account. Although you may not have much control over some of the underlying causes, there are a few ways to alter your routine and address others.
- Diet: Kim points to studies that have linked high glycemic index foods (for example, white bread, potatoes, and white rice) and consuming cow’s milk to acne but suggests that more research is necessary. However, if you've noticed any obvious triggers, diet is certainly something to consider. "I do ask my athletic weightlifting patients with sudden onset of acne whether they recently started to consume shakes made with whey protein, which is a milk protein," Kim explains.
- Poor habits: As Kim points out, nicotine, from smoking cigarettes and vaping, could be linked to acne, so add breakouts to the long list of reasons why you should kick the habit. A balanced, healthy diet and lifestyle will benefit your overall health and your skin, according to Kim. Additionally, not showering after working out and not washing your face in the evening can also result in breakouts.
- Stress: Because stress can cause hormone surges that lead to breakouts, it's important to identify the source of it in your life and manage your stress levels. Some ways to de-stress are to practice self-care and breathing exercises, and, in some cases, seeking a professional counselor.
Treatment for Non-Inflammatory Acne
Kim says the most effective way to treat and prevent comedones is by using products that normalize cell shedding, breakup sebum, and gently exfoliate the dead skin cells of the stratum corneum on top of our epidermis. But keep in mind that treating acne is a marathon, not a sprint; in other words, start low (ingredient percentage-wise and frequency) and go slow. Kim says you'll need to be patient and allow 6 to 8 weeks to really let your products transform your skin.
Exfoliating is crucial for treating comedonal acne, but that doesn't mean the harsher the scrub, the better. In lieu of a physical exfoliator, try gentle, chemical exfoliants, like this Byrdie-recommended face wash. Kim says to seek out products with alpha-hydroxy acids (like glycolic acid and lactic acid) and beta-hydroxy acid (salicylic acid) but warns users not to overdo it. If you're using an exfoliating cleanser, toner, mask, and all-over treatment, you'll wind up with acne on a background of red, dry, and peeling skin or an irritant contact dermatitis. Remember: low and slow. If you have sensitive skin, Kim suggests products containing gentler exfoliants, such as azelaic acid, mandelic acid, or the botanical retinol-alternative bakuchiol.
Incorporate Retinoids into Your Routine
Topical retinols and prescription-strength retinoids aren't only great for addressing comedonal acne by unclogging pores, but they also encourage cell turnover, increase collagen production, reduce fine lines and wrinkles, and fade pigmentation. Start by using these products (Kim recommends Differin gel) one to two nights a week and slowly work your way up to every night if you can tolerate them without peeling, redness, or stinging. If you have no problems using an over-the-counter retinol every night, ask your dermatologist for a stronger prescription retinoid. And as is the case with any acne-treating product, consult your doctor before using retinoids if you are pregnant, breastfeeding, or planning on being pregnant.
Wash Your Face with a Facial Cleansing Device
Kim recommends using a facial cleansing device at nighttime to thoroughly remove makeup, sunscreen, oil, and environmental pollution—but not just any cleansing brush. Opt for one with ultrasonic technology, which is gentler on your skin than a rotating brush head. The above, which is made from a relatively antimicrobial silicone, is one of Kim's top picks.
Those with acne usually fear that any moisturizer is going to clog their pores and cause acne, but that's not the case. Kim says using an oil-free or non-comedogenic formula could actually help you to better tolerate your acne-fighting skin products for faster results. According to Kim, even a light hyaluronic acid serum (like this Byrdie-favorite from Rose Ingelton MD) could be a good option in the summertime or for oily skin types.
Treatment for Inflammatory Acne
The same principles of treating non-inflammatory acne apply to treating inflammatory acne: don't over-cleanse, over-scrub, or over-exfoliate your skin.
Kim explains it best: inflammatory acne lesions have their origin in non-inflammatory acne lesions. That's why the first recommendation for inflammatory acne is the same as the standard treatments for non-inflammatory acne. "I try to start every acne patient on a retinol or retinoid or an AHA/ BHA product to get to the source of all acne: the clogged pilosebaceous unit," Kim explains.
Cover Your Breakout With a Sticker
If you feel a deep cyst beginning to form but can’t get into your dermatologist’s office for a cortisone injection, Kim suggests covering it with a sticker from this kit, which will deliver beneficial ingredients, like salicylic acid, hyaluronic acid, niacinamide, and oligopeptide-76.
Try Antibacterial and Anti-Inflammatory Topical Ingredients
"The bacteria Cutibacterium acnes lives at the base of your hair follicles and breaks down your sebum into fatty acids, which in turn activates inflammation in the surrounding skin," Kim explains. "So while acne is not a true infection of your skin, antibacterial products are a mainstay of treating inflammatory acne." Icecreamwala says to look for benzoyl peroxide, which will kill bacteria and thus decrease inflammation caused by the bacteria. If you hate the way benzoyl peroxide bleaches your sheets (we don't blame you), Kim suggests the above OTC antimicrobial cleanser, which contains sodium hypochlorite as an alternative to benzoyl peroxide. Kim also suggests looking for anti-inflammatory topical ingredients, such as niacinamide, zinc, and sulfur.
Visit Your Dermatologist
Not all acne can or should be treated at home; cysts and nodules that are deeper in the skin may require a visit to your dermatologist. Sometimes prescription topicals, a cortisone injection, or even an incision and drainage are necessary. For moderate and severe inflammatory acne that could lead to scarring, prescription options, like oral antibiotics, spironolactone, and isotretinoin, are also options to consider.
For those who want to avoid taking oral medications, Kim adds that light- and energy-based devices could also be helpful by reducing C. acnes, sebum production, and overall redness and number of inflammatory lesions, as well as treating active cystic acne and acne scarring. With all of these in-office treatment options, clearly, the best way to clear skin is through your dermatologist.