Guide to different types of acne (and how to treat them)

By Mosh

22 January 2021

minute read

Man checking his face in the mirror

Treating acne isn’t a one size fits all approach. To find the right acne treatment, you first need to understand what type of acne you have. Read on to find out.

If you haven’t experienced spots or zits at some time in your teenage years, you’d be one of the rare few. Acne affects more than 90% of Australian adolescents aged 16–18 years. Usually, the dreaded spots clear up within 8-10 years of appearing, but in some cases, they can persist into adulthood, no matter how much we wish they wouldn’t. Then there are some people who only develop acne for the first time as adults.

No matter which camp you fall in, acne can be both physically and emotionally scarring. From hormonal acne (acne tied to fluctuations in your hormones) to acne as a result of other causes such as stress, it’s safe to say we just want it gone!

So, how can you best treat and get rid of acne? Identifying the type of acne you have is the first step. After that, getting prompt and correct treatment can reduce the risk of long-term skin complications, such as dark spots and scarring.

In general, acne can be divided into two groups – non-inflammatory and inflammatory – and it’s possible to have both types at once. Here, we’ll discuss the details of both and some possible treatment options.

Non-inflammatory acne

Blackheads and whiteheads are both considered non-inflammatory acne. They’re usually easier to treat than inflammatory acne, and can respond well to over-the-counter treatments.

Blackheads

Also known as open comedones, blackheads occur when a pore is clogged by a combination of sebum and dead skin cells. The top of the pore stays open despite the rest of it being clogged. They appear as small, slightly raised, black-coloured bumps.

Many people mistake the black colour for trapped dirt and may over exfoliate their skin. However, the black colour is simply a result of the blocked pore being exposed to air, so scrubbing excessively won’t help and may even lead to scarring. And while squeezing a blackhead is tempting (and often easy to do), it too can lead to scarring.

Man leaning against brick wall

Whiteheads

Whiteheads, also known as closed comedones, are small, whitish or flesh-coloured bumps. Unlike blackheads, the pore is entirely closed, so they can’t be removed easily by squeezing. If you try, you may also end up with scarring.

Treatments

Blackheads and whiteheads can be treated with the same over-the-counter creams or gels. Common ingredients in these products are sulfur, salicylic acid or benzoyl peroxide. Sulfur and salicylic acid work by removing dead skin cells and excess oil, while benzoyl peroxide works by penetrating the pores and killing acne-causing bacteria, as well as softening and peeling the outer layer of the skin.

Sulfur is the mildest of the treatments, with benzoyl peroxide being harsher, but the most effective. Salicylic acid is best for preventing future comedones from forming as it naturally exfoliates the skin.

It’s common for some irritation and skin dryness to occur with such treatments, though. If this happens, take a break from treatment and restart after a few days. You may also consider dropping to a lower strength product if you’ve started on something stronger. For example, benzoyl peroxide is available in 2.5%, 5% and 10% strengths. It’s advisable to start on the lowest strength and work up only if needed. If irritation continues, stop the treatment and consult a trusted Mosh Dermatologist about an alternative.

Alpha hydroxy acids such as glycolic acid and lactic acid are also commonly used in over-the-counter acne treatments. They help to remove dead skin cells and reduce any inflammation. They also stimulate the growth of new smoother skin and help to improve the appearance of acne scars.

In general, people find that they need to try different products with varying active ingredients (and often in different combinations) to find what works best for their skin. To help point you in the right direction faster, seek guidance from a Mosh Dermatologist.

Remember, when it comes to treating acne, patience is a virtue. Acne products take time to work and sometimes two or three months of use is needed to see results. It’s also possible for acne to look worse before it gets better.

To support the effectiveness of your acne treatments, you can make some easy lifestyle changes: Wash problem areas twice a day with a gentle, non-soap cleanser and use an oil-free water-based moisturiser to help alleviate dry, peeling skin. Also, avoid oily sunscreens and hair products and opt for products that are non-comedogenic, meaning they won’t clog pores.

Man applying face cream

Inflammatory acne

Pimples that are red and swollen are known as inflammatory acne. Inflammatory acne is more severe than non-inflammatory acne and is more likely to cause marks such as scarring or pitting.

Mild inflammatory acne includes papules and pustules, and the more severe types include nodules and cysts.

Papules

Papules occur when excess oil, bacteria, and dead skin cells push deeper into the skin and cause redness and swelling (inflammation). Essentially, they’re whiteheads or blackheads that have caused so much irritation that they’ve damaged some of the surrounding skin, leading to inflammation.

These nasty spots appear as small red bumps and may feel like sandpaper to touch if there are a lot in one area.

Pustules

Pustules are pus-filled pimples. They’re a lot like papules, except they contain yellowish pus in the centre – a collection of immune and bacterial cells. They also have a pink or red base indicating inflammation.

Nodules

Nodules are like larger, deeper papules but they have no visible centre or head. They are hard, painful, inflamed lumps, and because they’re deep within the skin, they’re harder to treat with over-the-counter medications. They can often leave behind dark spots or scarring.

Cysts

Cysts are the largest form of acne and the most severe. They appear as large red or white bumps that are often painful to the touch. They’re deeper than nodules and are filled with pus. This type of acne is also the most likely to scar.

Treatments

Benzoyl peroxide face washes and creams can be a useful first step for treating the milder inflammatory types of acne as they may help reduce swelling as well as get rid of bacteria within the skin.

Topical retinoids, which are derived from vitamin A, are also another option for combatting inflammatory papules and pustules and they can be used on non-inflammatory acne too. They work by promoting the exfoliation of dead skin cells as well as by boosting the production of new skin cells. Some retinoid creams are available over-the-counter – these are known as retinols. But for the more potent, effective retinoids, a prescription from a Mosh Dermatologist is required.

For the more severe inflammatory acne (nodules or cysts), it’s recommended that you consult with a Mosh Dermatologist who can provide you with a personalised treatment plan. The plan may contain stronger, more effective acne treatments including topical and/or oral medications, depending on the cause of your acne and it’s severity.

Tags: skin