The different types of acne (and how to manage them)

Many of us have heard of acne, but did you know that there are different forms of it?

Broadly speaking, acne falls into two different categories – inflammatory and non-inflammatory. And within these two categories, there are then sub-groups of acne (more on these sub-groups below).¹

But before we move on, let’s just establish what acne is.

What is acne?

According to the NHS, ‘Acne is a common skin condition that affects most people at some point. It causes spots, oily skin and sometimes skin that’s hot or painful to touch.’²

Also referred to as Acne Vulgaris, acne is caused by the hair follicles that are connected to the oil glands getting blocked up with too much oil, as well as dead skin cells. Teenagers tend to get it the most however, it’s possible for people of all ages to develop it.³

In terms of the extent and scale of who gets acne, around 95% of people aged 11 to 30 are affected by it. It also tends to be more common in 14 to 17-year-old girls and 16 to 19-year-old boys.⁴

What causes it?

As we’ve just mentioned, excess oil production and pores getting clogged with dead skin and oil that’s produced by the skin’s sebaceous glands, which is also known as sebum, can cause acne. Bacteria and hormones (excess androgens) can also cause acne too.⁵

Here are some other common acne-contributing culprits too:

Hormones

Our levels of the androgen hormone naturally rises during puberty, which results in the sebaceous glands creating more sebum.

It’s possible for women to get acne when pregnant because of the hormonal changes that are taking place. Oral contraceptives can also play a part in affecting hormone levels and sebum production, and therefore trigger acne. Meanwhile, having low levels of androgens have been known to make acne worse – this specifically applies to women.⁶

Diet

Studies have shown that certain foods, such as dairy products and carbohydrates, can potentially cause acne. It’s also believed chocolate can contribute to creating the condition too.

According to a study of 14 men with acne, their symptoms got worse after eating chocolate.⁷ Other food that is thought to cause acne includes: refined sugar, fast food and food that contains Omega-6 fats.⁸

Stress

Just to clarify, stress cannot cause acne, but it may make pre-existing acne worse. Research has found that wounds, include acne spots and sores, take longer to heal when a person feels stressed.

Acne that takes longer to heal, is more susceptible to getting worse due to the fact the pimples stay around for longer, increasing the chance of inflammation and infection.⁹

The different types of acne

As we’ve already established, there are two over-arching forms of acne – inflammatory and non-inflammatory. And then within those, there are various different types of acne. Let’s take a look at the main ones:¹⁰

ACNE TYPE #1: Blackheads AKA comedones (non-inflammatory)

Are created by the top of the pore staying open, despite the rest of it being blocked up with sebum and dead skin. This is why the surface of them looks black.

How to manage blackheads:¹¹

Exfoliate your skin – using a face scrub, facial cleansing brush or chemical exfoliant
Use a clay mask – to help reduce oil production and draw out impurities from your skin
Apply non-comedogenic skincare products – i.e. non pore-blogging products (most products should state whether or not they’re non-comedogenic or not)
Have an extraction facial – where your skin is steamed to loosen the pores and the blackheads are removed with an extractor tool
Use a retinoid – they’re Vitamin A based products that can help generate enhanced exfoliation

ACNE TYPE #2: Whiteheads AKA closed comedones (non-inflammatory)

Tend to form when pores gets clogged by sebum and dead skin cells, like with blackheads. However, the top of the pore closes up and forms a small bump that sticks out from the skin.

How to treat whiteheads:¹²

Apply Vitamin A cream – Vitamin A for acne can help healthy cell regeneration
Use tea tree oil – it has natural antibacterial properties
Dab some white hazel on – it has astringent, pore-opening qualities
Use apple cider vinegar as a toner – using apple cider vinegar for acne may sound a bit bizarre, but it can help dry out whiteheads. You can just put it on your whiteheads or use it as an overall toner.¹³

ACNE TYPE #3: Papules (inflammatory)

Happen when the walls surrounding the pores are broken down by severe inflammation. Hard, clogged pores form that feel tender and look pink because they’re sore.

How to treat papules:

Wash your face twice a day with an acne face wash that contains salicylic acid¹⁴
Over the counter products may be effective for mild breakouts¹⁵

ACNE TYPE #4: Pustules (inflammatory)

Also form when the surrounding pore walls break down. However, pustules are filled with pus, look redder and usually have a yellow or white head due to the pus.

How to treat pustules:

Wash your skin with warm water and mild cleanser
Do this twice a day to help prevent oil from building up
Use products containing salicylic acid

ACNE TYPE #5: Nodules (inflammatory)

Form when pre-existing clogged pores get more irritated over time and get bigger. They tend to form much deeper down within the skin than pustules and papules.

ACNE TYPE #6: Cysts (inflammatory)

Are created by combination of bacteria, sebum and dead skin. They also form deep down in the skin, much deeper than nodules.

They either look like red or white pumps and are painful to touch. If you’re wondering ‘what is cystic acne?’, then this is it. The acne cysts are more prone to scar your skin too because they are so much further down within your skin cells.

How to treat nodules and cysts:¹⁶

You may find that over the counter products don’t work for you
If this is the case, see a dermatologist
Isotretinoin is considered the best treatment for most forms of severe acne
Alternatively, you may be prescribed oral antibiotics instead

The advice above is aimed at providing you with an introduction to identifying and dealing with acne and how to clear acne.

Everybody’s skin is different, and different products are more effective on some people than others. Where possible, always seek expert advice and if you are trying a new product for the first time, always carry out a patch test 24 hours before.

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Last updated: 14 September 2020

Sources
1 https://www.healthline.com/health/beauty-skin-care/types-of-acne#noninflammatory-acne
2 https://www.nhs.uk/conditions/acne/
3 https://www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047
4 https://www.nhs.uk/conditions/acne/
5 https://www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047
6 https://www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047
7 https://www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047
8 https://www.healthline.com/nutrition/hormonal-acne-diet
9 https://www.healthline.com/health/stress-acne#types-of-acne
10 https://www.healthline.com/health/beauty-skin-care/types-of-acne#inflammatory-acne
11 https://www.cosmopolitan.com/uk/beauty-hair/g9178537/how-to-get-rid-of-blackheads/
12 https://www.healthline.com/health/beauty-skin-care/how-to-get-rid-of-whiteheads#natural-remedies
13 https://www.womenshealthmag.com/beauty/a19902539/apple-cider-vinegar-for-acne/
14 https://www.aad.org/public/diseases/acne/diy/types-breakouts
15 https://www.verywellhealth.com/papule-definition-of-an-acne-papule-15541
16 https://www.verywellhealth.com/nodular-acne-15817