Understanding your blemishes is the first step towards banishing them.

By Jaclyn Smock
December 31, 2019

All acne is not created equal, but we can all agree that it's a bad experience in any form: It pops up at the worst possible time and leaves a mess when it's gone. There are so many factors that can cause and worsen acne—hormones, diet, stress, and environmental damages, to name a few. It gets even more confusing when you factor in all of the different acne types, which are often indicators of those aforementioned factors and changes. Matching them up can feel impossible—but it doesn't have to. Here, industry experts explain the forms of blemishes, including the reasons behind them. Armed with this knowledge, you'll be able to forge the best possible treatment plan for your own skin.

Getty / Delmaine Donson

Related: Here's Why You Struggle with Adult Acne—Plus, How to Get Rid of It

There are two types of broad acne groups.

All acne is filed under one of two umbrellas: inflammatory and non-inflammatory acne. Understanding which category yours falls under is the first step in taking control of your complexion. "Non-inflammatory acne includes blackheads and whiteheads, which look like skin-colored bumps or congested black pores on the face," explains Dr. Joshua Zeichner, the director of Cosmetic and Clinical Research in Dermatology at the Mount Sinai Hospital in New York City. "Inflammatory acne includes red, angry bumps, pus pimples, and the painful, underground cysts."

Blackheads and whiteheads often appear together.

Non-inflammatory acne sticks together—so if you suffer from blackheads on your nose, you likely experience a smattering of whiteheads on your cheeks or chin every now and then. The reason? They share the same root cause. "Blackheads and whiteheads are caused by clogged pores filled with oil, dead skin cells, and propionibacterium acnes bacteria," explains Dr. Dendy Engelman, a New York City dermatologist. "If the mixture is exposed to air, it becomes oxidized, which causes it to turn black, forming what we know as a blackhead."

Whiteheads are also plugged with sebum and skin cells. But there's one key difference that distinguishes them from their counterparts. "The top opening of the pore is closed, which results in a tiny bump at the surface, adds Dr. Zeichner. Luckily, you can reduce both types with one treatment plan, he says: "If you suffer from blackheads and whiteheads, stick to ingredients like topical retinoids, which help open up blocked pores and reduce inflammation."

Inflammatory acne involves papules, pustules, cysts, and nodules.

Inflammatory acne types are exactly as they sound: red, swollen, and, oftentimes, painful to the touch. The four main forms of this subset—papules, pustules, nodules, and cysts—however, all have different identifying characteristics. "Papules are typically hard, pink or red, and painful plugged pores without pus. The pore wall is slightly broken down, which allows sideways expansion of the pore content," says Dr. Robb Akridge, Ph.D., the CEO and founder of REA Innovations. Pustules, on the other hand, have pus (their aptly named!); these lesions have a head that can be seen on the surface of the skin and are what we typically consider a "zit," says Dr. Zeichner. Pustules typically exist in the upper part of the skin, but as the pus intensifies, so does the depth and width of the blemish. The best way to treat both papules and pustules? "Look for benzoyl peroxide or salicylic acid. Benzoyl peroxide helps lower levels of acne-causing conditions, whereas salicylic acid is a beta hydroxy acid that helps remove excess oil from the skin and keep the pores clear," advises Dr. Zeichner.

But cysts and nodules are the most severe acne types.

Ask anyone who has ever suffered from a cyst and they'll tell you that these pus-filled inflammatory blemishes deserve a league of their own. Nodules, pus-free cysts, are equally as awful, and "are the hardest and deepest acne lesions found within the dermis and are associated with a hormonal imbalance," explains Dr. Akridge. They're hard and sore, and can take weeks—if not months—to go away. This leads us to the main problem: If you suffer from hormonal acne, even the most curated skincare routine won't make a difference. What will can only be found in the dermatologist's office.

"A doctor may need to prescribe a short course of oral antibiotics like tetracycline, not only for the bacterial reduction but also for the antibiotics' ability to reduce inflammation," shares Jacqueline Piotaz, a certified esthetician. In more severe cases, spironolactone (a drug that reduces testosterone in the body) and isotrentinoin (an intense oral therapy formerly known as Accutane) may also be utilized; cortisone shots can also be injected directly into cysts for quick relief. Whatever your cystic acne's severity, it's critical to leave these blemishes alone: Since nodules exist deep under the surface, you can't physically extract them at home—which is why they're better left to your dermatologist.

Related: Nine Ways to Improve Your Skin and Hair While You Sleep

Location matters.

A blemish can happen within any pore on your face; and pimples aren't limited to just one spot. While it's possible for all breakout types to appear just about anywhere (and together!), there are regions that are more prone to certain blemishes than others. "Blackheads and whiteheads tend to occur on the chin, forehead, tops of the cheeks, and all over the nose, whereas papules and pustules can occur anywhere on your face. In cases of hormonal acne, however, the cysts are usually found on the chin, cheeks, and along the jaw," explains Dr. Akridge.

You likely have more than one type.

Breakouts love company, which is why you likely have a mix of several blemish types. Just as whiteheads and blackheads often crop up together, so do nodules and cysts, notes Zeichner.

Make sure it's really acne.

Before treating breakouts around the nose and mouth, rule out perioral dermatitis and rosacea, two skin conditions that often mask as acne. "Perioral dermatitis tends to be around the mouth area, and rosacea tends to be on the cheeks closest to the nose," explains Dr. Carl Thornfeldt, a dermatologist and the founder of Epionce. Rosacea can even occur as a reaction to the environment or an over reaction to environmental triggers, like spicy foods and alcohol. "This leads to flushing and development of red bumps and pus pimples," explains Dr. Zeichner.

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