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Acne is a common condition that causes several types of skin blemishes, each with a distinct appearance and symptoms.

Acne vulgaris affects around 50 million Americans annually, with close to 85% of all adolescents experiencing some degree of symptoms.

Acne can present in a number of different forms, from small blemishes to noticeable cysts.

The following are common types of blemishes associated with acne and their commonly-used terms:

Each type of acne lesion requires a different treatment. Receiving prompt, correct treatment can reduce the risk of long-term skin complications, such as pitting and scarring.

Acne blemishes fall into two categories, depending on whether or not they cause inflammation of the surrounding skin.

Most minor acne blemishes respond to at-home care and over-the-counter medications. However, people with severe or long-term acne should speak with a doctor or dermatologist.

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Whiteheads and blackheads are types of noninflammatory acne lesions. They are typically the least severe forms of acne and do not cause swelling or discomfort.

Whiteheads

The medical term for whiteheads is closed comedones. These are small or flesh-colored spots or bumps. On lighter skin, they usually have a white, circular center surrounded by a red halo. On darker skin, the surrounding area may appear dark or even purple-hued. Whiteheads typically do not cause scarring.

A hair will sometimes emerge from the center of a whitehead or appear within the blemish. The skin around a whitehead may appear tight or wrinkled, especially when the whitehead is large or especially raised.

Blackheads

Blackheads, or open comedones, are small, dark-colored spots that may appear as slightly raised bumps. The skin around a blackhead usually appears normal, while the center of the blackhead is darker than the surrounding area.

This coloration is not a result of trapped dirt. Blackheads are simply whiteheads that have opened and widened. When the contents of a whitehead are exposed to air, they darken.

Treatment options

Many over-the-counter (OTC) rinses, moisturizers, gels, toners, and creams can treat noninflammatory acne blemishes. They often contain a mix of active ingredients.

The following ingredients in OTC treatments can help break down whiteheads and blackheads:

  • benzoyl peroxide
  • salicylic acid
  • azelaic acid
  • adapalene

Several home remedies and lifestyle changes also can help reduce most minor-to-mild forms of noninflammatory acne. These include:

  • washing with lukewarm water and soap twice daily
  • applying non-abrasive cleansers
  • staying hydrated
  • avoiding over-washing or irritating the skin
  • limiting exposure to the sun
  • always wearing sunscreen when outdoors

A person with acne should not irritate or pop their blemishes. Doing so can lead to complications such as scarring and the formation of cysts and nodules.

A person with a more severe case of acne may experience inflamed blemishes across their face, chest, and back. Inflammatory acne is more severe than its noninflammatory counterpart and can lead to complications such as scarring and pitting.

Inflammatory acne can vary from small bumps that respond to topical treatments to large cysts that may require surgical attention.

Mild forms

Papules

Papules are bumps under the skin’s surface that are less than 1 centimeter (cm) in diameter. Papules themselves will appear solid, tender, and raised. Typically the skin around a papule is also inflamed.

Unlike whiteheads, papules have no visible center, and unlike blackheads, the pores of a papule are not widened.

Pustules (pimples)

Pustules are larger, tender bumps with a defined circular center filled with whitish or yellowish pus. The area around a pustule appears red or pink on light skin and a deep brown or black on darker skin.

The pus in the pustule is typically a combination of immune cells and bacterial cells collected in the blocked pore.

Pustules typically look like much larger and more inflamed whiteheads.

Treatment options

Several home remedies and OTC medications can treat papules and pustules. These include:

  • washing the affected area with cool water and soap twice a day
  • using products with benzoyl peroxide to combat bacteria
  • using products with salicylic acid to remove dead skin cells and other debris

A doctor can prescribe other treatments including topical dapsone and antibiotics.

Studies show that superficial chemical face peels may also be an effective method of managing inflammatory acne lesions.

Chemical face peels are available for purchase online.

Severe forms

Nodules

Nodules are hard, inflamed lumps located deep within the skin. Like papules, nodules have no visible head.

Nodules are a severe form of acne blemish and can cause skin complications such as dark spots or scarring.

This type of acne lesion develops when clogged pores become infected, and swell beneath the skin’s surface. As a result, nodular acne may be more severe than its physical presentation suggests.

Cysts

Cysts are very large, painful, red or white lumps situated deep in the skin. Unlike nodules, these cysts fill with pus and are typically soft to the touch.

Cysts are the most severe type of acne blemish. In severe cases, a person may require surgical intervention to treat them. If not treated properly cysts can lead to visible scarring.

Treatment options

People cannot usually treat severe inflammatory blemishes at home. These lesions require care from a doctor or dermatologist.

A doctor may recommend a combination of medications and procedures to treat nodules and cysts. These may include:

  • antibiotics, such as tetracycline, doxycycline, and amoxicillin
  • oral contraceptives for hormonal-related acne
  • systematic retinoids, such as isotretinoin
  • steroid injections
  • photodynamic therapy to combat bacteria
  • surgical drainage and extraction to remove large cysts

Dead cells regularly collect on the skin and deposit in follicles, which is where hairs grow out of small openings in the skin’s surface. These cells typically rise to the surface of the openings and eventually fall away from the skin.

Sebaceous glands attached to the follicles produce an oil called sebum, which helps prevent the skin from drying out. When excess sebum builds up, it can cause dead cells to stick together, forming a mixture that becomes trapped in the follicle’s opening.

Acne occurs when a pore becomes clogged with dead skin cells, natural body oils, and bacteria includingCutibacterium acnes (C acnes.)

When these bacteria enter and infect clogged pores, they cause inflammation and the formation of acne blemishes. The resulting inflammation can damage the structure of the follicle, allowing bacteria, fatty acids, and lipids to pass into the surrounding skin. This can lead to wider inflammation, clusters of acne lesions, and more severe acne, such as cystic and nodular acne.

In cases of minor-to-moderate acne, a person may be required to use home and OTC remedies consistently for 2-3 months before they see results. More severe inflammatory types of acne tend to take much longer to clear up.

A person should speak to a doctor or dermatologist if whiteheads, blackheads, papules, or pustules:

  • are severe
  • do not respond to OTC medications
  • are very painful
  • are very large
  • bleed a lot
  • release a lot of pus
  • cover a significant portion of the face or body
  • cause emotional distress
  • develop very close to sensitive areas, such as the eyes or lips

Treatments

Most active ingredients in OTC products also are available in prescription-strength treatments. A doctor may prescribe these if a person experiences severe acne symptoms.

Dermatologists can treat large, persistent lesions. They can also remove those that do not respond to other forms of treatment.

A person should always see a doctor or dermatologist about nodules and cysts because these require medical care. Untreated nodules and cysts, and those that have been picked or popped, can cause scarring.

There are several types of acne. These can vary from small bumps to serious cysts.

Acne can present as non-inflammatory blemishes such as blackheads and whiteheads. These result from a buildup of dead skin and oil in hair follicles and are most common on the face, back, and chest.

If these blockages become infected by bacteria, they may become inflamed. Inflammatory forms of acne can range from mild bumps, such as papules and pustules, to more severe forms, such as nodules and cysts.

Severe acne can have a negative effect on a person’s quality of life. However, a person will be able to manage most forms of acne at home with OTC remedies.

In more extreme cases, a doctor may prescribe topical ointments, antibiotics, or procedural intervention to reduce the formation of acne.