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:
- closed comedones, or whiteheads
- open comedones, or blackheads
- pustules, or pimples
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.
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.
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 purple-hued. Whiteheads typically do not cause scarring.
The skin around a whitehead may appear tight or wrinkled, especially when the whitehead is large or especially raised.
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.
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:
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
Learn more about the best sunscreen for sensitive and acne-prone skin.
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.
Papules are bumps under the skin’s surface that are less than
Unlike whiteheads, papules have no visible center, and unlike blackheads, the pores of a papule are not widened.
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.
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
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 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.
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 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
There are three stages of acne: mild, moderate, and severe.
The types of spots a person can develop during the different acne stages may include:
- Mild acne: A person will mostly developblackheads and whiteheads in mild acne. They may have some papules and pustules. The total number of lesions is typically under 30.
- Moderate acne: More papules and pustules will form in moderate acne, and a person can also have a higher number of blackheads and whiteheads. The total number of lesions is typically between 30–125.
- Severe acne: In severe acne, a person will develop a high number of large and painful papules, pustules, nodules, or cysts. A person may also have acne scarring. The total number of lesions is typically over 125.
A person’s acne stage may change over time with their hormones, stress levels, and other lifestyle factors all playing a part in the severity of their acne.
According to the American Academy of Dermatology Association (AAD), health conditions that can cause or look similar to acne include:
- Polycystic ovary syndrome (PCOS): A condition that affects the ovaries. A person with PCOS may experience many hormonal symptoms, including acne. Find out more about polycystic ovary syndrome.
- Rosacea: A skin condition that results in redness or rashes on the face. It may also cause acne. Find out more about rosacea here.
- Keratosis pilaris: A condition of the skin that causes small, rough bumps. This usually occurs on dry skin on the arms and thighs. Find out more about keratosis pilaris here.
- Hidradenitis suppurativa: A condition that causes painful spots and scarring. These usually occur near hair follicles that are near sweat glands, such as in the armpits or on the upper thighs. Find out more about hidradenitis suppurativa here.
- Perioral dermatitis: This condition results in small pimples around the mouth. These pimples may be red, dry, and look like a rash. Find out more about perioral dermatitis here.
- Chloracne: Chloracne is uncommon and usually results in blackheads on the face or body. Chloracne is the result of a person coming into contact with certain chemicals, such as dioxins.
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 including
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
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.
Below are answers to some frequently asked questions about acne.
What is a hard pimple?
Hard pimples are the result of dead skin cells or bacteria getting under the skin. Hard pimples are deep, often large, and occasionally pus-filled. They can be one of the most difficult types of pimples to get rid of.
Find out more about hard pimples here.
How do I know if my acne is hormonal?
Hormonal acne is not a different condition from acne. It develops due to changes in a person’s hormones. A rise in testosterone can cause hormonal acne.
For adolescents, hormonal acne usually happens in the “T-zone”. This covers the forehead, nose, and chin. For adults aged 20 years and over, hormonal acne usually occurs on the lower areas of the face, such as the chin, jaw, and lower cheeks.
A person can work with a doctor to determine what is causing the acne.
Learn more about hormonal acne.
How do I identify my acne?
There are various types of acne and a person may develop different kinds of spots depending on which type they have. For instance, mild acne is characterized by up to 30 blackheads, whiteheads, and small papules or pustules. A person with severe acne will have over 100 pustules, papules, and cysts, and may find their acne painful.
A person should visit a doctor or dermatologist to help them understand which type and stage of acne they have.
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.