There are many different types of acne, from blackheads and pimples to cystic acne, even baby acne or sports acne. Explore our comprehensive guide to see what kind of acne you have.
When we say “acne,” we might be talking about a general skin condition, but there are quite a few different types of acne. Acne can be categorized by severity, by how it forms, or even by the age of the person with acne. For instance, do you have mild, moderate, or severe acne? Is your acne mostly blackheads? Papules? Cysts? Do you have one of the specialized types of acne, like acne inversa or fungal acne? Effective treatment depends on an accurate understanding of the problem, which means if you know what kind of acne you have, you are more likely to find the best acne treatment for you. To that end, we’ve created a comprehensive guide to all the types of acne for you to explore or discuss with your dermatologist.
Acne Vulgaris: Textbook Acne
There are actually many types of acne, but acne vulgaris is the generic term. There are many other acne terms that live under the umbrella of acne vulgaris, like acne mechanica, inflammatory acne, or baby acne, but these are actually just more specific types of acne vulgaris. It’s helpful to split acne vulgaris into a multitude of varying categories because it can present in a wide variety of ways, and the best treatment for one form of acne vulgaris may not work at all on a different form. But regardless of what kind of acne you’re dealing with, it is made up of specific types of acne lesions which can be categorized as blackheads, whiteheads, papules, pustules, or cysts.
Those Dark Acne Dots Are Really Blackheads
Sometimes referred to as “acne dots,” blackheads are small black dots that can appear individually or cover large areas of the face. They are one of the most common types of acne, and they are the result of two of the three main causes of acne: inflammation and oil production. Blackheads form when the skin becomes mildly inflamed and the pores constrict slightly but do not close. Our skin naturally produces oil to protect itself, and that oil can get trapped in a constricted pore, but when our skin overproduces oil, then blackheads become even more likely. Either way, oil and dead skin cells get stuck in the pore, and because it’s not closed off completely, air then oxidizes the oil, turning it a dark color, hence the term “blackhead.”
Many skin care companies put out advertisements claiming acne, especially blackheads, is “dirty,” and there’s a common misconception that blackheads are actually dirt that has gotten lodged in the pores. This causes us two big concerns: first, it propagates a stigma about acne that insinuates people with acne are unhygienic, when that is definitely untrue; and second, if these skin care companies believe blackheads are really caused by dirt, then they will design their products to solve that problem, but because there’s no dirt involved in blackheads, those products will likely not work.
At Exposed Skin Care, we understand how acne works, and design our products accordingly, so you can be assured that they work. No matter what type of acne you have, our Ultimate Kit has everything you could ever need to get rid of acne.
How to Spot a Whitehead
Whiteheads are very similar to blackheads, there is only one small difference between them: blackheads are made up of oil and dead skin cells trapped in a constricted but open pore, and with whiteheads, the pore is closed completely. The oil and dead skin cells are trapped completely beneath the surface of the skin, which is why they don’t get the dark color of blackheads.
Whiteheads are also the same as blackheads in that they can occur in isolation or all over. They look like small white bumps, and you can differentiate between a pimple and a whitehead because whiteheads are not red or inflamed at all.
What is a Papule?
Papules are one of the lesser known types of acne, but they are one of the most common. They are small, inflamed bumps that might be flesh-toned or could have a white or yellow color, but they do not have a defined head. Papules, like pustules and cysts, involve all three of the main causes of acne: inflammation and oil production, like blackheads and whiteheads, but also bacteria.
There is one specific kind of bacteria that is primarily associated with acne, appropriately named p. acnes. They are not inherently bad though. P. acnes always live on the surface of our skin, and when left alone, they could even help reduce acne. Their main food source is the oil our skin produces, so they can prevent the kind of buildup that leads to clogged pores, but often this is not the case. If our skin overproduces oil, the bacteria can start reproducing at much higher rates, and if our skin is inflamed, the bacteria are likely to get stuck in a pore with dead skin cells and oil, where they will also multiply at higher rates. Both of these can cause increased acne, and if both happen at once, serious acne can result.
So how does this relate to papules? Papules are the result of that initial growth in bacteria. The bacteria get trapped in a pore and start reproducing very quickly until the immune system recognizes it as an infection, and to fight it off, it triggers the inflammation response to isolate the infection to the one pore. This pore then becomes swollen and red, and it is officially a papule. Nearly all papules go on to become our next category of acne: pustules.
Pustules, AKA, Pimples
The word “pimple” is typically used to refer to all types of acne, but it’s really related to one kind in particular: pustules. Most pustules start as papules. Sometimes an infection will generate so quickly that the papule stage is skipped completely and a fully-formed pimple emerges very quickly, but most of the time, the infection will spark the inflammation response, which will lead to a papule, and the ensuing battle between immune system and infection will gradually create a pustule.
Pustules are identifiable by their clearly defined head which is white or yellow-ish in color, and the surrounding skin, which is usually red and swollen. Pustules are the only kind of acne you should ever pop, and even then it should be done very carefully. See our article on How to Pop a Pimple to learn the best technique to avoid scars.
Cysts and Cystic Acne
Cysts are one of the most severe types of acne, and they are usually pretty easy to identify. Cysts are large, soft bumps, the size of a pebble or bigger, and they usually feel like they’re full of fluid. Unlike a blister, cysts typically have a relatively thick layer of skin over the fluid. Cysts form when the immune system struggles to fight off the p. acnes infection.
Typically, when p. acnes start to multiply in a pore, the immune system sends agents to kill the bacteria, they both die so pus is generated, and the infection goes away once enough bacteria have been killed. With cysts, however, the immune system starts attacking your own skin. This sometimes happens because p. acnes can release a chemical that binds to your skin cells and makes them seem like bacteria to your immune system. So instead of fighting the bacteria, your immune system starts fighting your own body, which allows the bacteria to continue growing in number, and eventually breaks down the pore so the infection can spread deeper into the skin.
Cystic acne can be difficult to treat, but definitely not impossible. The best results are usually seen from dermatologist intervention, although some studies suggest that tea tree oil could be an effective home remedy.
How to Categorize Acne
All of the various types of acne involve blackheads, whiteheads, papules, pustules, and/or cysts, so how do we categorize it from there? Most people do not have only blackheads or only cysts; most of us have a mixture, but there are still very different types of acne. In the acne community, two main systems have emerged for categorizing acne: level of inflammation and severity.
Using both systems is an effective way to describe most acne, but there are still types of acne that stand out, because they form in a very specific way, they are unique to a certain age group, or several other exceptional reasons. So we’re going to look at all of these systems: first the inflammation system, then the severity system, and finally, we’ll review some of the more unique types of acne.
What is Inflammatory Acne?
Inflammatory acne is basically what it sounds like: acne that is inflamed. If you remember though, all acne starts with inflammation. So isn’t all acne inflamed? Technically yes, but when we divide acne up into inflammatory acne and non-inflammatory acne (also known as comedonal acne), we are referring to inflammation that occurs after the acne lesion is formed.
For example, a papule is a type of inflammatory acne because after the initial inflammation traps oil, dead skin cells, and bacteria in the pore, more inflammation is triggered due to the bacteria. Because bacteria send a signal to the immune system that there is an infection, any acne involving bacteria is almost always inflammatory acne. Papules, pustules, and cysts are all considered inflammatory.
Comedones and Comedonal Acne
If acne is not inflammatory, it’s comedonal. Comedones is another word for clogged pores, and it refers to blackheads and whiteheads. Comedonal acne is characterized by oil and dead skin cells which are trapped in a pore that is constricted but has not triggered any further inflammation. Comedonal acne can be just as stubborn as inflammatory acne, but it is typically less painful and less likely to leave behind hyperpigmentation or scarring.
What Does Mild Acne Look Like?
We naturally think of acne along a spectrum from mild to extreme, but how do we distinguish from one category to the other? Even though we talk about mild acne, moderate acne, severe acne, and extreme acne, these are not clear-cut divisions. Your acne might fall somewhere between mild and moderate acne, or it may fluctuate between the two. Categorizing acne by severity is an art, not a science.
That being said, mild acne is defined by a few common traits:
- An absence of nodular or cystic acne
- Some days where no acne at all is present
- Mostly comedonal acne
- Occasional inflammatory acne, but not constant
- Responds well to consistent treatment
Although mild acne is, by definition, not as bad as some other types of acne, it can still have a profound psychological effect and should never be dismissed or invalidated as “no big deal.” Acne is a very normal experience, but because of how the media and some skin care companies talk about it, many people experience low self-esteem, anxiety, and depression related to their acne. This can happen with any kind of acne, mild or severe.
Finding a Middle-Ground: Defining Moderate Acne
Let’s say you have constant acne, but it’s not usually painful or cystic. That seems more extreme than mild acne, but it isn’t quite severe either, so it might be categorized as moderate acne. But what about if you have cystic acne, but the cysts only pop up every now and again, and otherwise your skin is crystal clear? That might be considered moderate acne as well. Moderate acne is tricky because it’s a bit of a catch-all for acne that isn’t quite mild but isn’t quite severe either.
Despite being a somewhat slippery category, there are a few potential ways to define moderate acne:
- Requires a full acne treatment system rather than just a good face wash or moisturizer
- Trouble finding a treatment that clears acne completely/permanently
- Constant comedonal acne with occasional inflammatory acne
- Occasional severe inflammatory acne, but otherwise clear skin
Identifying Severe Acne, AKA “Bad Acne”
Some sources might refer to severe acne as “bad acne,” but we try to avoid judgment words like that. The word “bad” implies that acne is something inherently wrong, when the truth is that acne is a totally normal part of the human experience for over 80% of people. However, it’s true that some acne is simply worse or harder to deal with than other types of acne, and it’s important to acknowledge that. But instead of calling it “bad acne” and perpetuating a message of skin negativity, we prefer the term “severe acne.”
There are a few key ways to spot severe acne:
- No acne-free days
- Significant, consistent inflammatory acne
- Significant, consistent comedonal acne that is widespread, with frequent inflammatory acne as well
- Nodular and/or cystic acne present at least 50% of the time
- Occasional or constant comedonal acne as well
- Hyperpigmentation or acne scarring prevalent
It’s important to note that acne is not locked in to one of these categories. You may have severe acne interspersed with periods of moderate acne, or the other way around. You could have acne that goes back and forth between all three categories. Treatment is the best way to ensure that acne continuously moves toward the mild category, and eventually disappears completely.
Extreme Acne: The Worst Acne Category
Acne is generally categorized along a spectrum from mild to severe, but there are some cases that rank as extreme acne, which is more or less the worst acne imaginable. Typically, these cases are more than simple acne vulgaris, which is the term for common acne. There are actually other specific types of acne, like acne keloidalis, acne conglobata, or acne inversa, that qualify as extreme acne for a variety of reasons. Some are very resistant to treatment, others form debilitating scars, and some are signs of bigger issues, like immune deficiencies.
If you feel that you have extreme acne that goes beyond even the severe acne category, it’s important to see a dermatologist. They are carefully trained in the art and science of your skin, and they can provide solutions. All acne is treatable, just bear in mind that it’s a process and it takes time.
Everything You Need to Know About Baby Acne
Believe it or not, baby acne is a very popular occurrence. Newborns are one of the populations that is most likely to have acne, after teenagers and 20-somethings. Babies can have all types of acne, from blackheads to cysts, and it can range anywhere from one or two spots to full-on breakouts, so this particular kind of acne is not categorized by level of inflammation or severity. Baby acne is separated as its own form of acne because of the very specific population it affects.
Babies can have acne for a number of reasons. Newborns are not used to the harshness of open air, and that can sometimes dry out their skin, which can lead to the kind of inflammation that starts acne. Newborns are also producing skin cells more quickly than we are; sometimes they’re producing them too quickly and they can get clogged in their pores. Sometimes the birth is traumatic, the baby may have been under high levels of bodily stress, which can directly link to acne because it also causes inflammation. Finally, some newborns haven’t quite developed their immune systems all the way, so p. acnes bacteria can easily trick them into attacking their own skin cells, creating cysts.
How to Know if You Have Nodular Acne
Nodular acne is a specific kind of acne that is usually associated with cystic acne, but the two are not always connected. Unlike cysts which are typically soft to the touch, nodules are hard, almost solid, beneath the skin. Dermatologists believe that nodules form the same way cysts do, but for some reason instead of forming soft pockets, they harden. In both cystic and nodular acne, a layer of healthy skin covers the actual infection, making it difficult for acne treatments to reach the root of the problem. Nodular acne is often related to our next section: painful acne.
Acne Under the Skin: The Causes of Painful Acne and Deep Acne
There are some types of acne that are so close to the surface of the skin, it’s tempting to just pop them. Then you have acne under the skin, deep acne, and painful acne, which most of us definitely do not want to pop.
These types of acne are often cystic, nodular, or a combination, called nodulocystic. Cysts and nodules are often the most painful acne because they are forms of deep acne. They extend to deeper levels in the skin and occupy multiple pores, meaning they can create a lot of pressure under the skin. Because of this, when you apply pressure to cysts or nodules from the surface of the skin, it can be very painful.
Although pustules are not deep acne, they can still be painful because of the same pressure. However, because pustules reside in the upper layers of the skin and the pressure is contained to one pore, the pain is usually lessened.
What to Do About Itchy Acne
If you’ve ever had itchy acne, you know it never seems to fade, and sometimes it can even get worse over time. This is because itchy acne is almost always caused by dry skin. We say almost because a small number of cases of itchy acne are caused by yeast (see the Fungal Acne section below) but odds are, if your acne itches but looks like normal acne, it’s probably due to dry skin.
Dry skin does not produce enough oil to protect it from irritants, so even mild irritations like extra pollen in the air can make dry skin itchy and inflamed. The inflammation is meant to protect the dry skin from whatever is irritating it, but it can also make the skin itchy, which can be a big problem because scratching dry, itchy skin causes even more irritation.
This is why itchy acne never seems to go away. It’s a vicious cycle of dry skin, irritation, inflammation, acne, itching, scratching, irritation, inflammation, etc. Often, the best thing for itchy acne is a gentle, sheer moisturizer. You don’t want to clog your pores, but it’s important to protect your skin. Resisting the urge to scratch can also make a big difference in getting rid of itchy acne.
Almost All Acne is Chronic Acne
Very few people experience acne that is not chronic. Sometimes acne may be a one-time reaction to an irritant or the temporary result of a briefly compromised immune system, but most people have acne that persists over a long period of time, or acne that continually comes back, also known as chronic acne.
All of the different types of acne discussed in this article can be chronic, and chronic acne has all the same possible causes as temporary or occasional acne. Generally, acne treatment is more focused on what causes it rather than its duration, but it is worth noting that if you have chronic acne despite using a well-known acne treatment system, you may want to try switching products or adding a moisturizer to your routine.
Many skin care companies make their products far too harsh in order to get rid of acne fast, but this harshness causes irritation, which just leads to more acne in the long run. If you have chronic acne, you may want to consider switching to a gentler brand, like Exposed Skin Care, or you may need to add a more nourishing step to your routine, like an oil-free moisturizer.
Identifying and Treating Acne Mechanica
Do you have acne on your chest, right where your sports bra tends to rub? What about on your chin, where you rest your flute when you play? Do you have shoulder acne where your backpack straps dig in when you have a lot of homework? That’s probably acne mechanica.
Typically called “sports acne,” acne mechanica is the particular type of acne that forms as a result of friction and pressure. This is a common occurrence with tight uniforms or pads, hence the sports acne nickname, but sports are definitely not the only way a person can get acne mechanica. Flautists and violinists tend to get acne mechanica on their chins, people who wear bras or binders sometimes get acne on their chest, and many students get acne mechanica on their shoulders. But how exactly does this work?
Let’s look at the example of a sports bra. Like sports pads or uniforms, these are made to be tight. A loose sports bra doesn’t meet its purpose. This tightness puts pressure on the skin, especially around the ribs or on the shoulders, and when you work out while wearing a sports bra, the bra and your skin both move and create friction. This combination of friction and pressure can easily irritate the skin and lead to inflammation and acne.
Although this is called acne mechanica, it is still a type of acne vulgaris, it just has a specific cause. This is not always the case, like with acne rosacea, which is not acne vulgaris at all, but an entirely different condition. Acne mechanica is regular acne, just specifically caused by friction and pressure.
When Acne Gets Out of Hand: Acne Conglobata
Although acne conglobata starts as acne vulgaris, it turns into something much more serious. In acne conglobata, the bacterial infection common in pimples and cysts spreads underneath the skin, connecting separate pores until a deep tract of infection runs beneath the skin.
This creates cysts, nodules, and abscesses, all of which can cause serious scarring because of how deep they run and how long they take to heal. The best treatment for acne conglobata is early treatment. If possible, you want to start fighting the infection before it can create too many abscesses or dig too deep, so if you think you may have acne conglobata, see a dermatologist. If it’s not acne conglobata, it may be something else a dermatologist can help you with, no harm, no foul. And if it is acne conglobata, then you may have caught it early enough to prevent significant scarring.
It’s unclear why some people develop acne conglobata while others simply have severe types of acne vulgaris, but it’s more common in men and people in their 20s and 30s. It rarely occurs in women, teens, or people in middle to late adulthood. Some studies indicate there may be a genetic factor, so if your family has a history of cystic acne and you feel your cysts are getting worse than usual, talk to your doctor about acne conglobata.
Acne Inversa, AKA Hidradenitis Suppurativa
This is the first type of acne we’re discussing that is not classified as a variation of acne vulgaris. Acne inversa is a completely different kind of acne, and is also commonly called hidradentitis suppurativa. Unlike traditional acne, acne inversa is not simply an inflammatory condition, although inflammation does play a key role. The cause of acne inversa is not fully understood, but current research suggests that it’s related to the immune system.
Acne inversa produces pimple-like bumps in areas near your lymph nodes and glands, like in your armpits or around your groin. You can usually tell it isn’t normal acne because acne vulgaris rarely occurs near the lymph nodes.
If Your Razor Burn Seems a Little Extreme, It Might Be Acne Keloidalis
Acne keloidalis is another form of acne that is not really acne. It’s really a form of folliculitis, a condition where the hair follicle is infected and inflamed. Acne keloidalis is typically associated with shaving, and occurs most often in black men.
Dermatologists aren’t completely sure how acne keloidalis happens. Like acne inversa, they think the immune system may play a role, but many instances start with shaving, especially the back of the neck or head. If a dull or unclean razor is used, the hair can get bent back into the follicle rather than being cut. When the hair continues to grow, it grows inward and your body perceives it as an invader, so it does everything it can to get rid of it, which leads to significant inflammation. If any bacteria also get trapped in the follicle, it can become infected and inflamed, forming papules and pustules.
This is similar to regular acne, but with acne keloidalis, these lesions do not simply go away. They create raised, keloid-like scars that continue to build up as the cycle of infection and inflammation continue, and they may even need surgery to remove.
Is Fungal Acne Really a Thing?
Yes and no. It’s a myth that Candida yeast can cause acne, but other yeast or fungi can potentially cause acne.
Fungal acne is a lot like acne vulgaris in how it looks and how it develops, but instead of bacteria creating an infection in the pore, a fungus (usually a form of yeast called Malassezia) is to blame. This makes it a whole different condition, because killing bacteria and killing a fungus require very different treatments, and even the most powerful acne treatments, like Accutane, are unlikely to make a difference for fungal acne.
Even though we usually associate fungus with athlete’s foot and yeast with yeast infections, Malassezia is a fungus that always lives on most people’s skin without ever causing a problem. Dermatologists aren’t sure what causes some people to develop fungal acne while Malassezia remains dormant in others, but if you suspect your acne could be caused by fungus rather than bacteria, it’s important to talk to your dermatologist to find the right treatment.
So now that you’ve seen nearly all the different types of acne, can you better identify the type of acne you have? Hopefully you can, but if you aren’t sure if your keloid scars are normal or a sign of acne keloidalis, or if you can’t tell if your cystic acne is turning into acne conglobata, it may be helpful to print this article and bring it in to your dermatologist.
The most important part of acne treatment is to remember that all types of acne are treatable, it just might take some time. Some acne treatments take up to six weeks of consistent use to show any results, so don’t give up hope if it’s been a month and you still have acne. The worst thing you can do when trying to treat acne is try a product for two or three weeks and then stop using it because it doesn’t seem to be working. This leads to a cycle of hopelessness, when the reality is that there’s lots of hope when it comes to acne. Work with your dermatologist, be honest if a skin care routine they suggest has too many steps and you know you won’t do them all, and remember that over 80% of people have acne at some point in their lives. You aren’t alone, and there are solutions.