According to the American Academy of Dermatology, 80% of people between ages 11 and 30 experience face acne, but how many of us really know the ins and outs of our skin? Acne on different areas of our face forms, grows, and heals differently, and knowing how the whole process works gives us an edge in treating acne wherever it may be. It’s also vital that you understand your skin because many things that look like acne are something else entirely and need completely different treatments. Before buying every charcoal strip at the drug store or running to a dermatologist’s office for as much Retin-A as you can get, read a little more about the intricacies of facial acne and look into some of our area-specific treatment recommendations.
What Is T Zone Acne?
One of the most common types of face acne is T zone acne—but what exactly is the T zone? Generally, the face can be divided up into two zones: the T zone and the U zone. The T zone includes the forehead and nose and the U zone includes the temples, jawline, and chin.
Acne forms in these areas for completely different reasons. T zone acne forms due to extra oil, while U zone acne forms because the skin is too dry. Even though they’re so different, these are both optimal conditions for acne formation. It all comes back to the three primary causes of acne: inflammation, excess oil production, and bacteria. These factors combine in various ways to create every type of acne, but all acne starts with inflammation. When the skin is inflamed, the pores constrict slightly, trapping oil, dead skin cells, and bacteria which can combine to form all kinds of acne.
The T zone is prone to more pimples because of all the extra oil it produces. The oil our skin produces is technically called sebum, and it’s produced in our sebaceous glands and emerges through our pores. The T zone contains more sebaceous glands than any other part of the body, so it produces quite a lot of sebum. Oil doesn’t form pimples on its own though. When oil is trapped in the pores it simply forms blackheads or whiteheads. However, p. acnes bacteria, the specific type of bacteria that causes pimples, consumes our sebum as its main food source, so areas with more sebum are also areas with more bacteria. When left to their own devices, p. acnes bacteria don’t cause any trouble, but when the skin is inflamed and p. acnes get trapped in a pore, they quickly form a minor infection that creates a pimple.
Why Dry Skin Can Cause Just As Many Problems As Oily Skin
The U zone has the opposite problem. There are far fewer sebaceous glands in the U zone, making it dry and prone to a different kind of acne. Even though too much oil can cause a problem, our skin does need a certain amount of oil to keep it healthy.
The topmost layer of our skin contains what’s called the epidermal barrier, a layer of specific fatty acids that help protect our skin from external irritants like allergens, pollution, or abrasion. Our sebum contains many of these essential fatty acids, and when too little sebum is produced, the epidermal barrier suffers and our skin is open to more harsh irritants. This is bad because irritation causes inflammation and oil production, which combine to create acne.
When our skin is irritated, it tries to create a last-ditch burst of oil to protect itself. Simultaneously, the skin’s inflammation response goes off in an attempt to isolate whatever is irritating the skin and prevent it from getting any deeper into the pores. Combined, this means the burst of oil will be met with pores that are already constricting, making the perfect recipe for blackheads and whiteheads. Even the oiliest of skin can be irritated, but dry skin is especially prone to irritation which is why the U zone gets acne too.
What About Cheek Acne?
If you’ll notice, the cheeks were not included in either the T zone or the U zone. That’s because cheek acne often differs from person to person. People with oilier skin often have cheeks that are less oily than the T zone, but not as dry as the U zone. This particular combination often results in relatively clear skin on the cheeks. People with dry skin often have dry cheeks, similar to the U zone. Other people have something called combination skin, where the cheeks can be just as oily as the T zone or just as dry as the U zone, resulting in widespread acne.
Even though all acne boils down to oil production, inflammation, and bacteria, there are other factors that can influence those causes and create acne in particular areas of the face. The cheeks, for instance, are impacted by everything they touch throughout the day and night.
Throughout the night, our cheeks are constantly pressing into our pillowcases, which isn’t a bad thing if you wash your sheets regularly. If you’re like most of us though, and only wash them when you think of it, they can easily become a problem for acne. The oils, dead skin cells, and bacteria from our face transfer to our pillowcase at night, and when we go too long without washing them, it builds up until the transfer can start going both ways, causing increased acne, especially on the cheeks.
The other major culprit of cheek acne is our own hands. Without even thinking, most of us touch our face constantly throughout the day. Our cheeks aren’t the only recipients of the unwanted oils, bacteria, and physical irritation that come with this fidgeting, but it’s one of the major factors in cheek acne.
The Chin Acne Struggle
Even though the chin technically falls into the U zone, chin acne can be sort of like cheek acne in that it really depends on the person. For most people, the chin is either dry or normal, but for people with oilier skin, the T zone can extend all the way down to include the chin.
Chin acne can be affected by the same fidgety touching as cheek acne, but some chin acne is caused by a slightly different phenomenon called acne mechanica. Acne mechanica is sometimes referred to as sports acne, but it would be more appropriate to call it friction acne. Acne mechanica forms when something rubs against the skin for an extended period of time. The classic example is acne where tight uniforms or pads consistently rub, but if you’re involved in any number of activities with helmets or if you play specific musical instruments, chin acne could be an example of acne mechanica as well.
Activities like horseback riding, football, and marching band all include helmets or hats that come with a chin strap. This strap is securely fastened and rubs against the skin relentlessly, generating a lot of irritation, which then generates a lot of oil production and inflammation. Instruments like the flute or violin often run into a similar problem. Flautists play with the headpiece of the instrument pressed tightly below the lower lip against the chin, and violinists typically play with the violin pressed against their jawline or under the chin. The constant pressure over an extended period of time causes irritation, inflammation, and acne in much the same way as chin straps.
The Trick to Treating Cheek and Chin Acne
So how are you supposed to treat these in between spaces? Carefully. Pay attention to your skin and figure out what it needs. If your chin or cheeks are always oily, no matter what time of day or what activities you’ve engaged in, then you should look for treatments that exfoliate the skin, like salicylic acid, sulfur, and citric acid. If your chin and cheeks are generally dry, look for moisturizers that won’t clog pores or make your skin feel greasy. Moisturizers work in a variety of ways, but if your acne seems to be caused by the irritation of dry skin, you want to find a moisturizer that focuses on strengthening your skin’s defenses against irritants. Finally, if the skin on your chin and cheeks seems to flip flop, oily one second, dry the next, then we recommend a fresh start with your skin care. When skin swings wildly from oily to dry, there’s a good chance that something in your skin care routine is too harsh and is causing both dryness and oiliness simultaneously. Try using a very mild exfoliant and a light moisturizer once a day and see if that evens things out. If not, you may want to see a dermatologist for a more professional solution.
What to Do About Acne on the Temples and Acne on the Side of the Face
Acne on the temples and acne on the side of the face falls squarely into the U zone and is almost always caused by some form of irritation. Like cheek acne, infrequently washed pillowcases and fidgety hands can lead to acne on your temples or the side of your face, but unlike cheek acne, the skin there is almost always dry.
This dryness means that the harsh acne products designed to strip away oil will only make things worse, but it also means that the acne that forms on the temples or the side of the face is probably more painful to pop. The pores in our T zone are typically bigger because of the oil that escapes through them every day, so when we pop a pimple or blackhead in the T zone, the pore is ready to be rid of the excess oil and return to a smaller state. But the pores in our U zone are already fairly small because so little oil comes through there, and the acne that forms in the U zone typically does so because of lots of irritation and inflammation. This makes getting rid of acne on the temples and acne on the side of the face extra difficult, because it can be painful to the touch.
In general, we recommend avoiding popping whenever possible, since popping usually only serves to increase inflammation, but this tip is especially important for acne on the temples or the side of the face. With the skin so inflamed already, any attempts at popping will be painful and largely ineffective. Instead, try to bring the inflammation down through gentle, moisturizing products. Honey and green tea extract are great natural options, but if you’re looking for a product designed to treat acne specifically, our signature Moisture Complex can do the trick.
The Top Three Reasons We All Get Jawline Acne
Jawline acne is one of the more painful types of acne, and one of the most common. It’s a key part of the U zone, so it’s usually dry and easily inflamed, but there are three main reasons jawline acne forms.
First, like the chin, the jawline is the ideal spot for acne mechanica, especially for chinstraps and violins. Chin straps often run along the jawline, consistently causing friction and irritation, and many violinists play with the violin pressed along their jawline. The second main cause of jawline acne is actually a main cause of most face acne: fidgety hands. Just as we often rest our cheeks or forehead in the palm of our hand, we also tend to rest our jaw in our palm or along the backs of our fingers. This transfers all kinds of oil and bacteria that can make jawline acne worse.
The third cause of acne on the jaw is makeup, but don’t worry, makeup itself doesn’t inherently cause acne. You just need to make sure you’re using oil-free, non-pore-clogging makeup, and you have to wash it off gently but thoroughly every night. This is where many people who wear makeup tend to run into trouble with their jawline specifically. When applying foundation, it’s important to apply it along the jawline and the top of the neck. This blends the color of the foundation with your skin and makes it look more natural. The trouble is, even if you’re careful to wash your face every night to remove your makeup, it’s easy to miss the jawline. It’s hard to splash water on your jaw without making a huge mess, so many of us miss it without even thinking about it. This allows makeup to buildup on the jawline, eventually clogging pores and generating acne.
Acne Behind the Ears: How Did It Even Get There?
Acne behind the ears might sound unlikely, but it’s more common than you think. Usually we are careful to point out that acne is not a hygiene issue, because even the cleanest people in the world can get acne, but when acne forms behind the ears, there’s a good chance you’re forgetting to wash back there.
The pores behind our ears are generally smaller and tighter than the pores on our face and they produce far less oil, making it much harder for them to get clogged and form acne. However, when we aren’t careful to wash behind our ears, the small amount of oil produced there can start to build up and eventually clog pores. Acne behind the ears usually takes the form of whiteheads, which are closed pores clogged with oil and dead skin cells. Blackheads are the same thing, except the pore is open, which allows the air to oxidize the oil, turning it a darker color. The pores behind the ear are so small, they tend to close up any time they’re clogged, resulting in small, hard whiteheads you might feel whenever you run your finger behind your ear.
A lack of washing is the biggest cause of acne behind the ears, but there is one other popular factor: hair supplies. Hair products like gel, heat spray, or hairspray often get applied to the ears or behind the ears as well as on the hair, and the chemicals in those products can easily irritate the skin or clog the pores.
Regardless of the reason for acne behind the ears, the best treatment is simply to wash back there more often. Don’t scrub, as that will simply irritate the skin, cause inflammation, and create more acne, but make sure you gently wash and wipe behind your ears in every shower.
How to Get Rid of Stubborn Acne on the Upper Lip
One of the most painful forms of acne is acne on the upper lip. Those small blackheads that embed themselves right on the edge of your upper lip don’t always go away on their own, but they bring tears to your eyes any time you try to pop them. We have a few tips for getting rid of those stubborn blackheads, but more importantly, we’ve found several key ways to prevent them from forming in the first place.
The mouth and lips have more nerve endings than almost any other part of the body, making them far more sensitive to pain, so it’s best to be gentle if you want to remove acne on the upper lip. As we said before, popping rarely makes acne better, and popping acne on the upper lip is often extra painful. If you want to remove these stubborn blackheads, we recommend a gentler method. Soak a washcloth in warm (but not hot) water and apply it to your upper lip for five minutes. Then wash your face in lukewarm water using a very gentle exfoliant, like 0.5% salicylic acid or 3% sulfur.
Although there are ways to remove nearly any kind of acne, it’s always better to focus on prevention. To prevent acne on the upper lip, first try switching toothpastes. Many toothpastes contain sodium lauryl sulfate, a chemical that clings to the plaque on our teeth and then foams up to carry the plaque away. The problem is, toothpaste foam often makes its way onto our lips, and sodium lauryl sulfate is very irritating and it can cause increased acne around the mouth. Second, apply less lip balm or lipstick. Both of these products can clog pores if they get on the skin around the lips, which then leads to increased rates of acne.
When Acne Isn’t Really Acne
If acne occurs somewhere on the face, it’s very likely that it is true acne, also called acne vulgaris. However, there are some areas on the face where acne is much less likely, and bumps that might look like acne are more likely to be a variety of other conditions, from fungal acne to ingrown hairs to natural elements of healthy skin. The following types of “acne” are often other issues in disguise, so it’s important to know how to tell the difference between true acne vulgaris and other skin conditions.
True Acne on the Lips Is Rare, but Cold Sores Are Not
Acne around the mouth or on the edges of the lips is fairly common, but if you have acne on the lips, there’s a good chance it isn’t actually acne. Bumps on the lips may look like acne, but more often than not, they’re actually cold sores.
When cold sores first form, it can be difficult to tell if they are cold sores or acne, but if they are on the pigmented part of your lip, there is little to no chance that it’s acne. Acne forms in the pores and hair follicles, and our lips have very few hair follicles and the pores on our lips don’t work quite the same way as the pores on the rest of our face. Cold sores, however, can easily form on our lips. Cold sores are caused by the herpes simplex virus, called HSV-1, a form of herpes that usually affects the mouth. This is different from HSV-2, the herpes virus that most commonly causes sores on the genitals, though they are very closely related. Many people carry HSV-1without showing any signs or symptoms, but others can develop frequent cold sores around the mouth or on the lips. In their early stages, cold sores could look like acne on the lips. They typically start with tingling or itching and then they form small bumps. These bumps quickly swell up to become fluid-filled blisters, which then pop and crust over, forming the painful scab that looks more like what many of us envision when we think of cold sores.
Cold sores will heal on their own in a few weeks, but you can also speed up the process with the use of antiviral medication, over-the-counter treatments containing a gentle drying ingredient, or moisturizing products like lip balm.
How to Tell the Difference Between Sebaceous Filaments and Acne on the Nose
Do you have acne on the nose? Does that acne look like tiny blackheads all over? Guess what—that probably isn’t acne. They are likely something called sebaceous filaments, a completely normal element of healthy skin.
The nose has plenty of pores and hair follicles, so it’s more than possible that you will have acne on your nose at some point, but if it feels like you constantly have small blackheads all over, you may be worrying over nothing. Earlier, we discussed how the oil our skin creates is technically called sebum, and how it’s produced in sebaceous glands throughout the skin. If sebum is meant to help create a protective layer for our skin, then it has to get to the surface, and it does so through sebaceous filaments. Sebaceous filaments live in the lining of our pores, and their main job is to help get sebum from the sebaceous glands to the surface of our skin. They are largely composed of oil themselves, and on our nose especially, they can look a lot like blackheads.
You can squeeze and pop pores with sebaceous filaments, just like blackheads, but unlike blackheads, you won’t get a dark lump out. Instead, a stringy yellow or white substance will come out—that’s the sebaceous filament. This will stretch your pore, leaving it open to bacteria and dead skin cells, making it more likely for real acne like blackheads and pimples to form. Plus, popping sebaceous filaments has no positive lasting effect. If anything, the pore will remain permanently expanded, making it especially susceptible to future acne. Within 30 days, sebaceous filaments reform and look just the same as before. The best way to make sebaceous filaments less visible is to use gentle exfoliating products and leave them alone as much as possible.
Most Eyebrow Acne and Acne Between the Eyebrows Is Really Irritated Hair Follicles
It’s more than possible to get true eyebrow acne or acne between the eyebrows, but more often than not, bumps in or between the eyebrows are signs of irritated hair follicles. Sometimes hair follicles are irritated by something as simple as makeup or hair products, but sometimes they are irritated by ingrown hairs.
If you have true eyebrow acne or acne between the eyebrows, it’s best to make sure you’re applying all of your acne products to your eyebrows as well as the rest of your face. It’s natural to avoid applying various acne creams or serums to your eyebrows because we usually don’t want our skin care products to come in contact with our hair, but if you’re developing acne in or between your eyebrows, it’s important to start treating them like you do the rest of your face.
If a bump around your eyebrows is very red or itchy, it might help to take a closer look because it may be an ingrown hair. Ingrown hairs happen when a hair turns and starts growing back into the skin. You can usually tell if an acne-like bump is really an ingrown hair by inspecting it closely. You can typically see a hair at the center of the swelling and redness if it’s an ingrown hair, whereas acne will not have a hair in the bump.
Ingrown hairs are best treated by plucking the hair and then applying a healing ointment like Neosporin or honey. Removing the hair prevents it from growing deeper and creating more of a problem, and healing ointments help keep the exposed hair follicle from getting infected by bacteria that reside on the skin.
Can You Really Get Acne on the Eyelid?
In short, probably not. Acne on the eyelid, or bumps that look like acne, are usually one of two things: a sty or a chalazion. Both involve the sebaceous glands in the eye, but they are very different from acne and never benefit from acne treatment products. In fact, you should never apply acne treatments on the eyes or too close to them, as they can often cause pain or damage.
A sty is a bump that forms relatively close to the lash line of the eyelid, and it is caused by a bacterial infection of the sebaceous gland. Unlike acne, which is caused by p. acnes bacteria, a sty is usually caused by an infection of staphylococcus aureus, commonly called Staph infection. A sty can be tender and painful to the touch, but with some simple home care, they often start to improve in just a few days. Simply apply a clean, warm washcloth to the sty several times a day and you should see the swelling start to go down. If it hasn’t improved at all in two days of at-home treatment, you may want to consult a doctor.
A chalazion is commonly mistaken for a sty, but there are some key differences. First, chalazions tend to occur further back on the eyelid, away from the lash line. Second, chalazions are not caused by a bacterial infection. They’re actually the closest thing to real acne on the eyelid. A chalazion is caused by a blockage in one of the sebaceous glands, and like acne, it will usually go away on its own after a few weeks. If you want to speed up the process the warm washcloth method works well for both a sty and a chalazion.
One last note: never try to pop a sty or chalazion.
What to Do About Stubborn, Itchy Acne on the Face
If you have itchy acne on the face, it may be completely normal. However, if normal acne products don’t seem to be taking care of your itchy acne, it may not be normal acne vulgaris. You could have fungal acne.
Fungal acne is all about a particular kind of yeast called malassezia, sometimes referred to as pityrosporum. This yeast always lives on the surface of our skin and usually doesn’t cause any problems, just like p. acnes. But when we produce too much oil, or when malassezia gets trapped in the pores, it can generate fungal acne. Some regular acne products can help with fungal acne, if they aim to reduce oil or inflammation, but acne products designed to kill p. acnes are not going to be effective on fungal acne. To get the right treatment, you have to be able to tell the difference between acne vulgaris and fungal acne.
Unfortunately, they look very similar. There are a few minor differences you may be able to spot, but if you’ve been using the same acne skin care routine consistently for six weeks and haven’t noticed any improvement, that could mean your acne isn’t caused by the traditional factors and could actually be fungal acne. The biggest sign of fungal acne is in the title of this section: it’s itchier than normal acne. The only other way to spot fungal acne is to look at how it forms. Fungal acne typically appears as clusters of whiteheads that appear to be nearly exactly the same size, whereas normal acne tends to be a bit more random and scattered. To treat fungal acne, you may want to consult a dermatologist. They can help determine what kind of acne you have so you can know for sure, and they can prescribe medication to help fight melassezia yeast.