Skin care newbies and veterans alike often find themselves asking “What kind of acne do I have?” This is because acne is treated as one thing, when really, it can act completely different based on your unique skin and what causes your acne. If you’ve had acne forever and none of the treatments you’ve tried seem to be working, it may be because those treatments weren’t meant for your skin type or your particular kind of acne. The best way to treat acne is to understand it, so if you’re ready to finally get an answer to “What kind of acne do I have?”, read on.
Acne Vulgaris: Basic Acne
When people talk about acne in general, they usually mean acne vulgaris. This is the technical term for acne caused by inflammation, oil production, and acne-causing bacteria, and it is the most common form of acne
Understanding acne vulgaris will give us a better base for understanding other forms of acne, so let’s review how typical acne forms. Acne vulgaris is an inflammatory condition, meaning all blackheads, whiteheads, and pimples start with inflammation. The skin can become inflamed for all kinds of reasons, from stress to allergies, but once it’s inflamed, the skin swells and the pores constrict. Blackheads and whiteheads form when oil and dead skin cells get trapped in a pore, and pimples form when a specific type of bacteria called p. acnes get trapped in a pore as well.
Even though inflammation is the root cause of acne vulgaris, excess oil production or excess p. acnes bacteria can also be significant factors all on their own. Our skin needs a thin layer of oil to build up the epidermal barrier, a protective layer that prevents minor things from irritating the skin. But when our oil production glands start producing too much oil, it can get clogged in the pores, leading to blackheads and whiteheads.
P. acnes, like oil, are a natural part of our skin, but when they get out of control, it can cause an acne problem. This typically goes hand-in-hand with excess oil production because p. acnes’ main source of food is the oil our skin produces. When they have extra food, p. acnes reproduce quicker and their numbers multiply until it’s very easy for them to get trapped in a pore and cause an infection that leads to a pimple.
How Acne Differs by Skin Type
Skin type can have a large influence over what type of acne you have. For instance, people with oily skin tend to have more pimples, while those with dry skin usually have more blackheads and whiteheads. But the differences don’t stop there. Skin type and skin color both play important roles in acne formation.
Dry Acne Prone Skin
We don’t often think of dry acne prone skin; typically we imagine acne prone skin as oily. But acne is just as likely to appear on dry skin as it is on oily skin—just for different reasons. Dry skin typically has a very weak epidermal barrier, which means the skin isn’t very well protected and it’s highly vulnerable to irritation.
When the skin is irritated, it tries to protect itself through inflammation and a last-minute burst of oil production. The inflammation has two main functions: prevent the irritant from spreading deeper into the skin, and increase blood flow to help repair any skin cell damage. Unfortunately, another result of inflammation is acne. The last-minute burst of oil is meant to be a last-ditch effort to build up the epidermal barrier and prevent further irritation, but because this extra oil is produced at the same time as the increased inflammation, the oil often gets trapped in the pores and blackheads and whiteheads form.
The trickiest thing about dry acne prone skin is that most people don’t realize they have dry skin. Because dry skin is so often irritated, it produces a lot of those last-minute bursts of oil, which can make skin seem oily, rather than dry. But it’s important to know if you have dry skin because many of the products made for oily skin are too harsh for dry skin, and can actually lead to more acne. If your skin feels tight or itchy right after washing it, or if your skin is often swollen and red, there’s a good chance you have dry skin. Dry acne prone skin is best treated with gentle products and a good moisturizer.
Oily Skin and Acne
If you have oily skin, your skin is much tougher when it comes to irritation and inflammation, but it also has a few acne-causing issues of its own. Excess oil leads to easily clogged pores and increased numbers of p. acnes bacteria, which can cause all kinds of acne.
Even though oily skin is less prone to inflammation, acne still forms relatively easily because of the sheer amount of oil being produced. If the skin produces enough oil, it can clog pores all on its own, without inflammation, because after a certain point, the oil has nowhere to go and starts backing up into the pore. Eventually it starts compacting and forms a clog that turns into a stubborn blackhead. Excess oil can also create pimples because p. acnes bacteria feed on the oil we produce. P. acnes can make their way to these pores clogged with excess oil and make themselves a home there, reproducing until an infection starts. From there, the infection will trigger the immune system, which will trigger the inflammation response, which will make acne worse.
If you have oily skin, you might try all kinds of antibacterial treatments to kill the p. acnes, but the best way to prevent acne from forming in the first place is to find gentle but effective exfoliators, like salicylic acid or sulfur. Exfoliators remove oil from the skin, and even though they don’t kill the bacteria, they take away their food so their numbers stay low, limiting the number of pimples that can form. The reason we say they should be gentle is because even oily skin needs some oil for the epidermal barrier, so you want to avoid incredibly harsh exfoliators that might strip the skin of oil it needs.
Acne Treatment for Sensitive Skin
Acne treatment for sensitive skin is often treated as a special separate category that isn’t oily or dry, but in reality, sensitive is a modifier that gets added to oily or dry skin. You can have dry sensitive skin or oily sensitive skin, but either way, there are a few treatment tips you need to know.
The biggest tip for acne treatment for sensitive skin is to always check the ingredient label. This is a good practice for all skin types, but it’s essential for sensitive skin. When you check the ingredients, you’re looking for several things. First, avoid anything you know you’re sensitive or allergic to. Second, avoid fragrances, dyes, and sulfates. These ingredients aren’t a huge problem for most people, but for sensitive skin, they could cause irritation, which could lead to more acne, not less. Third, look for low concentrations. Many acne treatment products contain an active ingredient in a specific concentration. For instance, many benzoyl peroxide products come in concentrations of 2.5%, 5%, or even 10%. If you have sensitive skin, you want to use the lowest available concentration, at least to start. If you find that your skin is able to handle the low concentration, you can slowly work your way up to a concentration that is safe for your skin, but also takes care of your acne.
Once you have all this in mind, you can follow the general advice for dealing with oily or dry skin, whichever you have. If you have oily sensitive skin, like me, look for the gentlest exfoliators you can find. If you have dry sensitive skin, make sure you find a good moisturizer without any fragrances or dyes.
Differences Between Fair Skin and Skin of Color
Like sensitive skin, your skin color is a modifier that gets added on to oily or dry—when it comes to treating acne itself. But when it comes to treating acne scars, skin color is the most important factor to consider.
Like most institutions in the world, the skin care industry has a history of racism that it hasn’t grown out of yet, meaning we know a lot less about skin of color than we know about fair skin, and we have far fewer treatments designed specifically for skin of color. However, we do have some key insights that can help if you have Black, Latinx, or Asian skin. One major difference between fair skin and skin of color is the level of scarring. Skin of color is more likely to develop hyperpigmentation (dark spots) and raised or keloid-like scarring, so products to help avoid scar formation are a must. The best way to prevent acne scars is to help acne heal as quickly as possible using antioxidants. Antioxidants, often found in fresh produce, help reduce cell damage, which speeds up the healing process.
Most non-white skin types have more troubles with acne scarring than fair skin types do, but that doesn’t mean all skin of color is the same. Black skin and Latinx skin have proven to be very similar, with the main difference being that people of Latin descent are more likely to experience cystic acne, a severe form of acne. Asian skin, on the other hand, is less likely to experience acne than all other skin colors, but even so, acne is still a very common condition in Asia and in people of Asian descent.
Acne Treatment for Men
Acne treatment for men is sometimes treated as its own unique form of treatment, but the truth is, acne is pretty much the same in men and women. It is caused by the same three factors, and while women tend to experience more hormonal acne, men can experience it as well.
The biggest difference between acne treatment for men and women is that women are more typically encouraged to seek treatment. This disparity can have a negative effect on both men and women. Because men are rarely included in skin care campaigns and advertisements, men might feel isolated, like they’re weird for being male and having acne, when in reality, men and women are both very likely to experience acne. This depiction can also harm women because it suggests that women need to do something about their acne, while men are allowed to have acne without needing to treat or hide it. It becomes one more thing, like makeup or complicated hair styles, that women are expected to do that men are not.
The best way to fix this broken dynamic is to speak openly about acne and gender. Men, women, and intersex/nonbinary folks are all very likely to get acne. According to the American Academy of Dermatology, 80% of people experience acne. Acne is a nearly universal human experience, regardless of gender, and the best acne treatment is the same for all genders: gentle, consistent skin care. Our products at Exposed Skin Care are designed for all skin types, from oily to sensitive, male to female, dark to light, and everything in between. All of our products contain a combination of scientific and natural ingredients, and they are carefully balanced to be both gentle and effective. Our Basic Kit is the perfect treatment for all kinds of skin and all kinds of acne.
What If It’s Not Acne Vulgaris?
Most people with acne have acne vulgaris, the common version of acne. But some people have different acne variations which may require different treatment. It’s important to know how to spot these acne variations so you can receive proper treatment. If you aren’t sure what kind of acne you’re dealing with, it’s best to make an appointment with a dermatologist to see what they think is going on.
The Mystery of Milia Acne
You may have heard of milia acne, but do you know how to spot it? Milia are very small, white, slightly raised dots that appear on the skin. They aren’t inflamed and the white spot isn’t pus, so they aren’t pimples, but then…what are they?
It sounds mysterious and different, but really, milia acne is just whiteheads. Some acne variations are completely different conditions, but others are just different names for the same problems. Milia form like blackheads, with oil and dead skin cells getting trapped in a pore, except with blackheads, the pore doesn’t close all the way, leaving it open for the air to oxidize the oil and turn it a dark color. With whiteheads, the pore constricts so tight that it closes up completely, trapping the oil and dead skin cells under the skin’s surface. Because the air can’t get to the oil to oxidize it, milia stay white, unlike blackheads.
The best treatment for milia acne is the same as for blackheads: a good exfoliator. However, because the skin is closed completely, an exfoliator may not do the trick for everyone. If you find that exfoliators don’t seem to be working, you may want to try a retinoid. Retinoids work like pace cars for the skin cells. They make sure skin cells are being produced and dying at the right speeds to avoid clogged pores. When skin cells are produced quickly but take too long to die, they cling to the side of the pore and cause clogs. But if skin cells are produced too slowly and die at a normal rate, there won’t be enough new skin cells to push the old ones out of the way, and clogs can form that way too. Retinoids assist with all of these issues, ensuring that the skin cell life cycle moves as smoothly as possible.
The Same But Different: Acne Before Period
Technically, acne before period is regular acne vulgaris, but hormonal acne works a little differently, so we thought it deserved its own section. If you have acne and you’re trying to figure out what’s causing it, try keeping track of when you have the most breakouts throughout the month and see how it correlates to your menstrual cycle.
Many people experience increased acne before their period because of the hormonal fluctuations. Whenever our hormone levels shift, it triggers an increase in oil production, and this often leads to more acne. You may notice more acne specifically along your jawline or on your chin or cheeks because these areas usually produce less oil, so when you get a large influx of oil, acne can suddenly appear. The best way to prevent hormonal acne is to even out your hormones, which is usually accomplished through combined oral contraceptives or androgen blockers like spironolactone. If you don’t want to mess with your hormone levels, or if you are pregnant or have another condition that prevents hormonal treatment, you can’t necessarily prevent hormonal acne, but you can still treat it. The best treatment is exfoliation; you want to remove as much of that extra oil as possible. Check out the section on oily skin again for some recommendations on good exfoliators.
Like we said in the section on acne treatment for men, even though hormonal acne is most commonly associated with women, men can actually get hormonal acne as well. Some studies show that men experience cycling hormones similar to women, so if you notice that your acne tends to flare up during specific times of the month, you may want to try similar treatments to help reduce excess oil production during that time.
What It Means If Your Acne Itches
If your acne itches, there’s a good chance it isn’t normal acne vulgaris. Itchy acne can be a number of things, but the three most common are acne rosacea, dry skin, and fungal acne.
Acne rosacea is commonly shortened to just rosacea, which is a good thing because it is a very different condition from acne vulgaris. Rosacea can sometimes look like acne because it can present with lots of small bumps, but it is often much redder than acne, and may look somewhat like a rash. Unlike acne vulgaris, dermatologists aren’t completely sure what causes rosacea, but they do know some of the related factors: h. pylori bacteria, family history of rosacea, and abnormalities in facial blood vessels.
Dry skin is another reason your acne might itch. As we discussed before in our section on treating dry acne prone skin, dry skin lacks a strong epidermal barrier, which means it is very easily irritated. Irritation typically results in inflammation, which can also cause itchiness. If your acne is caused by this dry skin and irritation, it might seem like the acne itself is itchy, when really it’s just a side effect of the dry skin.
Fungal acne differs from acne vulgaris in many ways, including the fact that fungal acne is often itchy. Even though it might sound gross, various fungi are a natural part of our skin’s microbiome and always live on the surface of our skin, just like p. acnes bacteria. However, when a specific fungus called malessezia grows a little too much, it can result in fungal acne. Fungal acne typically appears in groups of white dots that are almost exactly the same size, and it’s often itchy.
What Is Candida Acne?
Candida is a yeast that causes most fungal infections in humans, and some claim that it can also cause candida acne. Although it would make sense for Candida to cause some type of fungal acne, studies show that Candida and acne aren’t linked, and that Candida acne does not exist.
Many people think they have Candida acne because their treatments for normal acne aren’t working, so they think it must be fungal. Sometimes this is true—it just isn’t the Candida yeast causing the fungal acne, it’s malassezia. Even though fungal acne in general is a very real condition, it’s not the only answer if your acne treatment isn’t working. Most of the time, if an acne treatment isn’t working, it’s either too strong or too weak, or you aren’t using it consistently.
It makes sense that a weak treatment wouldn’t work, but it might seem counterintuitive that a strong treatment can be just as ineffective. When you have acne, it’s tempting to use the strongest products you can find in an attempt to get rid of as much acne as possible as quickly as possible, but that just isn’t how our skin works. The skin is very delicate, and using harsh acne products will only irritate it and trigger the inflammation response, which will then go on to cause more acne. Harsh acne products often give you relatively clear skin within the first week or two, but then within a month or so, the acne comes back.
The other reason your acne treatment might not be working is that you might be using it inconsistently. To reduce the causes of acne, you need to treat them every day. Skipping just one or two days a week is enough to make your treatment products relatively ineffective, which just increases frustration for you.
What Is Acne Fulminans?
Acne fulminans is a rare form of severe acne that is defined by large, painful cysts and nodules that are notoriously difficult to treat. It seems that acne fulminans is caused by many of the same factors as regular acne vulgaris, but researchers still aren’t sure why most people have acne vulgaris and why a rare few develop acne fulminans. It seems to be genetic, it primarily affects white boys and men, ages 13 to 22, and some research suggests the use of anabolic steroids could play a role. Like natural hormonal fluctuations, hormonal shifts due to steroids also cause a boost in oil production which can lead to more acne issues.
It is typically treated with a combination of corticosteroids and isotretinoin, and rarely comes back after treatment. Even though it is one of the rarer and more severe types of acne, it is sometimes mistaken for another rare type of acne: acne conglobata. Acne conglobata is characterized by many of the same features of acne fulminans: painful cysts, large nodules, and resistance to most normal acne treatments. However, acne conglobata is actually even more severe due to one extra feature: tunneling. In acne conglobata, the infection of the cysts and nodules actually form tunnels beneath the skin, making treatment even more difficult and the infection even more severe.
If you have many painful cysts or nodules, it’s important to see a dermatologist. It may be typical cystic acne, which is a severe form of typical acne vulgaris, but it could be acne fulminans or acne conglobata, so it’s important to consult a professional to get the best treatment.
Dealing with the Worst Case of Acne: What to Do If You Have Horrible Acne
If you have horrible acne, but it’s regular acne vulgaris, then rest assured that you don’t have the worst case of acne possible. But we understand that it can still be really hard. If you’re a teenager, everything is changing a lot right now, and there’s a lot of pressure to both fit in and stand out and acne can make it feel like you stand out in a bad way. If you’re an adult, there’s a ton of pressure to keep up with other adults, and having acne can make it feel like you’re stuck in your teenage years. No matter who you are, having acne can be hard, especially if you have “horrible acne.”
We don’t love talking about acne this way because we know the truth: that acne is a completely normal skin condition. Even if your acne is more severe, you are in good company and there’s nothing shameful about your skin. Acne by itself is not a serious condition, but the effects it can have on mental health are quite serious. Studies show that acne can contribute to issues with low self-esteem, anxiety, and depression, and much of this is because of how we talk about acne.
The skin care industry makes billions of dollars by feeding on our insecurities about our skin. Advertisements for various acne treatment products call acne “dirty,” “humiliating,” or horrible,” and it is this messaging, not acne itself, that causes the mental health issues surrounding acne. At Exposed, we refuse to contribute to this problem. We want to provide you with the best tools for getting clear skin, but we also want to say: it’s okay to have acne. The vast majority of us do.