No matter your confidence levels, and no matter the blemish — whether it’s a single pimple or a chronic breakout — acne is always debilitating. It’s an unsightly distraction from your otherwise charming face, and is often painful at the same time. (Not to mention stressful to cover up or minimise, as you anxiously wait for it to disappear.)
Whether it’s just before a first date, a job interview or your birthday there’s no ideal time to get a spot (or ten), but by understanding the different types of acne, what causes them and how to treat them, you can learn to prevent them altogether.
With that in mind, read through this acne guide, which includes expertise from board-certified dermatologist Dr Carly J. Roman, from Modern Dermatology in Seattle, for a better understanding of your blemishes.
What Is Acne?
To put it simply, acne forms when your pores get clogged. This usually happens as your body sheds dead skin cells (at a rate of around 40,000 a day), which get lodged inside the pores, mixing with sebum, dirt and bacteria to create one nasty cocktail.
“This creates small and superficial acne lesions — the clogged pores, also known as comedones,” says Dr Roman. “From there, oil, bacteria, and hormonal influences lead to inflammation, and the development of deeper acne, like red bumps and pus bumps.”
Sometimes, when the acne clears up, your skin returns to its normal state, but in more chronic cases, the lesions are embedded deeper in the skin. They not only take longer to heal and clear up, but they can leave behind large scars, often in high counts.
The process that leads to clogged pores is different for everyone. It can be a hormonal fluctuation, genetics (which affect your skin’s oil production or bodily response to some foods), stress, poor dietary choices, bacteria, dehydration, improper hygiene practices, an under-performing grooming regimen, and much more. This variety of causes means there are also a variety of comedones and breakouts that we need to understand in order to treat.
Common Types Of Acne
According to Dr Roman, most doctors classify breakouts in three ways: standard comedones (like blackheads and whiteheads), inflammatory acne (like papules and pustules), and nodulocystic acne (deep, tender lesions, known separately as nodules and cysts).
When a pore becomes clogged, a blackhead is the most common outcome. These are the tiny black dots that you might notice across your nose (the most common spot for them), and the colour is a result of the comedone breaking through the surface of the skin and being exposed to air.
Whiteheads are similar to blackheads, but they stay closed and create an oh-so-poppable bubble near the surface of the skin (though, this isn’t recommended). You can minimise their onset (as well as blackheads’) or expedite healing by using a salicylic acid face wash, to help dissolve dead skin cells that might otherwise clog the pores.
Papules look like small red, inflamed bubbles on the skin. They start out like any other kind of comedone, but grow inflamed after the excess buildup of oils and dead cells gathers around the hair follicle in the pore. Bacteria can proliferate here too, further aggravating the blemish. If you have a large breakout of papules, it’s likely a bacterial concern, which can be treated with topical or oral prescriptions from your dermatologist.
Pustules are similar to papules, but they are filled with pus, and grow yellow heads (resembling inflamed whiteheads). They have reddish perimeters, and can also grow en masse. They are commonly the result of hormonal shifts (natural or from substance use), and can grow on the face and back, though they also pop up on other body parts.
A nodule is the kind of acne that buries itself into all layers of the skin, and throbs when you touch it. The blemish itself doesn’t usually have a white head, and they take much longer to heal. They often leave a dark red spot behind, which itself can take months to go away, long after the actual blemish has subsided. (Nodules often lead to scarring too, which is why they should be treated by a doctor and not squeezed or irritated at home.) The most common causes for this type of acne are oil buildup, hormonal shifts, hyperactive bacteria or stress-related issues like burnout.
Cystic acne is very similar to acne, primarily because it is also embedded deep inside the layers of the skin. However, the main difference between the two is that cysts are filled with pus. You should see a dermatologist to help heal and minimise cysts, because popping them on your own can worsen the matter and delay healing.
Levels Of Acne
Though equally annoying, not all acne is the same. “Acne can range from superficial lesions like clogged pores or blackheads to painful, deep nodulocystic acne,” says Dr Roman. “The biggest concern with cystic acne lesions is the tendency for permanent scarring,” she adds. These ‘levels’ of acne also come from the size of the breakout itself, ranging from mild to severe.
Mild acne is anything from a single pimple to a small cluster of them. Even if it’s one or two minor cysts or nodules, these can usually be treated at home with a proper skincare regimen. Though not as extreme as other forms of acne, their cause can be harder to pinpoint, since so many things can result in mild breakouts.
Moderate acne is more of a one-off or constant breakout of around a dozen comedones, inflamed bumps, or minor lesions. While it will take weeks or even months to clear up, this can be done with the right topical and oral solutions, as prescribed by a doctor. The cause of moderate acne can often be determined, often tied to a significant hormonal shift, stressful incident, workout supplement intake, or bacterial spread. Mild scarring may occur, but it’s of less concern than more severe cases.
Any inflammation or sprawling breakout of over 100 pustules, papules, whiteheads or blackheads is considered severe. Don’t diagnose yourself without seeing a dermatologist, which should be the first thing you do. Together you’ll formulate a strict regimen to pinpoint the cause and reduce the threat of permanent scarring or spreading. This is especially important for people who experience multiple inflamed cystic and nodular pimples.
What Causes Acne?
Most acne is caused by genetics, oil, bacteria, and hormonal shifts. However, there are other common causes, like infrequently changing your pillowcases, eating lots of sugary or processed food, not showering after a workout, and wearing restrictive or poorly ventilated clothing. Each of these things influences acne growth and can hold the key to a fresher face.
Hormonal shifts — often an increase in testosterone — cause oil glands to go into overdrive, creating a sebum backup within pores. If these pores have other restrictions, like dead skin cells or bacterial buildup, they are prime candidates for acne. Hormonal shifts commonly happen during stress, after inadequate rest, while taking steroids or other supplements and during puberty.
Just like male pattern baldness, there are certain microscopic things that happen to our skin, as determined by our genes. Perhaps your dead skin cells don’t fall away or dissolve as easily; maybe your sebum production is greater than others; or perhaps your hormones are more prone to fluctuating. You may not be able to nail precisely what hereditary influence is causing your pimples, but it is known that some people are more predisposed to pimples than others.
Stress is one of the most frequent causes of acne because it leads to hormonal shifts and an increase in sebum production that can block pores. Think of other things that produce similar bodily responses: lack of sleep, excessive drinking or drug use, high caffeine intake, eating processed foods. These all tamper with your body’s regulated functions, from oil production to insulin levels, which are reflected in your complexion. In other words, what goes in must come out, and sometimes it’s on your face.
The clothes could be the unlikely culprit behind your outbreak, since they often host the sweat and bacteria that presses against your skin. It’s doubly bad when your clothing is restrictive or doesn’t help ventilate the body. Try wearing looser clothing, or at least clothing made from natural fibres (cotton, linen, wool etc.) which are more breathable and moisture-wicking than manmade ones, and be sure to wash them regularly.
Before buying a product, take a look at whether or not it is “non-comedogenic”. If it is, then it has been tested and proved not to clog pores. Some ingredients are known to clog pores on the face more than other body parts, which is why you’ll rarely see things like beeswax, cocoa butter, or many oils (like olive, coconut or almond) listed on a cleanser. If you use a hair product and find yourself sweating a lot, then it might be the reason for acne around the brow; this is because, even when they are water-soluble, they aren’t often tested for their comedogenic propensity.
Where Can You Get Acne?
It’s a cruel fact of life that acne can happen all over the body, not just on the face. “Acne originates from pores, which are located in the skin throughout the entire body, aside from palms and soles of the feet,” says Dr Roman. “Oil and bacteria also contribute to acne, which is why legions tend to favour the chest and back (the more oily areas) or buttocks and thighs (since there are more bacteria in those locations).”
Sebum production may be an essential bodily function (designed to keep the skin and hair moisturised), but throw in everything from sunscreen to serums, and things can quickly get out of whack. It’s commonly accepted that acne on the cheeks is the result of touching our faces, or from dirty pillowcases (change them weekly), whereas acne around the jaw is often hormonal, or the result of a clogged beard whisker.
The back is especially prone to oil buildup, as well as being prone to sweat. This makes it a prime spot for, well, spots. Guys who take workout supplements (like whey protein or even steroids) might experience a moderate or severe case of acne on the back, too, due to the increase in sebum production stemming from heightened levels of testosterone. If this is the case, you may want to try a prescription-strength topical cream to minimise breakouts.
Similar to the back, the chest is one of the oiliest parts of the body (after the face and scalp) and is also home to lots of hair follicles for the clogging to occur in. If you shave or wax your chest (or your back, for that matter), it’s common for a bacterial infection to start here as a result, which can lead to inflammation of any severity.
Dr Roman points out that the butt and the upper thighs are more prone to bacterial buildup than other parts of the body, due to sweating, rubbing, and lack of ventilation in the area. This commonly causes mild acne breakouts, which are easily fixed. More severe cases might point to a significant oversight in your hygiene regimen.
Acne that appears on the forehead is similar to that on the rest of your face. However, if it’s near the hairline, it is often caused by hair products or a dirty hat. If the styling aid you’re applying slides down your face when you sweat, or of it gathers under the hat brim, you get a mix of old product and bacteria, which leads to breakouts.
Acne can occur nearly anywhere, and the cause varies drastically — acne on the shoulders, for example, is different from acne in the groin or on the arms. Typically, breakouts can be washed daily and otherwise be ignored for a few days until they clear up. But if acne is cystic, nodular, stubborn, or persistent, you should see a doctor and figure out the root cause; it might be something more than oil and mild bacteria.
How To Get Rid Of Acne
While mild acne often goes away on its own — especially if you can resist the urge to pop those zits — some strategies, behaviours, and products can help the skin clear up more quickly, and safely.
The best defence is a good offence, they say. So to stave off spots, start with the easy stuff: eat healthy, natural foods, get ample rest and stay hydrated. Hygiene is another crucial factor, so don’t touch your face with dirty hands; cleanse both morning and night and change your pillowcases regularly. Do that, along with a skincare regime filled with non-comedogenic products and you’ll be well on your way.
For moderate or severe cases of acne, a dermatologist can advise on more specialist acne treatments like light therapy (which kills bacteria and shrinks oil glands), lasers (to remove dead cells and oil buildup), or even cortisone injections (where the doctor injects a steroid directly into a papule, cyst, or node, to quickly ‘deflate’ the mass and minimise skin damage).
In addition to topical creams, a doctor can also prescribe oral medications for more severe or persistent cases of acne. These might include doxycycline, an antibiotic which works from within to destroy bacteria all over the body. It’s important to follow any instructions given to the letter, as they often compromise the body’s good bacteria (in the case of doxy and other antibiotics), and their effects should be closely monitored.
If you already have acne or are prone to it, a salicylic acid cleanser will help dissolve dead skin cells and keep pores unclogged. A twice-weekly chemical exfoliant or gentle physical scrub can follow your cleanser, along with a non-comedogenic moisturiser. You can spot-check pimples — especially cystic or nodular ones — with a tea tree oil or similar zit-zapping treatment.
Staying healthy is the most proactive way to have healthy skin. (And not just when it comes to acne, but also reducing the signs of ageing, minimising dark spots on the skin and dark circles around the eyes.) Try to get plenty of sleep, stay hydrated, avoid processed foods and added sugars, cut back on alcohol and caffeine, and shower daily as well as immediately after a workout. Don’t take supplements like steroids or whey protein, and do whatever you can to minimise stress in your life.
Topical Acne Products
Regularly wake up with the devil trying to escape your pores? Ask your doctor about topical treatments for acne. Prescription-grade ones include hydrocortisone creams, which are often available over the counter and use small traces of steroids to fight bacteria; benzoyl peroxide, which you apply before bed to reduce bacteria; and retinol, which is more of an anti-ageing cream that in turn reduces and prevents acne).
How To Get Rid Of Acne Scars
Acne scars, like the blemishes themselves, can come in many different forms, and each requires a different treatment.
“Lesions tend to leave dark spots known as post-inflammatory hyperpigmentation,” says Dr Roman. “Thankfully, that hyperpigmentation will improve with time. Daily sunscreen and nightly gentle chemical exfoliators (like retinol or an alpha hydroxy acid) will improve the appearance faster. ”
Deeper acne scars, however, like divots or indentations, are better treated with procedures. “There are many available options including laser devices, chemical peels and/or micro-needling,” adds Dr Roman. If this is something you want to address, book an appointment with a board-certified dermatologist to determine the best combination of treatments for your case.