The Different Types of Acne and How to Treat Them

Acne is a common skincare concern that affects people of all ages and skin types. It ranges from pesky pimples that pop up before a big event to persistent breakouts that seem to linger no matter what you do. But did you know there are different types of acne, and that understanding them is the first step towards effective treatment? In this article, we explore the different types of acne and explain how to use this knowledge to get a healthier, clearer complexion.

What is Acne & What Causes It?

Acne is a chronic inflammatory skin condition that involves the sebaceous glands and hair follicles of the skin. It occurs due to a combination of factors including:

• Overproduction of oil: the sebaceous glands in the skin produce oil, which helps keep the skin moist and reduce trans-epidermal water loss. However, if these glands produce too much oil, it can clog the hair follicles.
• Dead skin cells: if dead skin cells do not shed properly, they can build up and clog the hair follicles.
• Bacteria: the bacterium Cutibacterium acnes (C. acnes, formerly Propionibacterium acnes) lives on the skin of most people. However, in people with acne, C. acnes can multiply and cause inflammation of the hair follicles.
• Hormones: androgens and related hormones can increase the production of oil by the sebaceous glands. This is why acne is more common in teenagers and young adults, when hormone levels are higher.
• Stress: this can trigger the release of hormones that can lead to acne.
• Diet: some foods, such as dairy products and sugary foods, may trigger acne in some people.
• Medications: some medications, such as steroids and lithium, can cause acne as a side effect.
• Skincare products: some skincare products, such as oil-based makeup and moisturisers, can clog the hair follicles and cause acne.

In general, the main characteristic of acne is the appearance of spots, pimples or blemishes on the skin. These terms are often used interchangeably with “breakouts” to describe how acne presents. Spots and pimples largely refer to the same thing. Blemishes, on the other hand, refer to any type of spot, mark or colour irregularity that appears on the skin. So whilst acne is a type of blemish, not all blemishes are acne.

Types of Acne Lesions

There are different types of acne lesions, each with its own characteristic appearance. It is important to understand these, as they will determine the severity of your condition and the best treatment for you. The main lesions are as follows:

• Blackheads and whiteheads (comedones): this is a form of non-inflammatory acne. It occurs when pores become clogged with excess sebum and dead skin cells. The clogged pore can stay open, in which case it is called a blackhead, or closed, which is known as a whitehead. These are usually the least severe form of acne.
• Papules and pustules: these are probably what most people picture as typical features of acne. They are forms of inflammatory acne that occur when bacteria, sebum and dead skin cells push deeper into the skin. This causes redness and swelling. Papules are small, red and tender bumps, whilst pustules are similar but contain a pus-filled centre.
• Nodules and cysts: these are the lesions you can feel under the skin and typically look like an enlarged, raised area with diffuse borders. They are not distinct superficial lesions and are not easy to see like comedones, papules or pustules. They occur when a pore becomes clogged and bacteria continue to multiply, causing an infection deep in the skin. Nodules are hard and painful lumps, whilst cysts contain pus and can lead to permanent scarring. Nodules and cysts are the most severe forms of acne.

In addition to these features of active acne, there is often a secondary set of features that appear after a breakout clears. Post-inflammatory hyperpigmentation (PIH) and scarring are two common blemishes that occur in the aftermath of acne. PIH leaves dark spots on the skin after a breakout, whilst acne scars are leave rough texture or indentations.

Different Types of Acne

To add to the confusion, acne is also often split into different types depending on the cause or trigger of the breakouts. I haven’t included rosacea here because, even though it has similar features, rosacea treatment is a little different. That’s because a lot of the skincare we use for acne can worsen rosacea. The main types are as follows:

• Acne vulgaris: the medical name for the most common type of acne is acne vulgaris. This includes a variety of lesion types, including blackheads, whiteheads, papules, pustules, nodules and cysts.
• Hormonal acne: all acne is to some extent “hormonal”. However, hormonal acne is specifically linked to fluctuations in hormones and is most common in women. It usually occurs in a characteristic pattern along the lower face, jawline and neck. It also typically flares up in sync with the menstrual cycle.
• Acne conglobata: this is a rare and severe type of acne. Acne conglobata involves many inflamed nodules that connect under the skin to other nodules. As a result, it often leaves deep, prominent scars.
• Acne mechanica: excess heat, pressure, friction or rubbing of the skin triggers this type of acne. As such, acne mechanica is common among athletes and those who sweat heavily or wear tight clothing.

The Acne Severity Spectrum

To make treatment planning and monitoring easier, it is useful to categorise acne by severity. Broadly speaking, it falls into three groups:

• Mild acne: few to several papules and pustules, but with little to no nodules.
• Moderate acne: several to many papules and pustules, plus few to several nodules.
• Severe acne: extensive or very painful papules, pustules or nodules.

Treating Different Types of Acne

Both the severity and type of acne affect how you can treat it. So it’s important to bear this in mind when considering skincare and also medical treatments for acne. Here is how treatment varies across the different lesions and types:

• Blackheads and whiteheads: these are in many ways the easiest to treat. Over-the-counter treatments containing salicylic acid, azelaic acid and benzoyl peroxide are commonly used and very effective. Retinoids can also prevent pore blockages by increasing skin-cell turnover.
• Papules and pustules: benzoyl peroxide is a great spot treatment to reduce the size and redness of new lesions and clear them faster. Salicylic acid, Retinol and sulfur can reduce the number of breakouts when used regularly. For stubborn acne, prescription topical or oral treatments like antibiotics or retinoids such as tretinoin, adapalene or isotretinoin will help clear and prevent breakouts.
• Nodules, cysts and acne conglobata: due to their severity, nodular and cystic acne often require prescription treatment. As such, you should see a dermatologist for these types of acne. The mainstay of treatment is usually oral isotretinoin. However, it may also involve in-office treatments including deep peels, lasers and even surgery if there is scarring. This also applies to acne conglobata, which requires aggressive treatment under the care of a dermatologist.
• Acne vulgaris and hormonal acne: this typically requires a multi-pronged approach. Good options will involve a skincare routine for acne-prone skin as well as prescription treatments like tretinoin cream or oral antibiotics. It may also need in-office treatments like chemical peels. Hormonal acne is usually treated like acne vulgaris. In addition, women are often offered hormonal treatments such as oral contraceptives or spironolactone.
• Acne mechanica: you can manage this type of acne with good skincare habits, like cleansing after sweating, wearing loose-fitting clothing and avoiding friction. Depending on where the acne is, cleansers and toners containing benzoyl peroxide can help acute breakouts. Using a regular salicylic acid wash will also help keep this condition at bay.

Acne can feel like an uphill battle, but understanding the different types and their appropriate treatments is a significant step towards winning the fight. It’s essential to remember that everyone’s skin is unique, and different products have different effects on different people. So if you’re struggling to manage your acne, or you suspect it’s severe, see a dermatologist or other skin doctor. They will help get you on the right path. Remember too that patience is key when treating acne. It may take at least 6 to 8 weeks to see an improvement, so consistency really matters.

At City Skin Clinic, we are passionate about personalised skincare. Our doctors offer safe and effective custom treatments using ingredients like tretinoin, clindamycin, azelaic acid and spironolactone where appropriate, through our online clinic. Our doctors treat acne, hyperpigmentation, melasma, rosacea and skin ageing through bespoke compounded treatments designed around you. To start your personalised plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.

This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any health concerns or questions you might have.