Understanding Acne: A Complete Guide to Different Types of Acne & Treatment

Acne is a common skin condition that affects millions of people worldwide, irrespective of age, gender, or skin type. It occurs when hair follicles become clogged with dead skin cells, excess oil, and bacteria, leading to the formation of various types of lesions on the skin.

Although acne is most commonly associated with the teenage years, it can persist into adulthood and sometimes even appear for the first time later in life.

In this blog, we will explore the different types of acne, their characteristics, causes, and potential treatments.

Non-inflammatory Acne

Non-inflammatory acne is the mildest type of acne. It does not cause any inflammation, so it does not typically hurt or be red.

The most common types of non-inflammatory acne are:

Comedones:

Comedonal acne is one of the mildest forms of acne and is characterized by the presence of comedones, which are non-inflammatory lesions. These are plugged hair follicles. These comedones can be further categorized into two types:

1. Whiteheads (Closed Comedones):

Whiteheads occur when hair follicles become plugged with sebum (oil), dead skin cells, and bacteria, but the pore remains closed. They appear as small, white or flesh-colored bumps on the skin’s surface.

2. Blackheads (Open Comedones):

Blackheads form when the pore is partially open, allowing the trapped material to be exposed to air, causing it to oxidize and turn black. They are slightly raised, dark spots on the skin.

Milia:

These are small, white bumps that are caused by trapped keratin. They are usually not noticeable and do not require treatment.

Inflammatory Acne

Inflammatory acne is more severe than non-inflammatory acne. It is caused by the body’s immune system reacting to the bacteria that are present in the clogged hair follicles.

The most common types of inflammatory acne are:

Papules:

These are small, red bumps that may be tender to the touch. Papular acne is a mild to moderate form of acne that results from the inflammation of comedones. The clogged pores become red, tender, and swollen, leading to the development of small, pink or red bumps on the skin, known as papules. They do not contain pus but can be sensitive to the touch.

Pustules:

These are small, red bumps that contain pus. Pustular acne is a more severe form of acne that develops when the inflammation of papules progresses further.

Pustules are red, inflamed bumps with a white or yellow center filled with pus. They can be painful and may leave temporary marks or scars on the skin if not treated properly.

Nodules:

These are larger, deeper bumps that can be painful. Nodular acne is a severe form of acne that involves large, painful, and solid lesions deep within the skin.

These nodules are larger and more extensive than papules and pustules, often causing significant discomfort and scarring. Nodular acne requires professional medical attention as it may not respond well to over-the-counter treatments.

Cysts:

These are large, painful bumps that can cause scarring. Cystic acne is the most severe and potentially debilitating type of acne. It occurs when the infection and inflammation spread beneath the skin, forming large, painful, fluid-filled cysts.

Cysts are soft, sac-like structures that can cause significant scarring and should be treated by a dermatologist to prevent complications.

Other Types of Acne:-

There are a few other types of acne that are less common. These include:

• Hormonal Acne: This type of acne is caused by changes in hormones, such as those that occur during puberty, pregnancy, or menopause.
• Acne Conglobata: This is a severe form of acne that is characterized by large, painful cysts.
• Acne Keloidalis: This is a type of acne that causes scarring.

Causes of Acne

Several factors contribute to the development of acne:

• Excess Sebum Production: Increased sebum production can clog hair follicles, leading to acne formation.
• Hormonal Imbalance: Hormonal changes during puberty, menstruation, pregnancy, or hormonal disorders can trigger acne.
• Bacterial Growth: The bacterium Propionibacterium acnes can worsen acne by causing inflammation.
• Dead Skin Cells: Shedding of dead skin cells can clog pores and lead to acne.
• Family History: A family history of acne can increase the likelihood of experiencing it.
• Diet: Some studies suggest that certain dietary factors, like high-glycemic foods and dairy, may influence acne development.

Preventing Acne

There are a few things that you can do to help prevent acne, such as:

• Wash your face twice a day with a gentle cleanser.
• Avoid touching your face throughout the day.
• Use oil-free cosmetics and sunscreen.
• Don’t pick or squeeze your pimples.
• Eat a healthy diet and drink plenty of water.

If you are struggling with acne, it is important to see a dermatologist. They can help you to determine the best treatment for your individual needs.

Here are some additional tips for managing acne:

• Use a gentle cleanser that is non-comedogenic, meaning it will not clog your pores.
• Avoid using harsh scrubs or toners, as these can irritate your skin.
• Moisturize your skin regularly, but choose a moisturizer that is oil-free or non-comedogenic.
• Wear sunscreen with an SPF of 30 or higher every day, even if it is cloudy.
• Get enough sleep.
• Manage stress.

Acne can be a frustrating condition, but it is important to remember that you are not alone. There are many effective treatments available, and with the right care, you can clear up your acne and achieve clear, healthy skin.

Treatment for Acne

The treatment of acne varies depending on the severity and type. Mild cases may improve with over-the-counter topical treatments containing ingredients like benzoyl peroxide, salicylic acid, or alpha hydroxy acids.

However, for moderate to severe acne, it’s best to consult a dermatologist who can recommend a personalized treatment plan, which may include:

• Topical Medications: Prescription-strength creams, gels, or lotions with ingredients like retinoids, antibiotics, or azelaic acid.
• Oral Medications: Antibiotics, combined oral contraceptives (for hormonal acne in women), or oral retinoids (for severe acne).
• Procedures: Dermatological procedures such as chemical peels, laser therapy, or drainage/extraction of large cysts.
• Lifestyle Changes: Adopting a healthy lifestyle, maintaining proper skincare, and avoiding acne-triggering factors can help manage and prevent acne.

How Severe is Each Type of Acne?

The severity of each type of acne can vary, ranging from mild to severe. The classification of acne severity is based on the number of lesions, their size, distribution, and the degree of inflammation and scarring present. Here’s a breakdown of the severity of each type of acne:

Comedonal Acne:

Severity: Mild

Description: Comedonal acne is generally considered the mildest form of acne. It primarily involves non-inflammatory lesions, such as whiteheads and blackheads, without significant redness or swelling.

Mild acne can usually be treated with over-the-counter (OTC) medications, such as benzoyl peroxide or salicylic acid.

Characteristics: Presence of closed comedones (whiteheads) and open comedones (blackheads) on the skin’s surface.

Papular Acne:

Severity: Mild to Moderate

Description: Papular acne is a step up in severity from comedonal acne as it involves inflammation of the comedones. Papular acne may require prescription medication, such as topical retinoids or antibiotics.

Characteristics: The skin develops small, red, raised bumps (papules) that can be tender to the touch.

Pustular Acne:

Severity: Moderate

Description: Pustular acne is characterized by inflamed papules that progress to the formation of pus-filled lesions called pustules. Pustular acne may require prescription medication, such as topical retinoids or antibiotics.

Characteristics: The skin contains red, tender, and visibly inflamed bumps with a central white or yellowish head.

Nodular Acne:

Severity: Severe

Description: Nodular acne represents a more severe form of acne that involves larger, deeper, and more painful lesions compared to papules and pustules. Severe acne may require oral medication, such as isotretinoin (Accutane).

Characteristics: The skin develops large, solid, painful bumps (nodules) that extend deep within the skin layers.

Cystic Acne:

Severity: Severe

Description: Cystic acne is the most severe and potentially debilitating type of acne. It involves deep inflammation and can lead to significant scarring. cystic acne may require oral medication, such as isotretinoin (Accutane)

Characteristics: Large, painful, fluid-filled cysts form beneath the skin’s surface, causing extensive damage and scarring.

Note — It’s important to note that acne severity can vary from person to person, and individuals may experience a combination of different acne types at the same time.

Additionally, the emotional and psychological impact of acne should not be overlooked, as even mild acne can affect a person’s self-esteem and well-being. Seeking professional medical advice from a dermatologist is crucial for accurate diagnosis and appropriate treatment, especially for moderate to severe cases of acne, to prevent complications and improve skin health.

Can Acne Cause Scars?

Yes, acne can cause scars, especially when the condition is severe or left untreated. In fact, about 10–40% of people with acne will develop scars.

Acne scars are a result of the skin’s attempt to heal itself after the inflammation and damage caused by acne lesions. The severity of scarring can vary, depending on factors such as the type of acne, individual skin characteristics, and how the acne was managed.

There are two main types of acne scars:

1. Atrophic Scars (Depressed scars): Atrophic scars result from a loss of tissue. They are more common and occur when the skin does not produce enough collagen during the healing process.

There are three subtypes of atrophic scars:

a. Ice Pick Scars: Deep, narrow, and V-shaped scars that resemble small punctures in the skin.

b. Boxcar Scars: Broad depressions with well-defined edges, similar to chickenpox scars.

c. Rolling Scars: Scars with a wavy, rolling appearance caused by fibrous bands pulling the epidermis downward.

2. Hypertrophic and Keloid Scars (Raised scars): These scars occur when the body produces too much collagen during the healing process, leading to raised and thickened scars.

They are more common in individuals with a genetic predisposition to keloid formation.

Factors That Can Contribute To The Development Of Acne Scars Include:

• The severity of your acne: The more severe your acne, the more likely you are to develop scars.
• Picking or squeezing acne lesions, which can worsen inflammation and damage the skin.
• Delayed or inadequate treatment of acne, allowing it to worsen and cause deeper damage.
• Severe forms of acne, such as nodular and cystic acne, which are more likely to lead to scarring.
• Genetics and individual skin healing response.

Preventing Acne Scars

To reduce the risk of acne scars, it’s essential to manage acne effectively and avoid picking or squeezing blemishes. Here are some preventive measures:

• Early Treatment: Start treatment as soon as acne develops to prevent it from worsening and causing deeper inflammation.
• Gentle Skin Care: Use a gentle cleanser and avoid harsh scrubbing that could irritate the skin and worsen acne.
• Hands-Off Approach: Avoid picking, squeezing, or popping acne lesions, as this can lead to scarring and worsen inflammation.
• Professional Guidance: Seek advice from a dermatologist for proper acne management and to explore scar-prevention options.

Treatment for Acne Scars

Various treatments can help improve the appearance of acne scars. The choice of treatment depends on the type and severity of the scars and may include:

• Laser Therapy: Laser treatments can stimulate collagen production and resurface the skin to reduce the appearance of scars.
• Chemical Peels: Chemical peels can remove the outer layer of damaged skin, promoting the growth of new, smoother skin.
• Microneedling: Microneedling involves using tiny needles to stimulate collagen production and improve the texture of the skin.
• Dermal Fillers: Injectable fillers can help raise depressed scars and provide a smoother appearance.
• Subcision: This procedure involves breaking up the fibrous bands under the skin to release tethered scars and promote healing.

Acne has the potential to cause scars, particularly when it is severe or improperly managed. It is crucial to treat acne promptly and avoid actions that could worsen inflammation and damage the skin. Seeking professional advice from a dermatologist can help prevent and address acne scars effectively.

How is Acne Diagnosed?

Acne is usually diagnosed by a dermatologist during a physical exam. The process involves assessing the appearance of the skin, the type and severity of acne lesions, about your symptoms, such as when your acne started, and what treatments you have tried and discussing the patient’s medical history.

In some cases, the doctor may order blood tests or other tests to rule out other possible causes of your acne, such as a hormonal imbalance or a medical condition.

Here’s a step-by-step guide to how acne is diagnosed:

1. Medical History: The doctor will begin by taking a detailed medical history, which includes asking questions about the patient’s acne symptoms, such as when the acne started, how long it has been present, and whether any specific triggers or patterns are observed.

They will also inquire about any previous treatments or medications tried for acne and ask if the patient has any family history of acne or other skin conditions.

2. Visual Examination: The dermatologist will visually inspect the affected areas of the skin to assess the presence and distribution of acne lesions. They will examine the face, neck, chest, back, and any other areas where acne is present.

During the examination, the doctor will identify the types of acne lesions, such as comedones (whiteheads and blackheads), papules, pustules, nodules, or cysts, and assess their severity.

3. Classification of Acne: Based on the examination, the healthcare provider will classify the acne into one of the several grades of severity (mild, moderate, or severe) and may also specify the type of acne present (comedonal, papular, pustular, nodular, or cystic acne).

4. Rule Out Other Conditions: In some cases, certain skin conditions may mimic acne, so the dermatologist will rule out other possible diagnoses, such as rosacea, folliculitis, or perioral dermatitis, to ensure an accurate diagnosis.

5. Additional Tests (if necessary): In most cases, a physical examination and medical history are sufficient to diagnose acne. However, if there are concerns about hormonal imbalances or underlying medical conditions contributing to acne, the doctor may order additional tests, such as blood tests or hormone level assessments.

6. Tailored Treatment Plan: Once the diagnosis is confirmed, the dermatologist will develop a personalized treatment plan based on the type and severity of acne, the patient’s medical history, and any underlying factors that may contribute to acne development.

The treatment plan may include topical or oral medications, lifestyle modifications, and recommendations for proper skincare routines.

Note — Diagnosing acne involves a thorough medical history, visual examination of the affected skin, and classification of the acne type and severity. By accurately diagnosing acne, healthcare professionals can create effective treatment plans to manage the condition and help patients achieve clearer, healthier skin.

If you are experiencing acne or concerns about your skin, it’s essential to consult a dermatologist for a proper evaluation and personalized treatment approach.

Take Away

Acne is a widespread skin condition that affects individuals of all ages and can vary in severity. Understanding the different types of acne and their characteristics is essential for proper diagnosis and treatment.

While mild cases can often be managed with over-the-counter products, moderate to severe acne may require professional medical attention to prevent scarring and achieve clearer skin. With the right approach and treatment, most individuals can effectively manage their acne and improve their overall skin health.