You might not know all the different types of acne offhand, but you know the annoying bumps on your face when you see them. Whether they’re big, red, and angry, or small and practically undetectable, if your breakouts bother you, that’s reason enough to address them. The only problem? Treating acne is a little easier said than done. To help us sort through the complex world of acne and how best to approach each type of acne, we turned to board-certified dermatologists Christine Choi Kim, MD, Devika Icecreamwala, MD, and David Lortscher, MD, CEO of Curology. Together, the skin experts break down everything there is to know about your breakouts.
What Is Acne?
Simply put: acne occurs when sebum (the oil that naturally lubricates our skin) mixes with dead skin cells and bacteria and clogs your pores. Kim says those with acne have abnormal shedding of the cells that line their hair follicles as well as hyperproduction of sebum, and these two factors lead to congestion of the pores.
Types of Acne
According to Lortscher, acne is generally broken down into two main categories, non-inflammatory and inflammatory acne, and within those subgroups, you’ll find all the different types with different recognizable characteristics.
Non-Inflammatory Acne
With this type of acne, also called comedonal acne, you won’t find any big, angry, red pimples. Instead, you’ll see little blackheads and whiteheads, generally where your face is oilier, like the T-zone area (but also your chest and back). This type of acne is caused by the clogging of the pilosebaceous units (hair follicles) of the skin. Now, the difference between whiteheads and blackheads:
- Whiteheads: Also called closed comedones, this type appears as little white bumps because of the trapped dead skin cells and sebum. Lortscher explains that whiteheads are covered by a thin layer of skin, and the contents are not exposed to the air, so they appear white or yellowish, which is the default color of oil and dead skin cells.
- Blackheads: On the contrary, this type is best described as open comedones that expose the trapped oil and dead skin cells to the air. As Lortscher explains it, oxygen in the air reacts with the trapped substances (a process called oxidation) and makes the pimple look black (hence the name).
Inflammatory Acne
According to Icecreamwala, inflammatory acne is often caused by an overgrowth of a bacteria that lives on the skin called P. acnes that increases inflammation. This type of acne can appear as papules, pustules, nodules, and cysts.
- Papules: These are tender bumps with redness and swelling that have no visible fluid (in other words, no whitehead) and are usually less than 5 mm (think smaller than the size of a pencil eraser). Icecreamwala says papules are often caused by dead skin cells clogging the pores and increasing inflammation.
- Pustules: Pustules are inflamed lesions with a visible whitehead that may be tempting to squeeze (but it’s a good idea not to), and Lortscher says they’re usually raised 1 to 5 mm. Icecreamwala notes that pustules are often caused by the overgrowth of P. acnes.
- Nodules: When you think of a nodule, think large, firm, red bumps. Lortscher says these extend deeper than a papule and are notoriously painful.
- Cysts: Another painful form of inflammatory acne, cysts are the deep kind of acne under the skin that seems to take forever to go away. Lortscher describes cystic acne as highly inflamed and/or draining acne nodules. Icecreamwala explains that cysts can have more of a genetic or hormonal origin.
Treatment for Non-Inflammatory Acne
Kim says the most effective way to treat and prevent comedones is by using products that normalize cell shedding, breakup sebum, and gently exfoliate the dead skin cells of the stratum corneum on top of our epidermis. But keep in mind that treating acne is a marathon, not a sprint; in other words, start low (ingredient percentage-wise and frequency) and go slow. Kim says you’ll need to be patient and allow 6 to 8 weeks to really let your products transform your skin.
Gently Exfoliate
Exfoliating is crucial for treating comedonal acne, but that doesn’t mean the harsher the scrub, the better. In lieu of a physical exfoliator, try gentle, chemical exfoliants, like SkinMedica’s AHA/BHA Exfoliating Cleanser ($48), a Byrdie-recommended face wash. Kim says to seek out products with alpha-hydroxy acids (like glycolic acid and lactic acid) and beta-hydroxy acid (salicylic acid) but warns users not to overdo it. If you’re using an exfoliating cleanser, toner, mask, and all-over treatment, you’ll wind up with acne on a background of red, dry, and peeling skin or an irritant contact dermatitis. Remember: low and slow. If you have sensitive skin, Kim suggests products containing gentler exfoliants, such as azelaic acid, mandelic acid, or the botanical retinol-alternative bakuchiol.
Incorporate Retinoids into Your Routine
Topical retinols and prescription-strength retinoids aren’t only great for addressing comedonal acne by unclogging pores, but they also encourage cell turnover, increase collagen production, reduce fine lines and wrinkles, and fade pigmentation. Start by using these products (Kim recommends Differin Adapalene Gel, $15) one to two nights a week and slowly work your way up to every night if you can tolerate them without peeling, redness, or stinging. If you have no problems using an over-the-counter retinol every night, ask your dermatologist for a stronger prescription retinoid. And as is the case with any acne-treating product, consult your doctor before using retinoids if you are pregnant, breastfeeding, or planning on being pregnant.
Wash Your Face with a Facial Cleansing Device
Kim recommends using a facial cleansing device at nighttime to thoroughly remove makeup, sunscreen, oil, and environmental pollution—but not just any cleansing brush. Opt for one with ultrasonic technology, which is gentler on your skin than a rotating brush head. The Foreo’s Luna 3 ($219), which is made from a relatively antimicrobial silicone, is one of Kim’s top picks.
Moisturize
Those with acne usually fear that any moisturizer is going to clog their pores and cause acne, but that’s not the case. Kim says using an oil-free or non-comedogenic formula could actually help you to better tolerate your acne-fighting skin products for faster results. According to Kim, even a light hyaluronic acid serum (like the Byrdie-favorite Rose Ingelton MD Skin Calming Booster, $70) could be a good option in the summertime or for oily skin types.
Treatment for Inflammatory Acne
The same principles of treating non-inflammatory acne apply to treating inflammatory acne: don’t over-cleanse, over-scrub, or over-exfoliate your skin.
Gently Exfoliate
Kim explains it best: inflammatory acne lesions have their origin in non-inflammatory acne lesions. That’s why the first recommendation for inflammatory acne is the same as the standard treatments for non-inflammatory acne. “I try to start every acne patient on a retinol or retinoid or an AHA/ BHA product to get to the source of all acne: the clogged pilosebaceous unit,” Kim explains.
Cover Your Breakout With a Sticker
If you feel a deep cyst beginning to form but can’t get into your dermatologist’s office for a cortisone injection, Kim suggests covering it with a sticker from ZitSticka’s Killa kit ($29), which will deliver beneficial ingredients, like salicylic acid, hyaluronic acid, niacinamide, and oligopeptide-76.
Try Antibacterial and Anti-Inflammatory Topical Ingredients
“The bacteria Cutibacterium acnes lives at the base of your hair follicles and breaks down your sebum into fatty acids, which in turn activates inflammation in the surrounding skin,” Kim explains. “So while acne is not a true infection of your skin, antibacterial products are a mainstay of treating inflammatory acne.” Icecreamwala says to look for benzoyl peroxide, which will kill bacteria and thus decrease inflammation caused by the bacteria. If you hate the way benzoyl peroxide bleaches your sheets (we don’t blame you), Kim suggests the CLn Acne Cleanser ($32), which contains sodium hypochlorite as an alternative to benzoyl peroxide. Kim also suggests looking for anti-inflammatory topical ingredients, such as niacinamide, zinc, and sulfur.
Visit Your Dermatologist
Not all acne can or should be treated at home; cysts and nodules that are deeper in the skin may require a visit to your dermatologist. Sometimes prescription topicals, a cortisone injection, or even an incision and drainage are necessary. For moderate and severe inflammatory acne that could lead to scarring, prescription options, like oral antibiotics, spironolactone, and isotretinoin, are also options to consider.
For those who want to avoid taking oral medications, Kim adds that light- and energy-based devices could also be helpful by reducing C. acnes, sebum production, and overall redness and number of inflammatory lesions, as well as treating active cystic acne and acne scarring. With all of these in-office treatment options, clearly, the best way to clear skin is through your dermatologist.
