Acne / Pimples Treatment

Acne can present in various forms, depending on how deeply the inflammation reaches the skin, how clogged the pores are, and whether or not bacteria are involved. It is generally classified into two main categories: non-inflammatory acne and inflammatory acne. Each type looks and behaves differently, requiring different treatment approaches. Below is a detailed overview of the most common acne types:

1. Non-Inflammatory Acne

These are milder forms of acne and usually do not cause pain or swelling. They form due to blocked pores but without significant inflammation.

a. Blackheads (Open Comedones)

Blackheads occur when a hair follicle or pore becomes clogged with sebum and dead skin cells. The pore remains open, and the surface of the clog oxidizes when exposed to air, turning it black. Despite common belief, the black color is not dirt but melanin reacting with oxygen. Blackheads are commonly found on the nose, chin, and forehead and are often persistent.

b. Whiteheads (Closed Comedones)

Whiteheads are similar to blackheads, but in this case, the clogged pore remains closed at the surface. This creates a small, flesh-colored or white bump on the skin. Because the follicle is closed, the trapped material is not exposed to oxygen and doesn’t darken. Whiteheads can be more difficult to treat because the blockage is under the skin.

2. Inflammatory Acne

Inflammatory acne involves red, swollen, and sometimes painful pimples. This happens when bacteria (especially Cutibacterium acnes, formerly Propionibacterium acnes) grow inside clogged pores, triggering an immune response and causing inflammation.

a. Papules

Papules are small red or pink bumps on the skin that are tender to the touch. They occur when a blocked pore becomes inflamed but doesn’t contain visible pus. Papules can cluster together and make the skin feel rough or uneven. It’s important not to squeeze them, as this can worsen inflammation or cause scarring.

b. Pustules

Pustules are inflamed lesions that look like papules but are filled with white or yellowish pus. They have a red base with a white center and resemble the classic “pimple.” Pustules are caused by a buildup of sebum, dead skin, and bacteria. Though tempting, popping them can lead to more breakouts or scarring.

c. Nodules

Nodules are large, painful lumps beneath the surface of the skin. They develop when the walls of a pore break deep within the skin, releasing infected material into surrounding tissue. This leads to a larger, firmer, and more deeply rooted lesion. Nodular acne can last for weeks or months and often requires medical treatment, as over-the-counter products are typically ineffective.

d. Cysts

Cystic acne is the most severe form. Cysts are deep, painful, pus-filled lumps that resemble boils. They form when the infection spreads deep into the skin, causing severe inflammation and swelling. Cystic acne often leads to permanent scarring if left untreated. It is common in people with a family history of severe acne and usually requires intervention by a dermatologist, including oral medications like isotretinoin.

3. Hormonal Acne

Hormonal acne is not a specific lesion type but rather a pattern of acne linked to hormonal fluctuations. It commonly affects adult women, especially around menstruation, pregnancy, menopause, or conditions like PCOS (Polycystic Ovary Syndrome). It typically appears on the lower face, jawline, and chin, and may consist of deep cysts or inflamed papules. Treatment often includes hormonal therapies like birth control pills or anti-androgens (e.g., spironolactone).

4. Acne Mechanica

This type of acne is caused by physical pressure, friction, or heat—often seen in athletes or people who wear tight clothing, helmets, or masks. It results in small bumps or inflamed pimples in areas where the skin is constantly irritated. Preventing friction and keeping the skin clean is crucial in managing acne mechanica.

5. Fungal Acne (Malassezia Folliculitis)

Although it looks like typical acne, fungal acne is caused by an overgrowth of yeast in the hair follicles, not bacteria. It appears as small, uniform red bumps or pustules, often itchy, and is commonly found on the chest, back, and shoulders. Because it is not bacterial, traditional acne treatments may worsen the condition, and antifungal medications are needed instead.