Acne starts when oil and dead skin cells clog up your pores. Some people call it blackheads, blemishes, whiteheads, pimples, or zits. When you have just a few red spots, or pimples, you have a mild form of acne. Severe acne can mean hundreds of pimples that can cover the face, neck, chest, and back. Or it can be bigger, solid, red lumps that are painful (cysts).
Acne is very common among teens. It usually gets better after the teen years. Some women who never had acne growing up will have it as an adult, often right before their menstrual periods.
Acne starts when oil and dead skin cells clog the skin’s pores camera. If germs get into the pores, the result can be swelling, redness, and pus.
For most people, acne starts during the teen years. This is because hormone changes make the skin oilier after puberty starts.
Using oil-based skin products or cosmetics can make acne worse. Use skin products that don’t clog your pores. They will say “noncomedogenic” on the label. Acne can run in families. If one of your parents had severe acne, you are more likely to have it.
Types of acne
Identifying which type of acne you’re experiencing is key to successful treatment. Acne may be noninflammatory or inflammatory. Subtypes of acne within these two categories include:
Noninflammatory acne includes blackheads and whiteheads. These normally don’t cause swelling. They also respond relatively well to over-the-counter (OTC) treatments.
Blackheads (open comedones)
Blackheads occur when a pore is clogged by a combination of sebum and dead skin cells. The top of the pore stays open, despite the rest of it being clogged. This results in the characteristic black color seen on the surface.
Whiteheads (closed comedones)
Whiteheads can also form when a pore gets clogged by sebum and dead skin cells. But unlike with blackheads, the top of the pore closes up. It looks like a small bump protruding from the skin.
Whiteheads are more difficult to treat because the pores are already closed. Products containing salicylic acid can be helpful. Topical retinoids give the best results for comedonal acne. Currently, adapalene (Differin) is available over the counter as a retinoid. If it does not work for you, stronger topical retinoids are available by prescription from your dermatologist.
Pimples that are red and swollen are referred to as inflammatory acne.
Although sebum and dead skin cells contribute to inflammatory acne, bacteria can also play a role in clogging up pores. Bacteria can cause an infection deep beneath the skin’s surface. This may result in painful acne spots that are hard to get rid of.
Products containing benzoyl-peroxide may help reduce swelling and get rid of bacteria within the skin. These can also remove excess sebum. Your doctor may prescribe either an oral or topical antibiotic along with the benzoyl-peroxide to treat your inflammatory acne. Topical retionoids are also an important part of combatting inflammatory papules and pustules.
Papules occur when the walls surrounding your pores break down from severe inflammation. This results in hard, clogged pores that are tender to the touch. The skin around these pores is usually pink.
Pustules can also form when the walls around your pores break down. Unlike papules, pustules are filled with pus. These bumps come out from the skin and are usually red in color. They often have yellow or white heads on top.
Nodules occur when clogged, swollen pores endure further irritation and grow larger. Unlike pustules and papules, nodules are deeper underneath the skin.
Because nodules are so deep within the skin, you can’t typically treat them at home. Prescription medication is necessary to help clear these up.
Your doctor or dermatologist will likely prescribe the oral medication isotretinoin (Sotret). This is made from a form of vitamin A and is taken daily for four to six months. It can treat and prevent nodules by decreasing oil gland size within the pores.
Cysts can develop when pores are clogged by a combination of bacteria, sebum, and dead skin cells. The clogs occur deep within the skin and are further below the surface than nodules.
These large red or white bumps are often painful to the touch. Cysts are the largest form of acne, and their formation usually results from a severe infection. This type of acne is also the most likely to scar.
The prescription medication isotretinoin (Sotret) is commonly used to treat cysts. In severe cases, your dermatologist may surgically remove a cyst.
It’s possible to have multiple types of acne at once — some cases may even be severe enough to warrant a visit to the dermatologist.
There are many home treatments that are effective for people with acne. However, if a more aggressive approach is needed a dermatologist use a variety of treatments.
Photodynamic therapy (PDT) and other light and laser-based therapies are being used to treat acne. These include the use of blue light, red light, intense pulsed light (IPL), and infrared or pulsed dye lasers. Sometimes these therapies are used along with medicines, but they may also help people who cannot be treated with medicines.
Other treatments include dermabrasion, microdermabrasion, and laser skin resurfacing are effective treatments for severe acne. They can make acne scars less noticeable. Dermal fillers also work well for some types of acne scars.