Types of Acne and Pimples

Did you know that there are many different types of pimples?  Knowing what type of blemishes you have will help you choose the most effective treatment for you.

All pimples begin as a pore blockage or comedo.  When bacteria infect a comedo, or it is irritated by squeezing, inflammation occurs.  There are four main types of inflamed acne blemishes -- papules, pustules, nodules, and cysts.

1
Papules

Acne papules
Acne papules. Photo: BSIP/UIG / Getty Images

Here's what they look like:  A papule is a red, inflamed blemish on the skin's surface. It doesn't have a white head.

Papules can be large or small.  They can occur anywhere on the face, neck, chest, shoulder or back.  They can even appear on the butt.

This is how papules develop: Papules result from a high break in the follicle wall, allowing cellular debris and bacteria to spill into the dermis. This break may occur when a pore becomes engorged with debris and oil, or is squeezed or otherwise irritated. A papule often progresses to a pustule.

Here's how you can treat them: First things first, don't squeeze a papule to try to make it come to a head.  You'll just make the breakout worse.  Most papules will heal quickly and without scarring since they are not deep lesions.

Over-the-counter benzoyl peroxide treatments can help heal papules and prevent new breakouts from forming.  If OTC products don't improve your breakouts after ten to 12 weeks, a prescription medication is the next step.

2
Pustules

Acne pustule
Acne pustule. Image: Daniya Meinikova / Getty Images

Here's what they look like: A pustule is your typical pimple -- red and inflamed with a white head. They range in size from small to fairly large. Sometimes the brownish comedonal core can be seen as a cap on the pus head.

This is how pustules form: Pustules follow papules after white blood cells invade. The white cap on a pustule is pus, sebaceous matter, and cellular debris.

Here's how you can treat them: Just like with papules, mild acne or occasional pustules can be treated at home with OTC benzoyl peroxide creams or cleansers.

If you have many pustules, or if they are very inflamed and hard to control with OTC products, see your dermatologist.  Prescription medications, like topical retinoids or combination acne treatments, can help get these breakouts cleared up.

Although it's tempting, it's best for your skin if you don't pop pustules.

3
Nodules

Nodules on the back
Photo © A.D.A.M.

Here's what they look like: Nodules are large inflamed lesions.  They feel like hard, painful lumps. Where papules occur at the surface, nodules occur deeper within the skin.

This is how nodules form: A nodule occurs when the follicle wall ruptures deep within the dermis. Contaminated debris from the follicle empties into the dermis and infects adjoining follicles. A nodule is a severe form of an acne lesion.

Here's how you can treat them: If you just get an occasional nodule (women are especially prone to them around the time of their monthly cycle) you can typically treat them at home. 

Try ice if your blemish is super painful, to help relieve swelling and make them feel better.  Don't squeeze them!

Want to banish that big zit fast?  Cortisone injections are especially helpful, but you'll have to see your dermatologist to get one. 

Speaking of dermatologists, if you're prone to nodular breakouts you'll definitely want to make an appointment.  These types of blemishes don't respond to over-the-counter acne treatments.  You'll need a prescription acne medication.

4
Cysts

Cystic acne of the back.
Photo © A.D.A.M.

Here's what they look like: Cysts are very large, inflamed lesions. They feel like soft, fluid-filled lumps under the skin's surface. The most severe form of a pimple, cysts are very painful.

This is how cysts develop: Like nodules, cysts begin as a deep break in the follicle wall. A membrane develops around the infection in the dermis.

As a cyst works its way to the surface, it damages healthy skin tissue, destroying the follicle. The likelihood of scarring is very high.

Many dermatologists say the term "cyst" is a bit of a misnomer because these types of blemishes aren't cysts in the true sense of the word.  Instead, they say cysts are actually severe nodules. 

But most people call these very serious types of blemishes cysts nonetheless.  

Here's how you treat them: If you are prone to cystic breakouts, you must talk to your dermatologist. Acne treatments you get at the drugstore just won't help these blemishes. 

You'll most likely need an oral acne medication, like isotretinoin, to get these type of breakouts under control.

Don't wait.  Cystic breakouts easily lead to scarring.  The sooner you see a dermatologist about your acne, the sooner you will start seeing improvement. 

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