Your Guide to Every Single Type of Acne

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. 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. But before we get into the different types of acne, let’s go over two different skin conditions that are commonly confused with but aren’t actually considered acne.

• Milia: According to Lortscher, milia can occur spontaneously, and they’re often mistaken for acne because they’re typically found on the face and appear as small white or yellow bumps with a smooth dome shape, but milia is essentially a hardened buildup of keratin that can’t be popped like a pimple. Lortscher describes them as very small (less than 3mm in diameter if you’re counting) and notes that they can vary from solitary to grouped lesions. Most often, milia resolve on their own or, funny enough, with topical acne medications that exfoliate the skin, but they can persist for many, many months. You can also see a dermatologist to extract them if their appearance bothers you.
• Malassezia folliculitis: If you have small, uniform (and at times itchy) bumps that spread across a central area, like your forehead, jaw, hairline, chest, and back, you might have what’s commonly called “fungal acne” (though this is not the medical term). This condition is tricky in the sense that there is a lot of overlap between ordinary acne (acne vulgaris) and acne made worse by fungus. “Fungal acne, or malassezia folliculitis, is caused by pityrosporum, a naturally occurring fungus that lives on our skin,” Lortscher explains. “The yeast of the fungus can grow in pores in moist environments—you might accidentally nurture the fungi by exposing your skin to sweat and friction, potentially pore-clogging ingredients, or humidity.” To help avoid fungal acne, rinse off any time you break a serious sweat and check your products for potentially pore-clogging ingredients. To treat it, Lortscher suggests using a product with zinc pyrithione, which has antimicrobial properties that help to stop the growth of acne-causing fungus and bacteria.

Now that we’ve covered what isn’t acne, let’s get into the nitty-gritty of what is.

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.

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