How to Tell which Type of Acne You Have, so You Can Effectively Treat It

Medically reviewed by Randie Kim, M.D., Ph.D.

Whether you’re dealing with stubborn blackheads or a cystic breakout, understanding the different types of acne can help you figure out what you can do to actually get rid of it.

“While most acne-prone people will benefit from over-the-counter (OTC) treatments, like benzoyl peroxide or salicylic acid cleansers and retinoids, the type and severity of your acne may influence whether other treatment options should be included in your regimen,” Marisa Garshick, M.D., assistant clinical professor of dermatology at Cornell-New York Presbyterian Medical Center, tells ishonest.

You might refer to any ol’ bump as a pimple, but acne vulgaris,1 or common acne, goes beyond the breakouts that plagued your teenage years. “It’s the medical term used to describe types of acne like blackheads, whiteheads, and other blemishes on the skin,” Dr. Garshick says. “Your face, chest, shoulders, and back are the most common areas where acne vulgaris appears.”

Studying up on the various bumps that can take root in your skin helps take the guesswork out of deciding which acne fighters to use (or may inspire you to finally book an appointment with a board-certified dermatologist). Ahead, ishonest asked skin experts to explain what’s what when it comes to acne.

What are the different types of acne?

“Dermatologists often categorize breakouts as non-inflammatory acne and inflammatory acne,” Dr. Garshick says. Blemishes are ranked by severity to determine the best course of action.

Mild acne, Dr. Garshick explains, is considered to be mostly whiteheads and blackheads, with a few papules and pustules; moderate acne refers to multiple papules and pustules covering less than half of your face; moderately severe acne means you have numerous papules and pustules with occasionally inflamed nodules on more than half of your face; and severe acne means you have numerous large, painful, and inflamed pustules, nodules, or cysts, usually affecting most of your face.

Here’s how to know which type of acne you’re dealing with—and how severe it might be—in order to pinpoint the best treatment options for your skin.

Whiteheads and blackheads

What causes them: Welcome to the world of comedones, which is the fancy term for a pore or hair follicle that’s become clogged with oil, bacteria, or dead skin cells, according to the American Academy of Dermatology (AAD). Blackheads and whiteheads can pop up anywhere on your body, but blackheads are especially common in areas with more sebaceous glands (your oil producers!), such as your nose and chin.

What they look and feel like: Whiteheads are generally small, flesh-colored bumps, Dr. Garshick says. They’re known as closed comedones, because there’s a thin layer of skin cells that covers all the gunk inside the pore (hence the whitish, fleshy color). Blackheads, on the other hand, are open comedones. The trapped contents are exposed to air, causing them to oxidize and appear black, Dr. Garshick adds. Regardless of your skin tone, there’s not too much inflammation involved with either type of breakout and they generally don’t hurt. Both can make the skin feel a bit textured or slightly bumpy, but blackheads tend to be flatter than whiteheads.

How to treat them: Whiteheads and blackheads are a mild type of acne, so you can start by trying OTC acne treatments, such as a benzoyl peroxide cleanser, which helps kill the P. acnes bacteria that contributes to breakouts, according to Hadley King, M.D., clinical instructor of dermatology at the Weill Medical College of Cornell University in New York. If you find your skin is a bit sensitive to benzoyl peroxide, however, you can try using a cleanser that contains salicylic acid, a beta-hydroxy acid that gently exfoliates the skin to unclog pores.

If you’re still struggling, Dr. Garshick recommends adding a topical retinoid to your nighttime skin-care routine. These vitamin A derivatives work to keep pores clear by increasing the rate of skin cell turnover2 (making retinoids a gold standard treatment for signs of aging too). Just note that you’ll need to start slowly. To begin with, apply your retinoid two to three times per week and gradually build up to every night or every other night, pair it with an acne-friendly moisturizer to reduce irritation, and be diligent about applying sunscreen in the morning. The AAD recommends giving your OTC comedone treatment roughly six to eight weeks to work its magic—after that, it’s time to see a derm.

• CeraVe Acne Foaming Cream Cleanser 4% Benzoyl Peroxide, $12, Amazon
• Vichy Normaderm Cleanser With Salicylic Acid, $18, Ulta
• Differin Adapalene 0.1% Acne Treatment Gel, $13, Amazon

Papules

What causes them: When oil and bacteria build up, you may develop inflammatory acne.3 “Papules occur when excess oil, dead skin cells, and bacteria become trapped deeper into the skin and trigger inflammation, leading to reddened skin and swelling,” Jacquelyn Sink, M.D., a board-certified dermatologist at Northwestern Medicine Central DuPage Hospital in Winfield, Illinois, tells ishonest.

What they look and feel like: This type of acne manifests as inflamed, reddened bumps and are what most people call pimples. The bumps don’t contain pus (so you won’t see a whitish, fleshy center) and tend to cluster together—typically, on the forehead, cheeks, or chin. Papules are also solid, raised, and between two to five millimeters in diameter, according to the Cleveland Clinic. They’re often firm and tender and can even feel sore.

How to treat them: You can try the same OTC treatments that help reduce comedones, but if your papules are really inflamed, then using a product with alpha-hydroxy acids, such as glycolic or lactic acids, or azelaic acid (which is often used to treat rosacea) can help reduce the appearance of inflamed skin and swelling, Dr. Garshick says.

If your acne isn’t getting better after a couple of months of consistent OTC treatment, then you may want to see a board-certified dermatologist, who can map out a more personalized plan, which may include prescription-strength oral or topical acne medications. In-office blue light therapy, which helps to kill P. acnes bacteria and minimize inflammation, is also a successful option for some people, Dr. Garshick says.

• Glytone Mild Gel Cleanser, $33, Dermstore
• The Ordinary Azelaic Acid 10% Suspension Brightening Cream, $8, Sephora

Pustules

What causes them: Pustules also develop when oil is pushed into the deeper layers of your skin. However, pustules also contain pus, a mix of bacteria, dead skin cells, and white blood cells, the latter of which are released by your immune system to help prevent an infection.4

What they look and feel like: This type of acne is a lot like papules, with one big exception. “Pustules typically appear as a bump that may have a central pus bump,” says Dr. Garshick. These are most common on your face, but they can also appear on your neck, shoulders, back, chest, armpits, and even your groin area. Similarly to papules, pustules are often about two to five millimeters in diameter and can feel very firm and tender, per the Cleveland Clinic.

How to treat them: You can try to treat pustules with the same products you’d use for papules, Dr. Garshick says. However, because these do have a head on them, your biggest job will be to avoid picking at your skin or trying to pop the pimple. Doing this only pushes all that gunk deeper into your skin, the AAD says, which can lead to more acne, noticeable scars, or even an infection. Dr. Garshick recommends applying pimple patches if you tend to pick at your zits because they provide a medicated barrier to speed up the healing process.

Again, it can take a couple of months for your acne to clear up with OTC treatments—if not, see a dermatologist for stronger options if you’re able to. Depending on your specific case, your doctor might prescribe antibiotics (either in addition to prescription-strength topicals or instead of them) for three to four months, depending on how well the drug works for you, according to the AAD.

• CosRx Master Intensive Patches, $14, Ulta
• ZitSticka KILLA Kit Deep Zit Microdart Patch 8-Pack, $29, Ulta

Acne mechanica

What causes it: This type of acne is a bit different from the rest, as it occurs when a material that sits on the skin creates repeated friction of the hair follicle and traps oil, sweat, and bacteria beneath it, creating the perfect home for acne to flourish. Acne mechanica is really common in athletes, the AAD explains, because sports equipment—from helmets to backpacks to face guards— frequently spur breakouts in people who wear them often.

Recently, due to the COVID-19 pandemic, acne mechanica has hit the mainstream due to mask acne (or maskne). “The occlusive nature of a protective mask creates a humid and warm environment under the mask from breathing and talking, which can lead to increased sebum and sweat,” Dr. King tells ishonest. Plus, a mask literally sits on and rubs against your skin, causing friction that can lead to inflammation.

What it looks and feels like: Acne mechanica leads to small, rough bumps that are typically more easily felt than seen, according to the AAD. You’ll notice the breakout wherever the suspected culprit has been rubbing against the skin. Eventually, if the material is consistently used in the same area without protection, these small bumps can progress into full-on papules, pustules, or cysts (more on those below).

How to treat it: Thankfully, mild acne mechanica tends to clear up more swiftly than other forms of acne. The acne-fighting products mentioned above can help, particularly those with salicylic acid, as it’s often most effective for unclogging pores, the AAD notes. If your bumps are caused by certain types of gear, wearing loose-fitting, moisture-wicking clothes can also help reduce friction and prevent excess sweat from sitting on your skin. For COVID-19 face coverings, look for breathable face masks made of soft fabrics, like cotton or silk, and wash them after each use if you can. Try to avoid wearing heavy makeup underneath, which can lead to clogged pores.

It’s also really important to apply lightweight moisturizer so your skin isn’t as irritated from the friction of your mask. Look for something labeled non- comedogenic, meaning it is formulated to not clog your pores, and apply it directly to moist skin after washing your face with cleanser for optimal absorption, Dr. Sink says. It’s also helpful to look for gel-based moisturizers that contain hydrators like ceramides and hyaluronic acid, as well dimethicone, which creates a barrier on your face to reduce skin irritation, according to the AAD.

• Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant, $30, Sephora
• Neutrogena Hydro Boost Gel-Cream, $18, Amazon
• La Roche-Posay Effaclar Mat, $32, Amazon

Nodules and cysts

What causes them: Nodular and cystic acne are both highly inflamed forms of acne that tend to appear with hormonal changes. Hormonal acne can develop during a person’s menstrual cycle because they typically produce more testosterone during that time, Dr. King explains, and testosterone can cause your skin to produce more oil (which, as we’ve learned, can also set the stage for whiteheads, blackheads, papules, and pustules). Fluctuations of estrogen and progesterone also play a role here.

“A nodule is when a pore ruptures under the skin, resulting in a large, raised bump,” Dendy Engelman, M.D., a board-certified dermatologic surgeon at Shafer Clinic Fifth Avenue in New York City, previously told ishonest. However, “a cyst happens when a pore is clogged with oil, dead skin cells, or bacteria. The pore ruptures under the skin, causing the inflammation to spill out into the surrounding tissue. The difference here is that the body forms a cyst around it to stop the inflammation from spreading.”

What they look and feel like: Nodules and cysts are large, deep bumps underneath the skin that can stick around for weeks or even months. “They may appear skin- colored or reddened, depending on how inflamed they are,” Dr. Garshick says, and cysts sometimes form a whitish head on them. They’re often tender and can even be very painful—and both can cause acne scars or hyperpigmentation as they heal, the latter of which is particularly prevalent in people with dark skin.

How to treat them: Because nodular and cystic acne are more severe, seeing a pro is your best bet. You may need to use a combination of prescription- strength topical treatments and oral medications, such as birth control pills to help regulate hormones5 or an oral retinoid like isotretinoin (better known as Accutane). Your doctor might also recommend cortisone injections to reduce inflammation if you have very painful and large cysts, per the Cleveland Clinic.

Treating these types of acne can take some time, so it might take two to three months to start noticing improvements according to the AAD.

Acne conglobata

What causes it: Acne conglobata is a rare but severe skin condition involving deep, cystic nodules (which may contain a foul-smelling pus) that are often interconnected with each other beneath the skin.6 It isn’t entirely known why some people develop this form of acne. Some researchers theorize that the body suddenly becomes really sensitive to the P. acnes bacteria and has an intense immune system response that leads to very severe inflammation and breakouts.

What it looks like: These lesions may look like papules to start but contain pus underneath the skin. Over time, the pus runs into the surrounding skin and eventually appears on the surface of the skin. These can be dome-shaped and be about two to three centimeters in diameter. Understandably, acne conglobata can be really painful since these breakouts are very deep and inflamed.

How to treat it: Scars commonly occur with this type of acne, so seeing a dermatologist can help you avoid that during the treatment process.6 “Typically, acne conglobata requires systemic therapy with isotretinoin and may require a round of systemic steroids to reduce inflammation,” Dr. Garshick says. “Acne conglobata may also respond to local steroid injections for certain scarring and nodules.”

1. StatPearls, Acne Vulgaris
2. Dermatology and Therapy, Why Topical Retinoids Are Mainstay of Therapy for Acne Therapy
3. InformedHealth, Acne: Overview
4. JAMA, Skin Abscess
5. Dermatoendocrinology, An Update on the Role of the Sebaceous Gland In the Pathogenesis of Acne
6. StatPearls, Acne Conglobata

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