Treating acne can be difficult, especially when you are unsure of the root cause and the type of acne that you have. 

Typically speaking, acne (also known as acne vulgaris), is a broad term that encompasses all the different types of acne. Knowing the type of acne and its root cause will increase the chances of successfully eradicating acne for good. You may occasionally experience a small pimple here and there, but it will not be anywhere as severe, allowing old scars to heal properly.  

Let’s take a look at the different types of acne — how they form, what they look like, and what you can do to treat them.

1. Comedonal Acne

Acne form as a result of a pore or pores becoming clogged from excess oil/sebum, bacteria or unusual proliferation of skin cells. Hormonal changes such as excess androgen production can also drive excess sebum production.

Comedonal acne is a form of non-inflammatory acne.

Whiteheads, also known as “closed comedones,” happen when your pores become clogged all the way through. The length and the head of your pore are closed, creating a little white bump on top of your skin. 

Blackheads are known as "open comedones." The head of the pore stays open, causing sebum to oxidise once it is exposed to air. This oxidation causes the sebum to turn black. Therefore, whiteheads can become blackheads. 

Treating and preventing blackheads and whiteheads can be achieved with a consistent skin care routine. Cleansers with Salicylic Acid or Benzyl Peroxide are effective in removing excess oil and dead skin cells, preventing them from clogging the pores. 

Topical retinoids are also effective in treating and preventing non inflammatory acne. 

 

2. Inflammatory Acne

Papules are small red bumps that form when a clogged pore is trapped with bacteria called Cutibacterium acnes (formarly Propionibacterium acnes). The contents of this blocked pore spill out into the surrounding tissue, causing it to become inflamed. Papules do not contain pus. 

Pustules are small, bulging red bumps with a white center containing pus. They are usually found in clusters on the chest, face, or back. Pustules form when a blocked pore gets infected by the bacteria on the skin.

Treating inflammatory acne 

Benzyl peroxide can be effective when it comes to treating mild inflammatory acne due to its antibacterial activity. It is often prescribed with either topical or oral antibiotics when pustules are wide spread or severe.

Topical benzyl peroxide and adapalene (a type of retinoid) has also shown to be effective in treating mild-moderate inflammatory acne. This combination of product called Epiduo can now be purchased over the counter at your local pharmacy in Australia. In the US, a slightly different version called Differin can be purchased over the counter. 

The oral contraceptive pill and spironolactone is often prescribed when acne is driven by excess androgen production. Androgens are male sex hormones found in both men and women. They can increase the production of oil in the skin.

 

3. Nodulocystic Acne

Nodulocystic acne are deep painful breakouts that can leave scars and acne marks. 

Nodular acne are deep red or flesh coloured bumps that are often very painful and cannot be squeezed because there is nothing inside them. They occur when the clogged pore becomes inflamed. They are larger and more painful than papules.

Acne cysts are large, red, inflamed, painful, and pus-filled bumps. Acne cysts are softer and can be squeezed (and burst), however, this can lead to scarring. The contents (fluid) that leak from these cysts contain high amounts of bacteria and can infect the surrounding skin once it comes in contact. Adult acne or hormonal generally present themselves in the form of cystic acne. This can lead to low self esteem and fear of rejection especially in young adults. 

Nodulocystic acne is often the most difficult to treat and early intervention is critical to prevent permanent scarring. Treating cystic acne will require a consistent skincare routine with products containing a retinoid and benzyl peroxide. Natural antibacterials such as manuka honey or tea tree are also effective alternatives to benzyl peroxide.

Retinamide Forte contains a combination of a retinoid and manuka honey. This formulation helps to prevent the sticky skin cells from clogging pores and normalise the Cutibacterinum acnes species on the skin to prevent future breakouts. The synergistic actions of these ingredients also work to minimise and treat acne marks at the same time.

Often, dermatologist will also include a short course of oral antibiotics, the contraceptive pill and oral retinoids such as roaccutane in severe cases. It may seem like a lot of treatments to take on board at the same time. However, we highly recommend this approach and step down once improvements are seen. In clinical practice, this is by far the best method to prevent permanent acne scarring which can be very expensive to treat later. 

Long term antibiotic treatment is not recommended due to antibiotic resistance and oral roaccutane comes with severe adverse effects. These are only recommended in severe cases and for a maximum of three months at a time (the shorter the duration, the better). 

 

 

What Type of Acne Do You Have?

This is a general guide and people who have acne can have more than one of acne at any given time. It is important to note that food can also influence acne severity. 

• Comedonal acne usually resolves without leaving any marks.
• Papules and pustles usually resolve leaving a red or dark acne marks which fades over time.
• Cystic acne will always leave textural scarring, dents or pits in the skin. 

 

 

Author: Helen Huynh (B. Pharm) MPS

 

References: 

1. Australian Medicines Handbook 2021
2. Dall’Oglio, F et al (2021). "Diet and acne: review of the evidence from 2009 to 2020." International Journal of Dermatology. First published: 18 January 2021. Accessed: https://doi.org/10.1111/ijd.15390
3. "Can the Right Diet Get Rid of Acne?" American Academy of Dermatology Association. Accessed 3rd August, 2022.