Your Guide To Deciphering (And Treating) Your Acne, According To Derms
Consider this your go-to breakout breakdown.
When I started breaking out for the first time ever in my mid-20s, my mental health went downhill fast. Not only was I not a teenager when I had the worst acne of my life, but I was totally inexperienced with it and had no idea where to start when it came to treating it. I tried every over-the-counter product I could get my hands on, but spot treatments and OTC retinol didn’t do it for me.
Eventually, I visited Dr. Dendy Engelman, M.D., dermatologist extraordinaire. She took one look at my face and prescribed Epiduo. Within days, my acne began clearing up and — get this — disappeared for good. Apparently, your hormones are still changing when you’re in your mid-20s, which can trigger an unexpected acne flare-up like mine.
Whether you’re experiencing acne for the first time or if you’ve been dealing with it for decades, you have options. First, start by identifying what type of breakout you’re experiencing. Knowing how and where different types of acne appear can help give you a better understanding of how to heal them. From there, you can try over-the-counter products or, depending on severity and frequency, seek a prescription from a dermatologist. Read on to learn about the different types of breakouts, how to clear them, and what to do when those first pesky zits appear.
What Triggers Acne?
Before diving in, it’s important to know what acne actually is. “Acne is a common chronic inflammatory condition,” explains Dr. Naana Boakye, M.D., founder of Bergen Dermatology, “that occurs in the pilosebaceous unit, which is the hair follicle and sebaceous gland.”
The exact causes of acne are complex and specific to individuals. Research is still being done around acne, and the medical understanding of what causes it is still evolving, but Boakye explains that, by and large, acne is usually rooted in “excess sebum, an excess of bacteria, an increase in inflammatory markers, and proliferation of the skin cells.”
It’s important to manage your expectations when seeking help for acne. Because everyone is different, all treatments and causes will be different. While there’s no one-size-fits-all cause, treatment, or trigger for acne, Boakye points out the most common triggers below.
- Dietary factors: Some foods like whey protein and dairy can cause inflammation and trigger acne. Boakye suggests cutting out these ingredients if you deal with acne on a regular basis. Additionally, if you’re already prone to acne, ingesting vitamins B6 and B12 could trigger it as well.
- Medications like lithium, steroids, and testosterone
- Sleep deprivation and stress
- Genetics: “This is very complicated,” says Boakye. “Certain hormones such as excessive amounts of testosterone and progesterone can trigger acne. It is also important to look at estrogen, insulin, and cortisol levels when ovulating.”
- Hormones: Hormonal acne is essentially adult acne that can occur anywhere on the body around [patients’] menstrual cycles,” says Dr. Corey L. Hartman, M.D., founder of Skin Wellness Dermatology. Hormonal acne can look like whiteheads, blackheads, papules, or pustules. “Oftentimes, patients see a full stop in [hormonal] acne or a great reduction, with prescription, topical, and, sometimes, oral medication,” says Hartman.
Closed Comedones
Appearance: Whiteheads
Causes: Increased sebum, clogged pores
Approximate Time To Heal When Treated: One week
According to Dr. Hartman, whiteheads are one of the most common types of acne in patients. “Whiteheads are ‘closed comedones,’ meaning that the pore is clogged, and a layer of skin forms on top, leading to the creation of pus, which appears as small bumps, usually white in tone,” says Hartman. Whiteheads can appear anywhere on the body, but typically pop up on the chin and forehead.
If left untreated, this type of acne will typically clear on its own within a week. That said, Hartman explains that you can expedite the process by “using a salicylic acid spot treatment, which can help clear whiteheads in three to five days. Another way to keep your skin clear of whiteheads is to shop for non-comedogenic skin care products, aka products specifically formulated to not clog your pores. Look for products like this when reaching for sunscreens, moisturizers, and other skin care products you apply without rinsing if comedonal acne is common for you.
Open Comedones
Appearance: Blackheads
Causes: Increased sebum, oil, hormones
Approximate Time To Heal When Treated: Multiple weeks
Blackheads are one of the most annoying types of acne to deal with because they make themselves very known. Because of their texture, they’re also very difficult to cover up with makeup. Blackheads typically appear on the nose and cheeks. Unlike whiteheads, blackheads can take multiple weeks to heal if left untreated, Hartman explains. If you deal with this type of acne, an exfoliation routine will likely be extremely helpful.
“Blackheads are open comedones, meaning that the pore is clogged, but it is still open at the skin’s surface,” Hartman explains. “The result is a darker, blackish look to the pore.” On the bright side, blackheads respond well to regular, gentle exfoliation, both chemical and physical, which, if done effectively, keeps dirt and debris out of the pores.
“Chemical exfoliation is better for regular maintenance as many can use a chemical exfoliant, like salicylic acid, daily,” says Hartman. “You want to be gentle with physical exfoliation so you don’t stretch pores or scratch the skin. I’m a fan of Paula’s Choice 2% BHA Liquid Exfoliant.”
If you’re tempted to extract your blackheads yourself, Hartman urges you to reconsider and see a dermatologist or esthetician. If you’re dead-set on home extractions, he advises you only do so with very gentle pressure. “Use two Q-tips to extract,” says Hartman. “If you bend the Q-tip, you are using too much pressure.”
If you struggle with blackheads on the daily, Hartman explains that getting regular facials could be beneficial, as many kinds of facials focus on gently opening and cleansing pores.
Papules
Appearance: Angry, red, and often swollen bumps
Causes: Blocked pores and ruptured pores spreading dirt and oil to surrounding skin
Approximate Time To Heal When Treated: One to two weeks
When bacteria and dirt linger on the skin’s surface, your body’s immune response kicks in to combat it. This results in inflammation, which, in turn, causes papule acne. Because of their inflammatory characteristics, papules appear as large, red, swollen bumps. They are most often found on the face, neck, back, chest, shoulders, and arms.
“If you frequently have this type of acne, it's best to see a dermatologist, as a prescribed regimen of either topical or oral antibiotics, or both, may help with the breakout,” Hartman says. Frequent papules will often require a prescription to heal, but for mild cases of papule acne, Hartman suggests spot treatments like benzoyl peroxide to help relieve inflammation and kill acne-causing bacteria.
“You can also put a cool compress over the area to help soothe pain and inflammation,” he says. “Keep the area clear of dirt and debris as well — make sure to wash your face in the morning and evening, and always remove makeup and sunscreen before you sleep.”
Pustules
Appearance: Egg-like bulges with white shells of pus
Causes: Blocked pores and inflammation
Approximate Time To Heal When Treated: One to two weeks
Pustules are very similar to papules, but the inflamed area is filled with pus. Pustules, like papules, are caused by inflammation due to bacteria, dirt, and oil becoming lodged and trapped in an open pore. You can spot the difference by checking the color. While papules usually appear as red bumps, pustules are white, pus-filled abscesses.
Hartman recommends seeking help from a dermatologist if you have frequent pustule breakouts that you cannot control with over-the-counter products. How many breakouts count as frequent? Weekly, says Hartman, if you’re in your teens or early 20s.
If your pustule acne is mild, Hartman says benzoyl peroxide spot treatments may help.
Cysts and Nodules
Appearance: Deep lesions
Causes: Genetics, hormones, bacteria
Approximate Time To Heal When Treated: Three to five weeks
If you deal with cystic acne, you probably don’t need an article to tell you about it. This type of acne breakout occurs deeper in the skin and often causes pain and scarring. Hartman says this type of acne is difficult to treat at home and on your own, as it’s classified as a severe form of acne.
“Cystic acne is inflammatory, caused by a combination of clogged pores and bacteria, and is filled with pus,” he explains. “They most commonly appear on the back, buttocks, chest, neck, and shoulders. Acne nodules are also deep, painful pimples, but they differ from cysts, as they do not fill with pus.”
Because scarring is a major concern with these two types of acne, Hartman recommends working with a dermatologist to help manage and clear these breakouts. A dermatologist can even help reduce the appearance of acne scarring, including older scars.
“For nodules that arise, intralesional triamcinolone or steroid shots are fantastic to reduce the inflammation and make the nodules disappear in a matter of days,” says Hartman. “If there is a notable keratin plug present, then extraction does the trick.”
In addition to regular exfoliation and benzoyl peroxide spot treatments, Hartman says, “incorporating an OTC retinol can also help expedite cellular turnover, which can also help with acne.”
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