Here's what kind of acne you have, and what might be causing it.
Ah, acne. The great opportunist. Whether you’re a shy middle schooler prepping for your first dance or a tenacious businessperson about to close your biggest deal, pimples don’t discriminate. An estimated 50 million Americans — and counting — are dealing with breakouts at any given time. And thanks to Murphy’s Law, they usually pop up at the most inopportune moment.
But while acne afflicts so many of us, not every zit is the same. In fact, there are several different types of acne. And because they have different root causes, the corresponding treatments vary.
Acne vulgaris, the medical term for pimples, is caused by comedones — hair follicles that have become clogged with dead skin cells and oil. The most common places for breakouts are on the face, chest, shoulders, and back.
Acne falls into two main categories: non-inflamed and inflamed. The former, which includes whiteheads and blackheads, is typically considered mild. The latter, which causes the dreaded cystic variety, tends to be more severe and causes pain and redness and also carries a higher likelihood of scarring if picked.
Whiteheads are clogged pores that remain closed at the surface. They look like little white bumps on the skin and usually aren’t painful. They’re considered a mild form of acne.
So what causes them? Basically, a series of four things happening under the surface of the skin: 1) the follicle gets irritated; 2) dead skin cells pile up; 3) skin oil (sebum) increases and mixes with the excess skin cells; and 4) acne bacteria multiplies. A number of factors can cause the first three things to happen: hormonal changes that increase your sebum production; cosmetics that irritate the skin by drying it out, covering it in additional oils, or otherwise irritating it; and tight clothing, high humidity, and/or sweating, which trap oil and dead cells on the skin.
Sometimes whiteheads clear up on their own, though they typically respond well to over-the-counter or prescription topical treatments (we’ll get to that later).
Blackheads are basically just whiteheads that are open at the surface instead of closed. They look like little black “holes,” or slightly raised bumps on the surface, and aren’t painful. A common misconception is that they’re black because of dirt — that’s not true. In fact, dirt isn’t involved at all. The blackhead looks black simply due to exposure to the air. Blackheads, too, are considered mild and can often be treated with over-the-counter topical or prescription medications.
Papules and pustules
If a whitehead or blackhead becomes further inflamed, it becomes a papule. Papules look like small red or pink bumps without a clear head and may be sensitive to the touch. Papules usually develop into pustules — distinctive red bumps filled with white or yellow pus in the middle. Picking or squeezing either of these kinds of pimples can cause scarring and discoloration of the skin.
Nodules and cysts
And that brings us to the most severe forms of acne — nodules and cysts. These suckers are large, hard, inflamed, painful bumps that form deep within the skin. They have no visible heads. They are caused by a clogged pore damaging tissues within the lower layers of the skin and have a tendency to cause discoloration of the skin and scarring, as well as pitting (and most doctors will warn you not to even try to squeeze them, as there’s no head to pop and you’ll just cause further damage).
Researchers believe cystic acne likely has an underlying hormonal cause, and if your parents had or have it, you’re more likely to have it, too.