Takeaways

• Acne is one of the most common skin conditions in the UK
• Although Acne is typically seen as just "spots", there are different types of breakouts and lesions that can occur
• Being able to recognise the different types of spots will help you to understand the severity of the Acne and reach out for the most suitable treatment

What is Acne?

Acne is a common skin condition affecting up to 95% of people aged 11-30 but can also occur in older adults. It shows as spots, also known as blemishes or pimples, often on the face, chest and back. Generally, areas affected by Acne will look inflamed and bumpy and the spots may have small white tops (known as whiteheads) or dark points (called blackheads).

Spots form due to a build-up of excess skin cells and oil (known as sebum) in the pores of the skin. In more severe cases harmless bacteria which is found on the surface of the skin can then contaminate the blocked pore, leading to inflammation.  

Spots forming can happen for many reasons, but common causes of Acne include:

• Genetics
• Hormonal imbalances, especially during puberty, pregnancy or menopause
• Conditions such as Polycystic Ovary Syndrome
• A reaction to some cosmetic products
• Medications such as steroids, certain anti-depressants and some medications used to treat epilepsy

Having Acne can significantly impact confidence and quality of life and may lead to people covering up affected areas, or not wanting to show certain areas of their body which can impede them taking part in activities such as sport or swimming. Not treating Acne effectively can also lead to long-term scarring which can be challenging to reverse.

Depending on the severity of the Acne, different types of spots can occur. Understanding what these different spots look and feel like will help you to know which treatments may help you and who to speak to.

What are the Different Types of Spots?

There are several types of Acne, and this can indicate the severity of the condition. Each type of spot looks and feels different and can also develop in different areas of the body. 

Non-Inflammatory vs Inflammatory Acne

Types of spots can be divided into two categories – non-inflammatory and inflammatory.

• Non-Inflammatory spots do not cause inflammation in the skin surrounding the spot. They tend to be found in milder cases of Acne and are often manageable with over-the-counter products.
• Inflammatory spots cause inflammation in the area around the pimple. This can lead to further damage to the skin and in some cases scarring. Inflammatory Acne is more likely to need medical intervention with prescription treatment.

The number of inflammatory and non-inflammatory spots that are being experienced, will help to establish the severity of the Acne and this will influence the best treatment. 

Comedones

Comedones is a common name for spots. This is a non-inflammatory type of lesion and is predominantly found in mild cases of Acne. There are two types of Comedones:

• Closed Comedones – These small bumps are also known as Whiteheads and are usually the same colour as the skin. On paler skin tones the central lump may be surrounded by a red circle. On darker skin tones the surrounding skin may be darker or appear slightly purple.
• Open Comedones – Similar to Closed Comedones, but with a dark centre, Open Comedones have opened at the top, allowing the excess skin cells and sebum to oxidise and darken. This also explains why Open Comedones are also called Blackheads.

As they are non-inflammatory, Comedones do not usually cause scarring and often resolve on their own, or with over-the-counter treatments. 

Papules

Papules are a mild form of inflammatory Acne. They appear as lumps under the skin’s surface and are less than 1cm in diameter. They have no visible centre and feel hard and tender. The surrounding skin will also be tender and inflamed.  

Even with treatment, Papules can be very persistent and challenging to reduce quickly. 

Pustules

Pustules are similar to Papules, but are larger and have a defined centre filled with pus. The pus is usually made up of white blood cells and bacteria which has collected in the blocked pore.

The skin surrounding the Pustule will be inflamed and the area is likely to be sore and tender.  

If you are experiencing Pustules, it is important to not squeeze or pick the spot as this can lead to scarring or infection. 

Nodules

Nodules are a more severe form of Acne lesion. They are hard inflamed lumps which are formed deeper within the pores and have no visible head. They form when pores that are already blocked, become infected and begin to swell. This can be very painful and make the skin sore to touch.

Even when not picked or squeezed, Nodules can lead to scarring and damage to the skin.

If you think you may have Nodules as part of your Acne, it is important to speak to a Dermatologist to ensure any infection is treated and prevent further damage to the skin. 

Cysts

Cysts are the most severe type of spot. They are also painful inflamed lumps formed in the deeper layers of the skin, but unlike Nodules they fill with pus and are softer to the touch.

They can also lead to scarring and skin damage without timely treatment and require dermatologist assessment. 

How to Treat Different Types of Acne

Regardless of the type of spots you are experiencing, if you are concerned about having Acne or are struggling to treat it, speaking to a dermatologist will help you find the best treatment plan and understand the condition better.

For less severe types of Acne such as Comedones, Papules and Pustules, there are steps you can take at home to help reduce the spots and calm your skin. In more severe cases, or if you have been using at-home treatments and finding your Acne is persistent you may require advice from a dermatologist. 

Cleanse the skin regularly

Washing the affected areas twice a day with a suitable cleanser will help to keep the skin clean and prevent further build-up of skin cells and oil. However, it is also important to not cleanse the skin too much as this can cause dryness or oil imbalances which may lead to further breakouts. 

Some cleansers contain active ingredients which help to break down excess oil and exfoliate the skin.

Over-the-counter treatments

There are several spot treatments available which are effective in treating milder cases of Acne. Ingredients that are commonly found in these products include:

• Salicylic Acid – This is an exfoliating acid which breaks down the excess oil and skin cells within the pores. It is also anti-inflammatory and helps to calm the skin.
• Benzoyl Peroxide – As well as being anti-inflammatory, Benzoyl Peroxide kills the bacteria which can exacerbate Acne.
• Azelaic Acid – This is an ingredient which is often recommended for those with sensitive skin, who find that other active ingredients are irritating their skin. It is anti-inflammatory and also removes excess skin cells to unclog the pores.

If you aren’t sure which over-the-counter treatments may be suitable for you, speak to a dermatologist for help with developing a treatment plan. 

Protecting the skin

When an Acne breakout has occurred, the skin is often quite sensitive and may feel sore. To prevent the skin from flaring up further, it is important to keep any affected areas protected from sun exposure, with clothing or sunscreen.  

It is sometimes thought that sun exposure may help to treat skin conditions such as Acne. However, this is an old wives’ tale and exposure to the sun (or UV light through sun beds) is more damaging to the skin. 

Prescription medications

For people experiencing more severe Acne, with Nodules and Cysts, or who find their Acne isn’t improving with over-the-counter treatments, a dermatologist may recommend prescription medication.

There are several options for prescription Acne medication:

• Creams and ointments – There are many prescription creams and ointments available to treat Acne, which are often stronger versions of what is available over the counter. These medications may also combine different active ingredients to enhance the result
• Antibiotics – In cases where bacteria are having a significant effect on your Acne, antibiotics can be used to help reduce the spots and calm the skin.
• Oral Contraceptives – For patients who are experiencing hormonal acne, the oral contraceptive pill can be used to help balance hormones and reduce breakouts.
• Isotretinoin – This is a tablet and is effective in treating the most severe cases of Acne. Your dermatologist will often suggest trying other treatments before opting for this as it can have some uncomfortable side effects including very dry skin

When seeing a dermatologist about Acne treatment, it is important to keep an open mind, as they may wish to try different options to find what works best for you. They will try to develop a treatment plan which effectively reduces your Acne whilst maintaining your overall skin health. 

Conclusion

There are several different types of spots, and it is important to understand how each of these may affect your Acne treatment. Being able to recognise that more severe spots are developing will help you to know when you need to seek medical advice. However, it is important to know that if you are worried about your Acne and wish to speak to a dermatologist, you can do this at any point, and you don’t need to wait for your Acne to become severe before booking a dermatology consultation.

Cadogan Clinic has a team of expert consultant dermatologists who are experienced in treating Acne. Contact our dedicated dermatology patient advisors today to arrange a consultation where you can start your treatment plan. 

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