Different Types of Acne and Their Treatments

Acne is a very common condition that affects many. Often, many students come and see us during the fall with flaring breakouts. This is usually due to back-to-school activities with added stressors of class work and higher participation in sports with sweating and wearing of protective gear. Some types of acne improve using over-the-counter treatments, but persistent and deep acne requires treatment at a medical office. Let’s review why we get acne, what types of acne are possible and how we would treat each type.

There are four main reasons acne develops:

  1. Plugging of the hair follicle 
  2. Excess oil production 
  3. Presence of a bacteria called Cutibacterium acnes
  4. Inflammation 

As a result of the above factors, people may develop four main types of acne: comedonal acne, hormonal acne,  inflammatory acne, and cystic acne. People can have a combination of multiple types of acne.

Comedonal acne is commonly described as a collection of blackheads and whiteheads. This leads to an overall “bumpy” skin texture, most commonly located along the forehead, temples, and chin. We treat this type of acne by using gentle chemical exfoliants that help clear the sebum clogging the pores and then keep those pores clear. Over-the-counter products that include active ingredients such as adapalene, AHAs, or BHAs can be helpful in treating comedonal acne. These types of products can irritate the skin, so we recommend starting a few times per week and increasing to nightly as tolerated. Improvement of comedonal acne requires patience; 3-6 months of treatment is required to see improvement in symptoms. In our clinic, we offer evaluation for prescription topicals that will help improve the skin quicker, as well as chemical peels that help open up clogged pores.

Hormonal acne is caused by increased androgens, a hormone that increases oil production. This type of acne is most common in women, typically along the jawline, resulting in red, inflamed pimples and sometimes cysts. It can be cyclical and correlate with the menstrual cycle. This type of acne is difficult to treat over the counter. It requires adjustment to birth control methods or androgen blockers that come in the form of a prescription pill or topical cream. This type of acne typically peaks around puberty but also can occur around menopause.

Inflammatory acne usually looks like red, painful pimples; these can be present anywhere along the face, jawline, chest, or back. Sometimes, there can be a connection to rosacea, another inflammatory condition. Inflammatory acne can be treated with over-the-counter products with active ingredients like benzoyl peroxide or salicylic acid. If inflammatory acne is not well managed with over-the-counter treatments, dermatologists can provide many topical and oral treatments to help manage breakouts. Topical treatments include topical antibiotics to treat bacteria on the skin and topical retinoids to help clear pores and keep them clear. Sometimes oral antibiotics are necessary; these typically are used for several months and then tapered off, and there are long-term side effects of being on antibiotics.

A subtype of inflammatory acne is nodulocystic acne. This presents as deep nodules and cysts that are often painful. This type of acne is considered more severe. It will not respond to over-the-counter products. It requires a visit with a dermatologist for oral medications such as antibiotics or often isotretinoin. Isotretinoin is an oral pill with high doses of vitamin A that addresses the four reasons above why acne develops. Isotretinoin is the closest thing we have to a cure for acne. It does come with the possibility of many side effects, so it requires many months of use with close monitoring, but can provide amazing resolution of symptoms for our patients.