Ask a Doctor: Four Types of Acne and How to Control It

shutterstock_179902229 Acne flare-ups can seem completely unpredictable, or annoyingly on cue (just in time for that big event). Regardless of when, or how, breakouts happen, they are painfully unwelcome – and always frustrating. When acne rears its ugly head, don’t just reach for the zit zapping cream you started using in high school. It’s time to get smart about acne. If you’re reacting the same way to every kind of breakout, you’re probably still having problems – that’s because there are several different kinds of acne, and each one requires a different kind of treatment and prevention.

Get familiar with these four most common types of acne, and beat your breakouts . . .

Comedonal Acne

Every kind of acne does have one thing in common, says NDDA’s Dr. Melissa Rubenstein. “Breakouts are caused by a buildup of excess oil and how your skin reacts to that excess oil.” Comedonal acne begins with blocked oil glands, or pores in the skin – which is often the beginning of an acne problem. Instead of moving freely through pores, the oil on the surface of the skin becomes thick and forms a plug in the pore where oil naturally surfaces. This blockage then causes pores to enlarge and even develop into blackheads.

To treat this kind of acne, Dr. Rubenstein recommends sticking to oil-free moisturizers and using exfoliation to get pore-clogging oil and other irritants out of the skin’s surface. Another important way to keep this kind of acne under control is to keep pores clear to begin with. Look for products containing salicylic acid, a beta hydroxyl acid that aids in exfoliation. Prescription retinoids are also helpful for this type of acne.

Inflammatory Acne

When comedonal acne leads to the breakdown of a hair follicle or traps bacteria in a pore, it develops into a localized infection, creating inflammation and bumpy acne. This kind of acne can surface as a “pustule,” or whitehead on skin. “Normally what you are seeing with inflammatory acne is the body’s immune system reacting to the infection with a flood of white blood cells,” says Dr. Rubenstein.

The best way to treat this kind of acne is to consult with your dermatologist to find the best treatment options for your skin and reduce the chances of another breakout.

Cystic Acne

Take inflammatory acne up a few notches in severity and you’ve got the third common type of acne – cystic acne. It’s caused by the most severe buildup of bacteria and oil in a pore and attracts the biggest immune response, often appearing as a small boil under the skin’s surface. This can also be one of the most frustrating forms of acne, says Dr. Rubenstein. “The skin that covers cystic acne is smooth, and that adds to the feeling of a painful infection below the surface.”

Unfortunately, there aren’t a lot of options for treating cystic acne once it has developed – a process that can take several weeks, and may not even be noticed until the blemish is fully formed. Your dermatologist can treat the cyst with a diluted corticosteroid, or “steroid shot,” that will resolve it immediately. However, the best treatment is to leave it alone and let the cyst go away on its own. If you are prone to cystic acne, Dr. Rubenstein suggests focusing on a good prevention method, which usually involves working with your dermatologist to plan a cleansing routine and prescription regimen that may include oral medications including antibiotics or accutane that keeps skin free of oil gland blockages to begin with.

Hormonal Acne

The fourth most common type of acne is also the most predictable. If your breakouts seem to follow a schedule, and especially if they show up in the same general area every month, hormonal acne is most likely to blame. If you’re a guy, you probably don’t have to deal with this one. “The majority of hormonal acne cases we see are in women,” says Dr. Rubenstein.

As with other forms of acne, controlling oil and keeping skin clean will help control the severity of the breakout. And because these breakouts are in sync with hormonal fluctuations, hormone regulating treatments like birth control pills or a medication called spironolactone are great options.

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North Dallas Dermatology Associates8144 Walnut Hill Lane Suite 1300
Dallas Texas 75231
Fax: (214) 420-7380

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, Ask a Doctor: Four Types of Acne and How to Control It