Types of Acne and Pimples — Identify What’s Happening on Your Skin

Not all acne looks or behaves the same. It is important to understand the type of acne lesions you have so that you can choose the appropriate treatment and prevent long-term damage such as pimple scars or post-inflammatory pigmentation.

You may use the generic terms like pimples or breakouts, but medically, acne is classified into distinct lesion types, each with its own cause, severity, and response to treatment.

Broadly, acne is divided into non-inflammatory acne (comedonal) and inflammatory acne. Severe forms extend deeper into the skin and carry a higher risk of scarring.

1. Acne Vulgaris: The Most Common Form

Acne vulgaris is the medical term for the typical acne seen in teenagers and adults. It includes the following:

1. Comedonal acne (blackheads and whiteheads)
2. Inflammatory acne (papules, pustules, nodules, and cysts)
   
   

It develops through the same four main mechanisms discussed in Section 2: excess sebum, abnormal shedding of dead skin cells, bacterial proliferation (Cutibacterium acnes), and inflammation. Most over-the-counter treatments, including salicylic acid face wash, benzoyl peroxide, and adapalene gel, target acne vulgaris. Severe forms may require prescription therapy.

In short, when people say “pimples” or “acne,” they are usually referring to acne vulgaris.

I. Comedonal Acne (Clogged Pores Without Inflammation)

Comedonal acne is the earliest and mildest form of acne. It occurs when pores are blocked by sebum and dead skin cells but without significant inflammation.

1. Open Comedones (Blackheads)

• Appear as small black or dark brown dots
• Common on the nose, forehead, and chin
• Color is due to oxidation, not dirt
• Often persistent and slow to resolve

Blackheads on the face respond best to salicylic acid cleansers, retinoids like adapalene gel, and consistent exfoliation. Physical blackhead remover tools can worsen inflammation if misused.

2. Closed Comedones (Whiteheads)

• Small, flesh-colored or white bumps under the skin
• Common on the cheeks, jawline, and forehead
• Often mistaken for milia or skin texture

Closed whiteheads are more stubborn than blackheads and are a frequent precursor to inflammatory acne. Topical retinoids are essential for treating and preventing them.

II. Inflammatory Acne (Red, Painful Lesions)

Inflammatory acne develops when bacteria multiply inside clogged pores and trigger an immune response.

Papules

• Small, red, tender bumps
• No visible pus
• Often feel sore to touch

Papules are an early sign that acne is progressing and should be treated promptly to prevent worsening.

Pustules

• Red base with a white or yellow center
• Commonly referred to as “pimples”
• Often tempt people to pop them (which should be avoided)

Pustules respond well to benzoyl peroxide gel, benzoyl peroxide face wash, and combination therapy with retinoids.

2. Nodular Acne (Deep, Firm Lesions)

Nodules are large, solid, painful lumps that form deep within the skin. They:

• Do not come to a head
• Last for weeks or months
• Have a high risk of scarring

Nodules cannot be treated with over-the-counter products alone. Prescription treatments and dermatologic care are required.

3. Cystic Acne and Hemorrhagic Cysts

Cystic acne represents the most severe form of acne. These lesions are:

• Large, soft, painful swellings
• Filled with pus and inflammatory fluid
• Often leave permanent scars

Hemorrhagic cysts: are an advanced variant in which bleeding occurs inside the cyst, making them dark, swollen, and extremely painful. These cases often require systemic treatment such as isotretinoin under medical supervision.

4. Hormonal Acne

Hormonal acne is not defined by a single lesion type but by pattern and timing. It commonly:

• Appears on the chin, jawline, and lower face
• Worsens around menstrual cycles
• Persists into adulthood, especially in women

Lesions may include closed comedones, papules, or cysts. Hormonal pimples often do not respond fully to topical treatments alone and may require internal management.

5. Acne by Location: What Breakout Areas Reveal

The location where acne develops can give you clues about its potential triggers.

• Forehead pimples: Excess oil, hair products, sweat
• Pimples on chin: Hormonal fluctuations
• Cheek acne: Friction, pollution, clogged pores
• Black pimples on face/nose: Oxidized open comedones

Recognized patterns can help determine treatments and lifestyle changes.

Acne vs. Other Bumps: What It Is Not

Not every bump is acne. Conditions often confused with acne include:

• Milia (keratin cysts)
• Folliculitis
• Rosacea
• Allergic reactions

This is why persistent or unusual lesions should be evaluated rather than repeatedly treated with random products.

Identifying Acne Type Matters

Different acne types require different treatments:

• Comedonal acne → retinoids + salicylic acid
• Inflammatory acne → benzoyl peroxide + retinoids
• Nodules/cysts → medical therapy

Using the wrong product, such as heavy creams or harsh soaps for pimples, can worsen the condition rather than to improve it.