Let’s be real: Acne is the great equalizer. Like it or not, most of us have — at some point or another — dealt with it. Whether it’s cystic, adolescence-related, or the hormonal acne that can affect us well into our twenties, thirties, and forties, just about everyone has a relationship with acne that ranges from casual to decades-long.
Fortunately, there is much that can be done to heal and even prevent active breakouts, so long as you know what kind of acne you are treating. Here, a guide to the different types of acne that can crop up on the face and body alongside direct-from-the-dermatologist tips on how to address it from an ingredient, product, and prescription perspective.
While ‘comedone’ is the technical term, you most likely know this type of non-inflammatory acne as ‘blackheads’ and ‘whiteheads.’ As such, there are two types of comedones:
- Closed Comedones (a.k.a. whiteheads): Non-inflammatory lesions that form when the pore closes on top of a buildup of sebum and dead skin cells, resulting in a small — usually white — bump.
- Open Comedones (a.k.a. blackheads): Non-inflammatory lesions that occur when the pore remains open despite being clogged with excess oil and dead skin cells, causing a dark-colored spot on the surface of the skin.
“They are variations of congested pores filled with compacted dead skin cells, primarily keratin proteins and sebum,” says Jessica Weiser, MD, a board certified dermatologist and founder of Weiser Skin in New York City. “Open comedones are true blackheads — clogged pores with dilated openings at the skin surface — whereas closed comedones have the same compacted keratin plug, but a thin layer of skin typically obstructs the follicle opening.”
As Connecticut-based board certified dermatologist Mona Gohara, MD, explains, comedonal acne often affects teenagers due to increased oil production. “This is typical around puberty,” she says. But adults can deal with blackheads and whiteheads, too. “They can also form from skincare that is too occlusive, hair products, and friction from clothing that is too tight,” Dr. Gohara adds.
Recommended Treatments for Comedones
- Vitamin A derivatives (think: retinol and retinoids)
- Alpha Hydroxy Acids (i.e. glycolic acid)
- Beta Hydroxy Acids (read: salicylic acid)
- Azelaic Acid
- Benzoyl Peroxide
One thing all our experts agree on? Comedonal acne is best treated with topical vitamin A derivatives, like prescription retinoids and over-the-counter retinols. “I think of [topical retinoids] as pipe cleaners for your skin,” says Joshua Zeichner, MD, a board certified dermatologist and director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. “At the same time, they help reduce inflammation.”
Dr. Gohara, for one, is a fan of over-the-counter Differin and prescription Retin-A and Tazorac. Altreno is another prescription-strength option that is specifically formulated for sensitive skin. While many vitamin A derivatives can be irritating, Altreno “contains hydrating ingredients that reduce potential irritation,” Dr. Zeichner says. On the OTC retinol front, Dr. Weiser recommends Skin Better AlphaRet Overnight Cream, Allies of Skin 1A Retinal + Peptides Overnight Mask, and SkinCeuticals Retinol 1.0.
If retinoids and retinol are not for you, most exfoliating ingredients should do the trick. Since this type of acne is primarily due to blockage of the follicle, New York City-based board certified dermatologist Sejal Shah, MD, generally recommends using products featuring ingredients that increase cell turnover like hydroxy acids and azelaic acid. She likes La Roche Posay Effaclar Medicated Gel Face Cleanser and Nip + Fab Salicylic Fix Pads. Benzoyl peroxide is another good option, says Dr. Gohara, adding that non-comedogenic products are a must for those prone to comedonal acne. “It should say that on the label,” she shares.
If you’re looking for cleaner formulas that are just as effective at eradicating non-inflammatory acne, try the Orveda Cleansing Bamboo & Enzymatic Water to remove makeup. The Susanne Kaufmann Tonic Clarifying, meanwhile, is a great pick to refresh the complexion and reduce inflammation. To finish off this clean routine, apply the African Botanics Neroli Infused Marula Oil morning and night to balance oily skin.
2. Hormonal Acne
Not just for teenagers, hormonal acne can stay with women well into their late thirties and forties, Dr. Gohara says. Unlike the superficial nature of non-inflammatory comedones, Dr. Weiser explains that hormonal acne is often “deep, painful cystic papules or nodules” that appear on the jaw, chin, and neck. “Hormonal breakouts are triggered by internal hormones levels including androgens (testosterone) and cortisol (stress hormone) levels,” she notes, which means oral contraceptives can both cause and treat it.
Recommended Treatments for Hormonal Acne
- Oral medications like Sprionolactone and Accutane
- Oral Contraceptives
- Blue Light Therapy
- Chemical Peels
- Laser Treatments
There isn’t all that much that can be done at home to treat hormonal acne because the lesions occur deep beneath the surface of the skin and very rarely ever come to the surface, Dr. Weiser says. “Warm compresses can be helpful at reducing swelling,” she explains. “But these lesions are more likely to rupture under the skin surface, further worsening the inflammation and swelling and risking a larger and more serious skin infection.”
While OTC products tend to not work for this type of acne, there are prescription oral medications that offer some relief. “Prescription treatments that internally control hormones — such as spironolactone and certain types of oral contraceptives — are generally the most effective ways to control this hormonally-driven acne,” Dr. Weisner says. Isotretinoin (a.k.a. Accutane) is another option.
3. Body Acne
Typically caused by friction (often from athletic gear) and not changing out of clothing after working out, Dr. Gohara says that body acne is most common on the chest, shoulders, and back. Appearing in the form of non-inflammatory comedones and inflammatory pustules and papules, body breakouts can impact men and women of all ages. “While body acne is quite common in puberty and teens, it can also afflict adult men and women, especially those who naturally sweat excessively or exercise intensely,” Dr. Weiser says. She adds that it’s important to cleanse skin immediately after sweating to prevent sebum, bacteria, and debris from sitting on the surface of the skin for prolonged periods.
Recommended Treatments for Body Acne
- Topical Salicylic Acid and Benzoyl Peroxide
- Oral medications
The treatments that body acne responds to depends on the type of lesions, Dr. Shah notes. “If mild or mild-moderate, it may respond to topical treatments,” she says. “But more moderate to severe body acne may require oral medication.”
To treat mild to moderate body acne, Dr. Gohara recommends body washes formulated with benzoyl peroxide or salicylic acid body washes, like the CeraVe SA Body Wash. In addition to BHA-spiked washes, Dr. Weiser says to look for a combination of products that contain antimicrobial ingredients and retinol to control oil glands. She likes Murad Acne Control Body Wash and ZO Skin Health Oil Control Acne Pads.
4. Nodules or Cystic Acne
Cysts refer to swollen, red pimples that manifest as both small pustules (a pus-filled whitehead) at the skin surface and deeper lesions beneath the skin. Inflammatory acne occurs as a result of bacteria (usually Propionibacterium acnes, known as P. acnes) in the lesions that triggers the body to form an immune reaction. “These lesions often still begin as clogged pores due to excess oil production that become secondarily infected with bacteria,” Dr. Weiser says. Those who deal with cystic acne and nodules are typically predisposed to it. Dr. Gohara says that this type of acne is hormonal and “often this is a genetic factor.”
Recommended Treatments for Cystic Acne
- Topical products with Benzoyl Peroxide, Retinoids, Sulfur, and Hydroxy Acids
- Oral medications like Sprionolactone and Accutane
- Steroid Injections
Due to the severity of this acne, cysts and nodules generally require combination therapy, as medications and topical treatments alone are usually not effective. “It may be helpful to use topical benzoyl peroxide products, such as PanOxyl Acne Foaming Wash, retinoids, or hydroxy acids,” Dr. Shah says. “But often this type of acne responds better to oral medications — spironolactone in women and isotretinoin.”
Dr. Weiser notes that treatment of inflammatory acne involves antimicrobial therapy to address the bacterial component and treatment of the underlying oil production and congestion. “Look for products that contain antibacterial sulfur and probiotics, in addition to prescription-strength antibacterial topical medications,” she says. Her picks include 111Skin 3 Phase Anti Blemish Booster and Eminence Clear Skin Probiotic Mask.
For acutely inflamed lesions, Dr. Shah says that steroid injections can also be helpful.
Whether you are dealing with acne on the face or body, there is much that can be done to speed up the healing process and — with regular maintenance — prevent it from recurring. Topical retinoids, hydroxy acids, and benzoyl peroxide can be used to effectively treat non-inflammatory comedonal acne (think: blackheads and whiteheads). When it comes to treating inflammatory hormonal, body, and cystic acne, a combination of topical skincare (OTC and prescription), oral medication, and professional procedures may be needed. Consulting with a board certified dermatologist will ensure you receive the best treatment regimen for your acne.
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