There are 6 different types of acne and I have something mammothly controversial to say. I strongly recommend you pick a very certain type of acne. I highly recommend you pick this type of acne because if you leave it be, your dark acne scarring can be much, much darker and your acne healing time can be a month plus, instead of days or a week.
When I work with wonderful women, to help them heal from acne naturally there’s one thing almost every woman’s telling me – I’ve been trying really hard to not pick my acne, I keep swearing I’m not going to pick them anymore but every time I look in the mirror I have to resist the urge to pop new ones and I often give in… my acne’s been getting worse and I know it’s my fault.
I say stop right there.
Acne is not your fault. And more importantly, the fact you’ve been popping pimples is not likely to be making your acne worse – that is so long as you’re popping the right type of acne – and you’re popping your acne in a clean and hygienic way – more about this clean and hygienic way soon.
The first fact you need to know is there are 6 types of acne.
The most common type of acne is the one I recommend you pick.
1. Blackheads/blackhead comedones (non-inflammatory acne)
Blackheads are a type of non-inflammatory acne meaning your skin’s immune function isn’t being hyper-activated.
Psst – your skin’s immune function gets hyper-activated when it senses a massive bacterial overgrowth or a bacterial imbalance – in this way, it’s easy to think of inflammatory acne a bit like a major infection.
Blackheads however are not inflammatory meaning we don’t have to worry about major acne bacteria overgrowth. This can make healing your blackheads an easier task. Wahoo!
It’s super common to be believing the cause of blackheads is the oxidation of too much oil inside your pores (aka sebum).
However, blackheads are actually caused a little differently. Blackheads are caused by oxidised melanin floating around inside the oil in your pore.
Let me rewind a little here.
You and I are shedding skin cells every day. In fact, we’re shedding dead skin cells right at this very moment. We’re constantly turning to dust 😂
In every skin cell we have there’s pigment/a colour called melanin.
Melanin is like human Crayola pens. It creates our skin colour.
As our dead skin cells shed – just like right now – they’re shedding into our pores. These dead skin cells then float around a bit inside pores that are oil filled. And if they hang out for too long they get oxidised by over exposure to oxygen or sunlight – this makes them way, way darker.
Think of this oxidation like tanning. And voilà – a blackhead’s born.
Can you pick blackheads? I never recommend you pick blackheads. The best way to treat blackheads is to make skincare, diet and lifestyle changes which balance your skin’s sebum production, reduce the size of your pores, normalises your skin’s natural exfoliating rate to prevent trapped dead skin cells and help prevent oxidation (the ‘tanning’ which causes blackheads). Wahoo – do all this and you can be free from blackheads.
2. Whiteheads/Whitehead comedones (non-inflammatory acne)
Whiteheads are the type of acne I bet you’re super familiar with. Whitehead acne is the most common type of acne spot. Whiteheads are tiny, whitish bumps and will cause you no pain. Every woman at some point in their life has had a white-headed acne spot. I’m holding my hand way up high – small non-inflammatory whiteheads were exactly how my acne started.
Did you notice how whiteheads and blackheads share that word comedones? Both whiteheads and blackheads are a type of acne called comedonal acne.
Comedonal acne looks like small bumps or marks on your skin. Just another way of saying it’s not inflamed i.e. really red, swollen and angry. A whitehead comedone is closed at the surface of your pore and a blackhead comedone is open at the surface of your pore. That’s why these two different types of acne look very different.
So exactly what causes whiteheads? This science quote explains exactly how your skin forms whiteheads;
A whitehead is an acne lesion that forms when oil and skin cells block the opening of a hair follicle.Skin Res Technol. 2012 Feb;18(1):1-14
The difference between a whitehead and a blackhead is the size of the front door on your pore. If the front door is big you’re getting an open blackhead spot. If the front door is small, you’re getting a closed whitehead spot.
This is why blackheads are crazy common on your nose – your pores here often have the largest front doors.
Psst – it’s super important to know whitehead spots are not a major acne infection. The bacteria which naturally live in your pores and on your skin are fairly normal when you have a small whitehead spot. That’s great news and the reason why whiteheads are not painful or swollen.
Can you pick whitehead spots? Heck yes in my scientific opinion, you absolutely can and should… but only when they’re ripe. Whitehead spots are trying to pick themselves open – that’s the only way they can quickly get rid of their bundle of dead skin cells and oil.
Think of whiteheads like a suitcase you’re packing for a holiday, one you have to sit on to zip up. Eventually, your suitcase will explode (you’re just hoping it’s not on the aeroplane) – and the fact is, once you’re at this point of ‘explosion’ your suitcase has stretched.
Your suitcase will now always be a bit bigger. We don’t want your pores to always be a bit bigger. We don’t want your pores to get tissue damage – this can mean the same spot keeps coming back again and again in exactly the same place.
How to pick a whitehead acne spot;
- Be sure to wash your face and hands before – you can even use alcohol sanitiser
- Squeeze from the outside of your spot upwards – this helps drive the pus bundle up and never down into your suitcase pore
- (You can also use a sterilised needle to gently pick open the very head of the spot instead)
- After you’ve picked your whitehead – you want to use a very specific type of spot treatment to speed up your spot’s healing cycle – one that can heal whiteheads overnight – I’m showing you exactly which spot treatments do this inside my online video course, Acne Warrior
The pustular type of acne tells us exactly what it is – it’s straightforward – a spot filled full of pus we can see. The difference between a whitehead and a pustule is inflammation. A whitehead is small, it’s not really pink, red or painful. A pustule is big, it’s pink, red, swollen and can get angry and sore.
Pustules are full of visible pus… red at the base with a yellowish or a whitish center.Skin Res Technol. 2012 Feb;18(1):1-14
It’s common to get stuck in a never-ending cycle of deep-rooted pustules when you have hormonal chin acne. When my acne was starting I would get these deep-rooted pustules along my jawline. There aren’t many photos of my acne because I felt so horrible about my skin that I would hide it from the camera. Here’s one I found by accident, I’m wearing makeup and cover up yet you can still see the big, pink, angry chin breakout.
My client Kristine (who is now clear) also had this exact type of acne;
Pustules can be incredibly painful and can go on to form cystic acne which is when a pustule suddenly feels hard and painful and is over 5mm in size.
Take a peek at this science quote here with me… and don’t worry if it sounds gooky, I’m explaining everything after;
Psst – p.acnes is a type of bacteria linked to causing acne.
The presence of significantly higher levels of antibodies to P. acnes in patients with cystic and pustular acne compared with mild comedopapular acne and persons with healthy skin further strengthened the belief that P. acnes is important in the aetiopathogenesis of acne. This also led to the hypothesis that hypersensitivity to P. acnes may account for the variation in acne severity.Br J Dermatol. 2011 Sep;165(3):474-85
Science eh. So many big words (!) but don’t worry, you’ve got me, your friendly scientist who hates big words to help de-gook this for you.
Here’s the human version of this science quote – antibodies are what fight off infections. It’s your immune system kicking in. In pustular acne your skin’s immune function seems to be hyper-activated – that’s either because there’s a big overgrowth of acne bacteria (aka P.acnes) or your skin’s immune function for some reason gets hyper to even the smallest overgrowth of acne bacteria. It’s like having a sensitivity to spicy food – one human can eat Vindaloo for breakfast, lunch and dinner and love life, whereas another human’s sweating at even the thought of a Korma.
When you have pustular acne there’s a build-up of oil and dead skin cells inside your pore, just like there is when a whitehead forms, but now you also have an overgrowth of acne bacteria and as a consequence a major inflammatory reaction.
Should you pick acne pustules? This here’s a tricky one. Most of the time my scientific answer is no, sometimes it’s yes. It depends on the ripeness of your pustule plus the severity of swelling. If the very top of your pustule is easily broken, then yes. This releases the infection and allows your skin to go straight into healing mode. This is where we want it. I recommend picking pustular acne sometimes because releasing infection reduces the risk of tissue damage plus it prevents a worsening of post-inflammatory hyperpigmentation (PIH) the dark marks left behind by acne breakouts.
Your next step: my online course Acne Warrior teaches you how to heal whiteheads, pustular, hormonal and cystic acne.
4. Papules (inflammatory acne)
Ever described a spot as blind-headed? Or said to a friend – I’ve got these spots that just feel like hard lumps under the surface, they never really come to a head and I never see a whitehead.
This is a papule. Papules are pink, warm and painful.
They’re very similar to pustules but they don’t contain pus.
Because they don’t come to a whitehead they can look like inflamed mosquito bites.
Should you pick acne papules? Heck no. Papules are not filled with pus that can be released like a pustule is. Picking a pustule will make it redder, hotter, angrier and bigger.
5. Nodules (inflammatory acne)
Nodular acne is a bit like a man competing to have the biggest bit 😉
Nodules are just bigger papules;
A nodule is similar to a papule but is greater than either 5 or 10mm in both width and depth.Skin Res Technol. 2012 Feb;18(1):1-14
Should I pick nodular acne? Heck no and this is a big heck no. Both papules and nodules are types of acne with big risk of causing tissue damage meaning they’re rupturing through the walls of your pores. As there’s no pus to release, picking a nodule will only be causing you extra inflammation – and that extra inflammation worsens tissue damage.
6. Cystic acne (inflammatory acne)
Cystic acne is the largest type of acne. It’s all the acne symptoms we’ve just talked about on steroids.
Cysts are large pus-filled lesions that are usually present deep within the skin. The cysts are very painful lesions, as they are inflammatory.Skin Res Technol. 2012 Feb;18(1):1-14
Nodules are papules on steroids.
Cystic acne is like pustules on steroids.
Cystic acne breakouts tend to be deeper in your skin than a pustular breakout and they’re much bigger.
A pustule technically stops being a pustule when it grows larger than 5mm. If your pustule is over 5mm then technically it’s become a cystic acne breakout.
Many women believe they have cystic chin acne when actually it’s pustular chin acne.
Cystic acne is the least common type of acne breakout.
It’s extremely important to get help when you’re experiencing cystic acne as cysts are most likely to leave you with texture scarring like ice pick, rolling or boxcar scars. These are all types of scars which look like indents within your skin. They’re the hardest acne scars to heal. If you’re experiencing indented acne scarring then you likley have cystic acne.
Should you pick cystic acne? That’s a mammoth no. Cystic acne’s deep-rooted and highly prone to scarring. If you pick at a cystic acne breakout it’s unlikely you’ll be releasing pus as the pus in a cystic breakout’s hidden in the depths of your skin like a mole burrowing deep underground. Picking at cystic acne will make indented acne scarring worse.
Remember, your skin can heal. It can, it can, it can. I’ve healed from acne when I thought I’d be struggling with acne forever. I know healing is possible for you too.
Your next step: my online course Acne Warrior teaches you how to heal whiteheads, pustular, hormonal and cystic acne. You can enrol here.
Which types of acne are you battling with?
Cheryl Woodman is a scientist, skin health expert & award-winning skincare formulator who’s more friend next door than bow tie wearing professor. Through her 1-2-1 services and video courses she’s here helping you get healthier, happier skin you feel comfortable, confident and like the freakin’ awesomesauce you are in. Select the option which best describes your skin health here to see and hear the amazing transformations you could be getting.