Pimples, blackheads, acne - all accumulate to the epitome of the adolescent experience. While most treat these pesky imperfections with exasperation, anger, and a myriad of other delightful emotions, very few treat them with the proper care and attention that they deserve. 

The world of skincare can be hard to navigate. So many brands claim to fight breakouts and clear skin, but how do we know which ingredients are legitimate, and how do they work? To truly comprehend effective acne treatment, we must delve deeper into understanding the many distinct types of acne.

There are three general categories that most types of acne fall under: comedonal, inflammatory, and nodulocystic. Comedonal acne refers to surface-level clogged pores and hair follicles, mainly caused by a buildup of dirt, sebum, and other deposits. Inflammatory acne refers to red and swollen blemishes that often contain small bouts of pus and bacteria. Nodulocystic acne is the most severe form of acne, and refers to clogged pores that develop deep within the skin. Further classifications can be made within each category, as denoted by the diagram above:

1. Black Heads (Open Comedones): clogged pores with open tops, which allows sebum to become oxidized and turn darker in color

2. White Heads (Closed Comedones): clogged pores covered by a thin layer of skin, which contributes to their “white” appearance

3. Papules: inflamed pores with deteriorated pore walls that are often hard and tender to the touch

4. Pustules: papules filled with pus that characteristically appear white

5. Nodules: large, swollen pores that occur deeper beneath the skin than papules and pustules

6. Cysts: deep, clogged pores that develop further below the skin’s surface than nodules, and often result in infection

Comedonal Acne

Unlike other forms of acne, blackheads can be safely extracted manually using round loop extractors or other instruments. Removals that do not use specialized instruments are advised against, as they can cause irritation. Oral and topical medications like tretinoin, tazarotene, or adapalene that contain Vitamin A can also prove effective in both blackhead and whitehead prevention, as Vitamin A contributes to rapid skin cell turnover and a decrease in the formation of clogs. 

Inflammatory Acne

Depending on severity, papules and pustules can either be treated topically with salicylic acid and benzoyl peroxide, or with the ingestion or application of antibiotics. Both salicylic acid and benzoyl peroxide help absorb excess oil to prevent further clogging. Antibiotics can either be applied to the affected area or ingested orally, killing bacteria and reducing inflammation and redness. Given that papules and pustules are both infections, it is encouraged to avoid pinching and squeezing them to avoid worsening the infection.

Nodulocystic Acne 

Similar to papules and pustules, topical medications and antibiotics are also used to treat cystic and nodular acne, yet these forms of treatment are often not strong enough to produce any drastic results. Isotretinoin, commonly referred to as accutane, is considered to be one of the most effective modern medicines in treating cystic and nodular acne. Like other topical retinoids, isotretinoin contains Vitamin A, but in a highly concentrated form that is much more powerful than typical topical retinoids. Although most people who take isotretinoin see improvements within six months, there may also be negative repercussions associated with the ingestion of this medicine. Severe side effects may include skin irritation/infection, headaches, and nosebleeds.

Navigating topical skin issues can seem like a daunting task, but they are not as impossible as they first appear to be. Through investigation and proper identification, acne can be much more easily handled, whether it’s just a pesky blackhead or a serious large cyst. Once the acne is classified, you can follow the corresponding treatment tactics described above and you’ll be on the right path to smooth, healthy skin! Always remember to be patient with your body and best of luck on your acne-ridding endeavors.