The 4 Types of Acne and How to Treat Them All
Dr. Anne Chiu shares her tips for treating every type of acne. (Photo: Trunk Archive/Kenneth Willardt)
If you are prone to breakouts, you’re not alone. Acne is the single most common skin condition in the United States. The good news is, once you’ve determined the type of acne you have, there are a variety of ways you can treat and prevent it going forward. If you’re looking to clear up your complexion as you head back to school (or work), we’ve got solutions.
Comedonal acne
What is it? Simply put, comedonal acne is all about clogged pores. “This is usually found in people whose skin doesn’t turn over as quickly or as well,” says dermatologist Annie Chiu, MD. “They tend to have little bits of oil or waxes under the skin.” This looks like tiny bumps all over the skin, but often concentrated in the T-zone.
How to treat it: The good news is that comedonal acne is fairly easy to treat. Chiu recommends a prescription retinoid, which will increase skin turnover and exfoliation, resulting in unclogged pores. If you have a mild form of comedonal acne, you can treat it over the counter by using products that contain salicylic or glycolic acid to exfoliate the top layer of your skin. “Make sure you are compliant with washing your face twice a day and using cleansers and treatment products that contain exfoliants,” says Chiu. Another piece of advice: Take a look at your makeup. If it’s heavy and pore-clogging, you’ll want to re-evaluate.
Inflammatory acne
What is it? When you think of acne, the image that pops up in your head is probably that of inflammatory acne — red bumps, whiteheads, and blackheads. Inflammatory acne tends to be more random, says Chiu, meaning you might wake up with a spot for no rhyme or reason. “The causes are all over the place,” she says. “Clogged pores are a part of it, but with inflammatory acne, it’s the body’s inflammatory response to the clogged follicle and the waxes and oils irritating the body.” Inflammatory acne tends to be more common in men due to higher testosterone levels leading to more oil production.
How to treat it: If you’re looking for an over-the-counter treatment plan, Chiu recommends washing your face twice a day and focusing on oil control. Look for products that contain tea tree oil, salicylic acid, or benzoyl peroxide. “Benzoyl peroxide has two benefits,” says Chiu. “It reduces bacteria that we think is associated with inflammatory acne, and it also acts as an oil-reducing and skin-unclogging product.” It’s important to note that many people are sensitive to benzoyl peroxide because it can be drying and irritating to the skin, so be careful when using products that include it. (I am one of those people, and I can tell you it’s not fun to wake up in the morning with your face as red as a tomato.)
When it comes to prescription treatments for inflammatory acne, there are a lot of options that can be adjusted based on your skin type. “If you’re too sensitive for benzoyl peroxide, this may be when you need an oral antibiotic or a non-irritating topical medication like Aczone to reduce inflammation or a prescription retinoid like Retin-A,” says Chiu. Because inflammatory acne comes and goes, it’s important to stick to a routine and give it time (two to three months) before you start to see a difference in your skin. Chiu also pointed out that the use of antibiotics comes with risks, including antibiotic resistance. “We use it when we need to reduce inflammation, but we are developing protocols in the field to use it to jump-start people and then maintain them on nonantibiotic products like Aczone.”
Cystic acne
What is it? Cystic acne is a scarring type of acne with deep inflammation in the skin. It’s the most severe form of acne and something that you want to start treating early on. “There is a whole social impact and an emotional impact,” Chiu says of cystic acne. “We recommend intervening early and aggressively.”
How to treat it: Accutane is often recommended for the treatment of cystic acne. “Accutane is an incredible medication that can be life-changing for people with acne,” says Chiu. “It’s usually five to six months of medication, and it’s a commitment. There are potential risks associated, but there are numerous benefits.” According to Chiu, 30 percent of people who undergo an Accutane regimen never get acne again, and for most people the acne will become more manageable and less inflamed. She also points out that there are options out there for those who do not want to go on Accutane, but you should see your dermatologist to determine what combination of topical and oral antibiotics are right for you.
Hormonal-onset acne
What is it? “Hormonal acne is interesting because it usually occurs with women in their late 20s or 30s, and they will come to me and say, ‘I’ve always had perfect skin — I don’t understand,’” says Chiu. The reason for the sudden breakouts? A drop in estrogen levels, which usually starts when women are in their early 30s. This type of acne typically occurs on the lower third of the face, around the chin and mouth in a U-shaped pattern, and often occurs right before, during, or after the menstrual cycle.
How to treat it: This is where something like birth control can be an effective treatment method, as it works to rebalance the hormones. For someone who doesn’t want to be on birth control, Chiu recommends spironolactone, another medication that is a testosterone blocker. “It doesn’t actually change the hormones in the body, but it blocks testosterone, so it can be extremely effective.”
Advice for every type of acne: Don’t pick!
You’ve heard this dozens of times before, but whatever you do, do not pick at your acne spots. Chiu says this is extremely important because it’s often hard to tell which spots are even appropriate to extract just by looking at them. “I tell everyone that to avoid scarring and worsening, don’t pick at any of them,” she says. “I understand that there is a compulsiveness, but you have to recognize that this is very tempting and instead put on a gentle topical treatment as many times a day as you want, every time you feel like picking.” Finding an alternative behavior is going to make resisting the picking a whole lot easier. And if you are thinking of buying that extractor tool you saw at the beauty supply store, think again. Oftentimes these tools are not sterile and can lead to infections and scarring. “We are seeing scarring as a result of [extractor use], when really it was just a bump that would’ve gone away.”
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