Inflammatory Acne
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Medically reviewed by Susan Bard, MDMedically reviewed by Susan Bard, MD
Inflammatory acne is a type of acne breakout that causes the skin to look red or discolored, swollen, and inflamed. Like other acne, inflamed acne is caused by bacteria, oil, and dead skin cells clogging your pores. However, unlike non-inflammatory forms of acne like blackheads and whiteheads inflammatory acne triggers an immune response that leads to inflammation.
If you have inflammatory acne, you may have small or large inflamed zits, nodules, or cysts. These breakouts usually form on your face, back, chest, and shoulders. Inflammatory acne can also be very painful and increases your risk of scarring.
Over-the-counter, prescription, and professional treatments are available to help heal existing breakouts and prevent inflammatory acne from returning.
Types of Inflammatory Acne
Inflammatory acne causes moderate to severe forms of discolored, swollen acne. There are a few types of this acne which may include:
Papules: Commonly called a pimple or zit, a papule looks like a raised, red, or discolored bump on the skin. These sit on the surface of the skin.
Pustules: Papules turn into pustules if they fill with fluid called pus. These types of pimples are inflamed and contain white or yellow pus.
Nodules: Firm lumps that form underneath the skin. From the surface, they look like hard pink, red, or purple bumps. They are often more painful and larger than pustules and papules.
Cysts: Fluid-filled bumps that form deep under the skin. They are usually large, painful, and filled with pus. Cysts are the most severe type of inflammatory acne.
Symptoms
Inflammatory acne typically looks like red and pink on lighter skin tones or red and purple raised bumps on darker skin tones. Some bumps may also have yellow or white pus inside. These bumps can sit on the surface or appear to protrude from beneath deeper layers of skin. The increase in swelling and inflammation often makes inflammatory acne painful.
This type of acne can appear anywhere on your body, but it’s more common on the face, chest, shoulders, and back. You may have one small blemish or several inflammatory acne lesions. Nodules and cysts are typically larger than pimples and more likely to scar.
What Causes Inflammatory Acne?
Like other forms of acne, blocked pores lead to inflammatory acne. Pores are tiny skin openings that hold your hair follicles and have a sebaceous (oil) gland underneath them. These glands create oil (also known as sebum) to help soften the hair and skin.
Bacteria, dead skin cells, and sebum can accumulate in your pores, causing them to clog, stretch, and rupture. As a result, your immune system tells white blood cells to fight any potential infections and bacteria in your pores. This immune response leads to redness and swelling of the pores and surrounding tissue.
When pore blockage and inflammation occur in the epidermis (the top layer of skin), inflammatory papules can develop. If these start to fill with pus, they turn into pustules. Meanwhile, nodules and cysts develop from clogged pores in the subepidermal layer (the lowest layer of the epidermis) or dermis (the middle layer of skin).
Risk Factors
Anyone can develop inflammatory acne, but certain factors that increase your risk of developing inflammatory acne, include:
Age: Adolescents and teenagers going through puberty are more likely to develop inflammatory acne. They produce more androgens (male sex hormones), making sebaceous glands larger and increasing oil production.
Hygiene: Not washing your skin after sweating, picking at existing acne, and scrubbing your skin can lead to inflammatory acne. Some makeup, skincare, or haircare products can also clog pores.
Hormonal changes and conditions: Fluctuating hormones during your menstrual cycle or pregnancy can trigger inflammatory acne. People with polycystic ovary syndrome (PCOS) also have increased androgens that can trigger breakouts. PCOS is a hormonal condition that affects the female reproductive organs.
Genetics: People with an oily skin type or a family history of acne are more likely to experience inflammatory acne. Researchers have also found gene mutations (changes) linked to excess sebum production and inflammation, which can contribute to inflammatory acne.
Medications: Corticosteroids, lithium, and hormonal medications can cause inflammatory acne as a side effect.
Diet: Foods high in sugar can spike and drop blood sugar levels, releasing hormones that increase oil production. People who consume a lot of dairy or high glycemic foods (which raise blood sugar quickly) may also experience more breakouts.
Diagnosis
A dermatologist (a doctor specializing in skin, hair, and nail conditions) will perform a physical skin examination to determine whether or not you have inflammatory acne. Skin biopsies and other laboratory tests are not necessary to diagnose inflammatory acne.
If your dermatologist thinks an underlying condition is causing your inflammatory acne, you may require additional diagnostic tests to rule out other conditions.
Treatment
Inflammatory acne treatment involves clearing existing breakouts and preventing future breakouts. A basic skincare routine that includes cleansing, moisturizing, and sunscreen is a good start. You can treat inflammatory acne with different over-the-counter (OTC) or prescription topical treatments. Your dermatologist may also suggest oral medications or procedures to target more severe inflammation.
Over-the-Counter Acne Treatments
Over-the-counter (OTC) acne treatments that you apply directly to the skin can often clear acne when applied directly to the skin, including:
Azelaic acid: This topical (applied on top of the skin) helps open clogged pores, reduce inflammation, and kill bacteria that lead to acne.
Benzoyl peroxide: This treatment reduces bacteria on the skin that can lead to inflammatory acne.
Niacinamide: This form of vitamin B3 helps reduce inflammation and regulate oil production.
Differin (adapalene): This retinoid (a derivative of vitamin A) is approved by the U.S. Food and Drug Administration (FDA) to treat acne and increases cell turnover to clear pores.
Salicylic acid: This topical helps exfoliate away dead skin cells that can clog pores.
Glycolic acid: This alpha hydroxy acid (AHA) exfoliates and increases the collagen in your skin by getting rid of the dead skin cells on your skin quickly.
Prescription Acne Treatments
If OTC acne treatments don’t improve your inflammatory acne, a dermatologist can offer prescription-strength creams containing azelaic acid, benzoyl peroxide, or salicylic acid. Other prescription medications used to treat inflammatory acne include:
Retinoids: You can apply prescription retinoids like Tazorac (tazarotene) and Retin-A (tretinoin) topically to unclog pores and prevent future blockage.
Winlevi (clascoterone): This FDA-approved topical medication treats inflammatory acne caused by hormonal issues.
Antibiotics: Doxycycline (vibramycin), minocycline (minocin), or sarecycline (seysara) are prescribed for several months to help reduce acne-causing bacteria.
Hormonal birth control: Combined oral contraceptives, which contain estrogen and progestin, can help treat inflammatory acne caused by hormonal changes that increase oil production and breakouts.
Spironolactone (aldactone): This anti-androgen drug can help treat deep cysts caused by hormonal imbalances in people assigned female at birth.
Accutane (isotretinoin): An oral retinoid that helps treat severe nodular acne that doesn’t respond to other treatments. It can cause extreme dryness and severe birth defects if taken while pregnant.
Aczone (dapsone): Most often used as a gel, you can apply Aczone to your skin twice a day to treat acne breakouts by preventing the growth of bacteria on your skin.
Light Therapy
During light therapy, a dermatologist shoots a laser at your inflamed acne to help reduce inflammation and kill acne-causing bacteria. Different types of professional light therapy used to treat inflammatory acne include:
Blue, red, and blue + red light devices: These use visible light to treat cysts and nodules.
Infrared light: This light therapy is FDA-approved to treat papules and pustules.
Photodynamic therapy (PDT): Before using a laser or light device, a dermatologist uses a solution to make the skin more sensitive to light. This treats severe inflammatory acne, including cysts.
Photopneumatic therapy: Intense pulsed light (IPL) laser is combined with a gentle vacuum to remove excess oil and dead skin cells from pores. This is FDA-approved to treat some pimples.
Research shows light therapy is more effective when combined with other topical acne treatments. You may need to take several treatments before seeing results.
Cortisone Shots
If you have large, painful cysts or nodules, a dermatologist can inject a corticosteroid medication into your acne lesion via a microneedle. These one-time injections help shrink the wall of a swollen cyst, which helps reduce pain, redness, and swelling. They also help reduce your risk of scarring.
How To Prevent Inflammatory Acne
Skin hygiene habits and lifestyle changes can reduce your chances of future inflammatory acne breakouts. Some proven ways to help prevent inflammatory acne include:
Wash your face: Use a pH-balancing cleanser twice daily with benzoyl peroxide or salicylic acid to help manage acne-causing bacteria.
Stick to your skincare routine: Don’t expect immediate results. Acne treatment regimens can take several weeks to a few months to work.
Shower after sweating: Shampoo your hair to keep excess oils off your face and shower after sweaty activities like exercise.
Avoid touching your skin: Touching, picking, popping, and squeezing inflammatory acne transfers more bacteria to your face.
Eat a balanced diet: Reduce your processed food and sugar intake. Focus on eating more nutritious foods like fruits, vegetables, whole grains, and healthy fats.
Manage stress: Try to relax with yoga, exercise, reading, or meditation to prevent stress acne.
Complications
Inflammatory acne can increase your risk of skin infections, discoloration, and scarring—especially if you pick or pop pimples or cysts. Common complications include:
Postinflammatory hyperpigmentation: Flat dark spots on the skin caused by healed acne. These can take months to years to fade and are more common in darker skin tones.
Postinflammatory erythema: Flat red, pink, or purple marks on the skin leftover from inflammatory acne. These are more common in lighter skin tones.
Ice-pick scars: Small, deep, pitted scars that look like a sharp object punctured the skin.
Rolling scars: Wide, shallow scar tissue that forms under the skin, creating oval or wavy scars.
Boxcar scar: Scars that form round or oval craters in the skin.
Hypertrophic scar: A thick, raised scar caused by abnormal healing—usually on the jawline, chest, or back. These form one to two months after a breakout.
Keloid: A thick, raised scar that grows larger than the initial acne lesion. The scars usually begin to form 3-12 months after a breakout.
Papular scars: Raised bumps that look skin-colored or lighter. These scars usually form on the nose, jawline, chin, or back.
Inflammatory acne breakouts and scarring may also make you feel uncomfortable about your appearance. It's common to experience lowered self-esteem and higher risks of developing depression and anxiety.
Everyone is insecure about their appearance from time to time and we're our own harshest critics. If your condition is greatly affecting your mental health, consider seeing a mental health professional for additional support.
A Quick Review
Inflammatory acne occurs when clogged pores trigger an immune response, which leads to inflammation. Anything from hormones and genetics to puberty and diet can increase your risk of inflammatory acne.
OTC acne treatments like benzoyl peroxide and salicylic acid can often help treat inflammatory acne. However, more severe forms may require prescriptions, light therapy, or cortisone shots. If you're experiencing this condition, working with a dermatologist can help you find a treatment that works for you.
Frequently Asked Questions
Is inflammatory acne cystic?
Cystic acne is a form of inflammatory acne that forms deep in the skin. However, not all inflammatory acne is cystic. Pimples, pustules (pus-filled pimples), and nodules are also types of inflammatory acne.
How long does it take for inflamed pimples to go away?
Healing time varies depending on the person. Inflamed pimples may take several days or weeks to disappear. With consistent acne treatment, it usually takes two to three months to see noticeable skin improvements.
Is inflammatory acne hormonal or bacterial?
Both changing hormone levels and bacteria can contribute to inflammatory acne. Bacteria can enter pores and cause an inflammatory immune response. Hormonal changes can also increase oil production, which clogs the pore with sebum.
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