What are the Different Types of Acne?

There are many different types of acne. To understand how the different kinds form, we have to start at the beginning. Here is a normal follicle:

Normal Skin Follicle

Due to many possible reasons, sometimes the follicle gets clogged or plugged up. The oil which is used to keep your skin and hair from being too dry (sebum) builds up underneath and bacteria begins to grow.

This then forms what is called a microcomedone, which will eventually turn into a blackhead or whitehead:

Microcomedone Diagram

Now, depending on whether the microcomedone's pore opens or not, a blackhead or whitehead will form. When the pore is open and the sebum is exposed, it oxidizes the melanin (skin pigment) inside the sebum which makes it turn a dark brown/black color which is a blackhead. If the sebum is not exposed and stays trapped below the surface of the skin, it stays white and a whitehead is formed.

Some people classify blackheads and whiteheads as "Grade 1" in severity.

Whitehead Diagram

Blackhead Diagram

A blackhead or whitehead heal themselves by slowly leaking their contents to the surface of the skin. However, the follicle wall can sometimes (or often!) rupture making the sebum and bacteria leak into the dermis. This is why it is important to not pick your face and to reduce skin irritation as much as possible.

Papule Diagram

If a rupture does occur, white blood cells are sent to try and fix things and this causes inflammation. Papules and pustules then result.

A papule forms at the beginning of an inflammatory acne lesion, where the follicle wall has just ruptured. This is what we typically call a pimple. They look like small pink bumps that are tender to the touch.

Once the white blood cells have made it to the surface of the skin it is then called a pustule. This is what you see when the pink bump develops a white head.

Squeezing pustules so the bacteria, white blood cells, and sebum come out are what we are generally talking about whenever someone mentions "popping a zit".

Papules and pustules are classified as "Grade 2" in severity.

Sometimes the rupture of the follicle wall can be a little more dramatic, where it completely collapses or explodes. This can damage neighboring follicles and creates large nodules or cysts:

Cystic Acne

The difference between a nodules and a cyst is that a cyst is much more inflamed. Both are large and can be painful to the touch. Nodules are considered "Grade 3" in severity and Cysts are considered "Grade 4".

Diagrams courtesy of National Institute of Health

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