Acne: Signs and symptoms

When you have acne, you can develop any (or a combination) of these breakouts on your skin:

• Whiteheads

• Blackheads

• Pimples

• Nodules, cysts, or both (deep and painful)

The following describes how each of these breakouts develops, and pictures show what they look like.

Whitehead

Whiteheads

Picking at whiteheads can lead to more whiteheads and acne scars, so dermatologists recommend that you treat whiteheads with an acne treatment instead of picking at them.

A whitehead forms when excess oil and dead skin cells build up and plug the opening of a pore. This causes a blemish that is raised and white or flesh colored.

Medical name: Closed comedo, which means “closed pore.”

Blackhead

Blackheads

Dermatologists recommend treating this type of acne with a retinoid, as squeezing a blackhead can cause an infection or permanent scar.

This type of acne also develops when excess oil and dead skin cells build up inside a pore. As the buildup accumulates, it widens the opening of the pore and you see a blackhead.

Why are blackheads black? Many people mistakenly believe the black speck is dirt. What you’re really seeing is a chemical reaction. When the buildup inside the pore reacts with oxygen in the air, the black color appears. This reaction is similar to what happens when a cut-up apple turns brown.

Medical name: Open comedo, which means “open pore.”

Pimple

Treatment

If you have a few pimples, you can often successfully treat these with an acne product that contains benzoyl peroxide, retinoid, or azelaic acid.

Sometimes excess oil, dead skin cells, and bacteria get trapped inside a pore. The bacteria, which are normally found on our skin, can multiple quickly in the excess oil. As the pore fills with bacteria, inflammation (swelling) develops and a pimple appears.

Medical name: If the pimple contains pus, it’s called a pustule. A pimple without pus is called a papule.

Acne nodule or cyst

Acne cyst

If you have an extremely painful acne cyst or nodule, a dermatologist can inject it with medication to reduce the pain and help it clear more quickly.

When a pore fills with enough excess oil, dead skin cells, and bacteria to cause inflammation (swelling) that goes deep into the skin, an acne nodule or cyst develops. Because these breakouts go deep into the skin, they can feel tender or painful.

The main difference between an acne nodule and an acne cyst is that a cyst contains pus. Because nodules don’t contain pus, they feel harder to the touch than do cysts.

Acne can cause more than breakouts

Some people dismiss acne as a skin condition that you’ll eventually outgrow, but it can have a profound and lasting effect on someone’s life. Many people develop one or more of the following after getting acne.

Acne scars: When an acne breakout clears, it can leave a permanent scar. Some scars cause depressions in the skin. Others are raised. It’s impossible to predict who will develop scars when the acne clears, but the following increases your risk:

• Living with acne for an extended amount of time because you don’t treat it or treatment doesn’t work

• Having one or more close blood relatives who developed acne scars

Dark spots on the skin: As an acne breakout clears, some people see a spot where the acne once was. This completely flat spot can be pink, red, purple, black, or brown, and it’s often mistaken for a permanent acne scar.

Dark spots on skin

As the acne clears, it can leave long-lasting dark spots on the skin.

Unlike acne scars, these spots will eventually clear on their own. Clearing can take time, though. Some spots can last for a year or longer. The darker the spot, the longer it will take to clear. Treatment and the right skin care can help clear the spots more quickly and prevent new dark spots.

You’ll find out how you can treat and prevent these dark spots in skin of color at: 10 tips for clearing acne in skin of color.

The medical name for these spots is postinflammatory hyperpigmentation (PIH).

Lower self-esteem: Research shows that acne can deflate one’s self-esteem, and dermatologists see this in many patients who have acne. Lower self-esteem during the teen and early adulthood years can negatively affect one’s life.

For example, lower self-esteem can prevent someone from pursuing a desired career, speaking up in class, getting a part-time job, making friends, or dating.

Low self-esteem is also associated with anxiety and depression.

Treating acne rather than letting it run its course can prevent lowered self-esteem.

Depression: Studies reveal that teens with acne have a higher risk of developing depression, which may include thoughts of suicide, than do teens who have the occasional pimple. This is why dermatologists recommend treating acne when it begins and continuing treatment to prevent new breakouts.

While few people escape acne during their teenage years, some people are more likely to develop deep, painful pimples that leave scars. You’ll discover who is most likely to develop this type of acne at: Acne: Causes

Images
Image 1: Illustration property of the American Academy of Dermatology
Images 2 and 3: Used with permission of DermNet New Zealand Image Library.
Image 4: Getty Images
Image 5: Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
Image 6: J Am Acad Dermatol. 2014;70:108-14.

References
Dalgard F. Gieler U, et al. “Self-esteem and body satisfaction among late adolescents with acne: Results from a population survey.” J Am Acad Dermatol 2008;59:746-51.

Savory SA, Agim NG, et al. “Reliability assessment and validation of the postacne hyperpigmentation index (PAHPI), a new instrument to measure postinflammatory hyperpigmentation from acne vulgaris.” J Am Acad Dermatol. 2014;70:108-14.

Thiboutot DM, Dréno B, et al. “Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne.” J Am Acad Dermatol 2018;78:S1-23.

Zaenglein AL, Thiboutot DM. “Acne vulgaris.” In: Bolognia JL, et al. Dermatology. (fourth edition). Mosby Elsevier, China, 2018:588-92.

Zaenglein AL, Pathy AL, et al. “Guidelines of care for the management of acne vulgaris.” J Am Acad Dermatol. 2016;74:945-73.