Different types of pimples can have various appearances, causes, and treatments. Common types of inflamed pimples include papules, pustules, nodules, cysts, blackheads, and whiteheads. You're most likely to get pimples in areas with a lot of oil glands, which include your face, neck, shoulders, chest, and back.
Several different factors can increase your risk for pimples, including hormones, diet, and stress. Mild acne can often be treated at home with over-the-counter topical medications and prevented with the right skincare routine. For moderate or severe cases, a dermatologist can help by prescribing medication.
Click Play to Learn How to Identify Inflamed Pimples
This video has been medically reviewed by Casey Gallagher, MD.
Whiteheads and Blackheads
Blackheads and whiteheads are both formed when your pores (the opening to hair follicles) are clogged with dead skin, oil (sebum), and bacteria. If a clogged pore stays open, the top surface of sebum darkens and forms a blackhead.
If the pore closes, it forms a white bump on your skin called a whitehead, which is close to the skin's surface. In contrast, a deep or "blind" pimple is beneath the surface of the skin but not visible, even though you may feel it forming. When a blind pimple moves to the surface, it can become a whitehead.
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Reproduced with permission from © DermNet dermnetnz.org 2023.
Papules
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Happyfoto / Getty Images
Papules are inflamed blemishes that can be large or small. They look like red bumps or lumps on the skin and don't have a white head.
Papules can be caused by acne vulgaris. This occurs when the wall of a hair follicle or pore ruptures. When this happens, cellular debris and bacteria spill into the dermis (the deepest layer of skin).
A break in the pore can occur when the follicle fills with dead skin cells and oil. Pressure from squeezing a blackhead or blocked pore can also cause a rupture.
The rupture triggers inflammation in and around the follicle. The area turns red and swells. This is what creates the firm red bump we call a pimple.
Don't squeeze a papule to try and make it come to a head. You probably won't extract any debris from the pore. Instead, you may simply make it more inflamed.
Papules are not deep lesions. This means most of them will heal quickly without scarring.
Pustules
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Arnuphap Yaiphimai / Getty Images
Pustules are red and inflamed with an obvious head. The head is often white and has a pink or red ring surrounding it. The head can also be cream to yellow in color.
Sometimes a brownish spot appears in the middle of the head. This is the comedonal core. It is a plug of debris within the pore.
Acne pustules range in size from small to fairly large. They develop in the same areas that papules do. This is usually on the face, back, and shoulders.
Pustules follow papules. When the pore ruptures, the body sends white blood cells to fight bacteria. This is what causes pus. A mixture of pus, dead skin cells, and excess oil gives a pustule its white cap.
Nodules
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Nodules are serious acne pimples. They are large, inflamed lesions. They feel like hard, painful lumps under the skin.
An acne nodule develops when the follicle wall ruptures deep within the dermis. Contaminated debris from the follicle infects nearby follicles. The damage and irritation cause the area to swell. This makes nodules quite painful.
Like pustules, nodules can be filled with pus. Because they occur deep within the skin, though, you won't see a white head.
Nodules can take between a few weeks and several months to fully heal. This is because they are large and deep.
Females are prone to getting acne nodules around the time of their monthly cycle.
Cysts
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Dr. Milton Reisch / Getty Images
Cysts are very large, inflamed lesions. They feel like soft, fluid-filled lumps under the skin. Acne cysts are the most severe form of pimple. They can be very painful.
Like nodules, cysts begin as a deep break in the follicle wall. The body tries to wall off the infection by surrounding it with a membrane.
As an acne cyst works its way to the surface, it damages healthy skin tissue. This can destroy the follicle. The likelihood of acne scarring is very high.
An acne cyst isn't a true cyst. It is actually a severe, swollen acne nodule. You may hear the terms "acne cyst" and "acne nodule" used interchangeably.
Acne cysts are filled with pus. They may also contain blood. They can take several weeks to several months to fully heal.
Never try to extract an acne cyst on your own. If they must be drained, it has to be done by a doctor. Cystic breakouts scar easily. The sooner you see a dermatologist about your acne, the sooner you will see improvement.
What Causes Pimples?
Pimples can be caused by a combination of different things, including what you eat, hormones, genetics, and stress.
- Diet: Some foods are associated with an increase in pimples, including meat, chocolate, cow's milk, fast food, white bread, potato chips, and pastries. Vegetarian or vegan diets may also help to promote clearer complexions.
- Hormones: Fluctuating hormone levels increase the production of sebum, a waxy oil that can trap dead skin cells and clog pores. While it can affect any gender, it is more common in women and can be linked to menstrual cycles, pregnancy, and menopause.
- Fungus: Malessezia furfur is a yeast (fungus) that can grow in the hair follicles leading to pimples. Fungal acne causes whiteheads that often become red, inflamed, and irritated. It can also be very itchy.
- Bacteria: Sebum can trap dirt or debris in your pores, setting the stage for bacteria to multiply and cause pus-filled bumps. The bacteria trigger an immune response, leading to inflammation and acne breakouts.
- Stress: On its own, stress does not cause acne. However, if you already have acne-prone skin, stress can exacerbate it. This is because stress causes the release of hormones, like cortisol and androgens, that can contribute to breakouts by activating oil glands.
Treating Pimples
Different types of pimples respond to different medications. Papules and pustules often respond well to over-the-counter (OTC) treatments.
Your healthcare provider can prescribe treatment if you have a more stubborn case of acne, including cysts or nodules.
Let your healthcare provider know if you have any pimples that are inflamed or don't clear up after 10 to 12 weeks of OTC treatment.
At-Home Acne Treatments
Pimples can often be treated at home with OTC acne remedies. Papules and pustules can be treated with products containing:
- Benzoyl peroxide
- Salicylic acid
Hydrocolloid patches, sometimes called “pimple stickers,” may help get rid of pimples fast. These deliver medication to the spot, prevent sun exposure and irritating bacteria, and discourage picking. These products can be found at your local drugstore or pharmacy.
The occasional nodule pimple may clear up on its own. If your blemish is painful, you can ice the area to help relieve swelling.
There are no home remedies that can successfully treat cystic acne.
Why You Shouldn't Pop a Pimple
When you squeeze a pimple, you can drive the pus, dead skin cells, and excess oil deeper into the pore. This can make the blemish irritated, painful, and more obvious. Popping pimples can also cause an infection from bacteria on the fingers or permanent scars.
Topical Prescriptions
If OTC treatments fail to bring relief, more powerful topical medications may be prescribed. Ingredients in topical prescriptions treatments for acne include:
- Topical retinoids, a synthetic vitamin A, which include Retin-A Micro (tretinoin), Tazorac (tazarotene), and Differin (adapalene)
- Topical antibiotics, such as clindamycin and erythromycin
Topical combination medications are also prescribed for treating acne. These can include any combination of antibiotics, benzoyl peroxide, retinoids, or salicylic acid.
Cortisone Injections
Nodular and cystic acne can be treated with cortisone injections. Cortisone, an anti-inflammatory medication, helps reduce the redness, swelling, and pain of severe inflammatory acne breakouts.
Oral Antibiotics
Oral antibiotics are used to treat recurring acne breakouts. They work by reducing the bacteria responsible for most acne outbreaks.
Oral antibiotics commonly prescribed for acne include:
- Acticlate (doxycycline)
- Adoxa (tetracycline)
- Dynacin (minocycline)
- Erythrocin (erythromycin)
How Do You Know if Acne Is Bacterial?
Bacterial acne causes whiteheads with a red ring around the bump known as pustules. Most acne is caused by bacteria trapped in the pores. For moderate to severe breakouts, antibiotics may be prescribed.
Birth Control Pills
Acne breakouts related to the menstrual cycle can be controlled with oral contraceptives, also known as birth control pills. These work to reduce oil gland secretions by suppressing hormones known as androgens.
Oral contraceptives approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of acne include Ortho Tri-Cyclen and Beyaz.
Anti-Androgen Medication
Aldactone (spironolactone) is another oral medication used to treat acne caused by menstrual-related hormone fluctuations.
Though not specifically an acne medication or commonly prescribed, Aldactone works to treat acne by suppressing androgens.
Isotretinoin
Isotretinoin is an oral medication commonly used to treat cystic acne. First sold under the brand name Accutane (now discontinued), isotretinoin is a naturally occurring component of vitamin A.
Isotretinoin works to treat acne by shrinking sebaceous glands, reducing dead skin cells’ ability to stick to glands and cause acne, and eliminating acne-causing bacteria in the glands and on the skin.
Isotretinoin is available as a generic and under the following brand names:
- Absorica
- Amnesteem
- Claravis
- Myorisan
- Zenatane
Preventing Pimples
While not all pimples can be prevented, there are things you can do to minimize breakouts. This includes the following:
- Be consistent with your skincare routine and use the right products for your skin type.
- Wash your face twice a day with a gentle cleaner.
- Avoid irritating skin care products, astringents, toners, and exfoliants.
- Look for products labeled alcohol-free, non-comedogenic, or non-acnegenic.
- Don't overuse OTC acne treatments that contain benzoyl peroxide or salicylic acid, which can irritate your skin.
- If you’re prone to oily hair, shampoo more frequently and keep your hair off your face. Oil from your hair can contribute to acne on your face and neck.
- Minimize your sun exposure, use sunscreen, and avoid tanning beds.
- Stay hydrated and eat a varied diet.
When to See a Dermatologist
Acne that doesn't clear up with OTC treatments can be treated by a dermatologist. Contact your healthcare provider if you have the following:
- Cystic acne
- Nodular acne
- Pustule acne that is inflamed or does not clear up after 10 to 12 weeks of OTC treatment
- Scars from nodular and cystic pimples
Summary
There are four main types of pimples: papules, pustules, nodules, and cysts. Papules and pustules can be treated at home. Try a benzoyl peroxide cleanser or a salicylic spot treatment.
Nodules and acne cysts may require help from a dermatologist. A dermatologist can give you a cortisone injection or prescribe medication that will help clear up your skin.