How to Treat Different Types of Acne

Ah, yes. Those pesky little bumps. Some of us are prone to blackheads and whiteheads, while some of us seem to be playing whack-a-mole with a few consistent pimples at a time. Others see a hormonal or cystic rupture at least once monthly, and a few of us are blessed with only the very rare occurrence of face invaders.

They come in all shapes, sizes, colors, and depths. And while they all seem to be born of the same evil, they are not born of the same circumstances—some of them require specific treatment. Before you go picking and pinching, squeezing and scraping away at your own face (basically, never do that), take a moment to consider which bump is ailing you.

Some people worry that blackheads (also known as open comedones) are a dirtier, older, neglected form of acne, which is not the case. Anyone can get blackheads, regardless of how diligent their hygiene practices may be. The contents are the usual mix of dead skin and oil, and the color is derived from oxidation—the contents are sitting in a shallow pore or hair follicle, exposed to air. This means that those who are genetically predisposed to larger pores are the ones who see blackheads more often.

Sadly, despite many product claims over the years, we cannot shrink our pores. However, we can make them appear smaller and reduce the occurrence of blackheads, which of course draws attention to them, via exfoliation. While a manual scrub can work great, a clean muslin cloth with some cleanser on it will do just fine as well, and is gentle enough to use daily. Medical aesthetician Caroline Godsick of Facile Skin in West Hollywood, Los Angeles, says that an acid-containing cleanser is great for daily use when it comes to blackheads.

You don’t want to scrub too hard with a manual scrub because this can cause redness, irritation, and uneven abrasions across the skin, exacerbating the issue. Gentle is always best. Fruit enzymes, glycolic acid, and lactic acid are excellent ways to approach even and effective exfoliation without harming the surface of the skin. Deeply cleansed and exfoliated skin will result in less dead skin buildup and the appearance of smaller pores.

Whiteheads are a little different—they occur when the dead skin and oil becomes trapped under the thin, outermost layer of skin. While exfoliation is another major fighter in the battle against these blemishes, a spot treatment or clay mask will help draw out the contents without poking and prodding. Try steaming beforehand to soften the skin and make it more malleable for the mask to do its work. Then apply the mask, letting it almost dry completely, before rinsing it off with warm water and gently dabbing with a washcloth.

You don’t want to let intense clay masks dry completely for long periods of time, because this will overdry the skin and cause more oil to be produced in an endless cycle. If you are doing the most at home and can’t seem to stay ahead of your blackheads and whiteheads, a monthly facial with extractions from a professional might be a necessary step in working toward a more manageable complexion.

Perhaps a lesser-known type of pimple is a closed comedone. It is a flesh-colored bump that makes us ask, “What is that? Is that even a pimple?” Well, yes and no. A closed comedone is not red and inflamed like your typical pimple or the edges of your whiteheads, but is essentially the same thing, just under a deeper layer of skin where the opening to the pore is obstructed.

According to Godsick, “Retinoids are great for prevention and treatment when dealing with closed comedones. Retinoids penetrate the follicle and work deep in the pores.” However, if you’re someone who suffers from many closed comedones at a time, and often, she recommends regular exfoliation and facials as well.

Milia are not uncommon, but not as frequent of an occurrence. They are small, hard, white bumps that can appear anywhere but are most commonly found on the cheeks and skin around the eyes. Godsick makes it clear that “milia must be extracted by a physician since the oil and sebum have hardened deep under the skin.” They become hard from a formation of keratin mixed with the usual suspects, and often the extraction process involves lancing. The best way to prevent milia is to exfoliate regularly, but retinoids are also very helpful.

We’ve saved the worst for last: our mortal nemeses, cystic pimples. These are tricky, because cystic acne is rarely traceable to any one culprit. Godsick says, “The best place to start when addressing cystic acne is your diet, sleep, and stress. Cystic acne stems from an imbalance in the body.”

She warns to never poke or squeeze at them, as this will only—and we mean only—makes things worse, every time. “Keep the area clean and throw on an ice pack or cold roll the area to keep the inflammation down. Cortisone injections also relieve the inflammation.” A cortisone injection is not a super convenient trick to use for every occurance, but is very helpful if you see a cystic pimple festering before a big trip or event. Since we don’t see ourselves injecting cortisone into our cystic pimples at home anytime soon, we’ll leave that up to her.